-
Question 1
Correct
-
Who is recognized as the originator of the Cognitive Neoassociation Theory of Aggression?
Your Answer: Berkowitz
Explanation:Theories of aggression can be categorized into three main perspectives: psychodynamic, sociological/drive, and cognitive and learning. Psychodynamic theory, proposed by Freud, suggests that aggression arises from a primary instinct called thanatos, which aims for destruction and death. Sociobiological/drive theory, proposed by Lorenz, suggests that aggression is instinctual and necessary for survival, and that stronger genes are selected through aggression. Cognitive and learning theory, proposed by Berkowitz, Rotter, Bandura, and Anderson, suggests that aggression can be learned through observational learning and is influenced by environmental factors. Bandura’s work introduced the concept of reciprocal determinism, which suggests that behavior is influenced by both the environment and the individual’s behavior. Rotter’s social learning theory emphasizes the interaction between the individual and their environment, while Anderson and Bushman’s general aggression model considers the role of social, cognitive, developmental, and biological factors on aggression.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 2
Correct
-
Which symptom is atypical for individuals with Kluver-Bucy syndrome?
Your Answer: Prosopagnosia
Explanation:Kluver-Bucy syndrome is a neurological disorder that results from dysfunction in both the right and left medial temporal lobes of the brain. This condition is characterized by a range of symptoms, including docility, altered dietary habits, hyperorality, and changes in sexual behavior. Additionally, individuals with Kluver-Bucy syndrome may experience visual agnosia, which is a condition that impairs their ability to recognize and interpret visual stimuli.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 3
Incorrect
-
From which region of the developing brain does the retina originate?
Your Answer: Rhombencephalon
Correct Answer: Diencephalon
Explanation:The retina and optic nerves originate from protrusions of the diencephalon known as eye vesicles during development.
Neurodevelopment: Understanding Brain Development
The development of the central nervous system begins with the neuroectoderm, a specialized region of ectoderm. The embryonic brain is divided into three areas: the forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The prosencephalon further divides into the telencephalon and diencephalon, while the hindbrain subdivides into the metencephalon and myelencephalon.
The telencephalon, of cerebrum, consists of the cerebral cortex, underlying white matter, and the basal ganglia. The diencephalon includes the prethalamus, thalamus, hypothalamus, subthalamus, epithalamus, and pretectum. The mesencephalon comprises the tectum, tegmentum, ventricular mesocoelia, cerebral peduncles, and several nuclei and fasciculi.
The rhombencephalon includes the medulla, pons, and cerebellum, which can be subdivided into a variable number of transversal swellings called rhombomeres. In humans, eight rhombomeres can be distinguished, from caudal to rostral: Rh7-Rh1 and the isthmus. Rhombomeres Rh7-Rh4 form the myelencephalon, while Rh3-Rh1 form the metencephalon.
Understanding neurodevelopment is crucial in comprehending brain development and its complexities. By studying the different areas of the embryonic brain, we can gain insight into the formation of the central nervous system and its functions.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 4
Correct
-
What individual proposed a differentiation between fundamental and supplementary symptoms in schizophrenia?
Your Answer: Bleuler
Explanation:Historical Classification of Schizophrenia
The classification of schizophrenia has evolved over time, with various individuals contributing to its development. In 1801, Phillippe Pinel used the term ‘demencé’ to describe the loss of mental abilities in chronically ill patients. Benedict Morel coined the term ‘demencé precocé’ in 1852 to describe young patients with premature dementia. Kahlbaum was the first to describe ‘paraphrenia hebetica’ in the 1860s, which was later elaborated as ‘hebephrenia’ by Hecker in 1871.
In 1893, Emil Kraepelin used the term dementia praecox to describe the condition, emphasizing the importance of delusions, hallucinations, impaired attention, thought incoherence, stereotyped movements and expressions, deterioration of emotional life, and a loss of drive as key symptoms. In 1908, Eugen Bleuler coined the term ‘schizophrenia’ to replace dementia praecox, denoting ‘a splitting of the psychic functions.’ Bleuler expanded the concept to include presentations that did not include a ‘terminal state.’
Bleuler introduced a distinction between basic and accessory symptoms and primary and secondary symptoms. Basic symptoms are necessarily present in any case of schizophrenia, while accessory symptoms may of may not occur. The fundamental features of schizophrenia were loosening of associations, disturbances of affectivity, ambivalence, and autism. The alteration of associations is the only symptom that Bleuler regarded as both basic and primary, and can thus be described as the core disturbance in the Bleulerian conception of schizophrenia.
In 1939, Langfeldt introduced the term ‘schizophreniform psychosis’ to describe patients with Bleulerian schizophrenia who did not follow a progressively deteriorating course. In the 1960s, Rado/Meehl introduced the term ‘schizotypy’ to recognize the concept of a continuum of spectrum of schizophrenia-related phenotypes. In the 1980s, Crow proposed a subclassification of schizophrenia, dividing patients into types I and II. Type I patients present with positive symptoms such as delusions and hallucinations, while type II patients present with negative symptoms such as affective flattening and poverty of speech.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 5
Incorrect
-
Which component is not considered a key element in Link and Phelan's stigma model?
Your Answer: Separating
Correct Answer: Scapegoating
Explanation:Stigma Models
Stigma refers to any attribute, trait, of disorder that marks an individual as being unacceptably different from the normal people with whom they routinely interact, and that elicits some form of community sanction. The most popular model of stigma comes from the work of Link and Phelan, which has four aspects to it.
The first aspect is labelling, which refers to personal characteristics that mark individuals as different. These characteristics can be physical, mental, of social in nature and can include things like race, gender, sexual orientation, of mental illness.
The second aspect is stereotyping, which involves linking labelled characteristics to undesirable characteristics. For example, people with mental illness may be stereotyped as violent of unpredictable, even though the vast majority of them are not.
The third aspect is separating, which involves separating the labelled group and normal people by viewing them as very different. This can lead to social isolation and exclusion, which can further exacerbate the negative effects of stigma.
The fourth and final aspect is status loss and discrimination, which refers to the devaluing, rejecting, and excluding of the labelled group. This can take many forms, including employment discrimination, housing discrimination, and social exclusion.
Overall, the model of stigma developed by Link and Phelan provides a useful framework for understanding the complex and multifaceted nature of stigma and its effects on individuals and society as a whole.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 6
Correct
-
The author of the book 'Asylums' is...
Your Answer: Goffman
Explanation:Erving Goffman was a prominent sociologist who made significant contributions to the field. He is well-known for his works such as The Presentation of Self in Everyday Life, Asylums, and Stigma. In fact, he is credited with introducing the term stigma into the sociological lexicon. Goffman’s ideas and theories have had a lasting impact on the study of sociology and continue to be studied and applied today.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 7
Correct
-
A woman in her 50s experiences chronic back pain. Her doctor prescribes a medication that provides relief. She keeps the medication on hand and takes it as soon as the pain starts. What does this behavior demonstrate?
Your Answer: Escape conditioning
Explanation:Escape conditioning involves ending an unpleasant stimulus by performing a certain behavior, while avoidance conditioning involves avoiding the presentation of an unpleasant stimulus by performing a certain behavior.
Operant Conditioning: Reinforcement, Punishment, and More
Operant conditioning, also known as instrumental learning, is a theory of learning developed by B.F. Skinner. It suggests that people learn by interacting with their environment. Reinforcement and punishment are key concepts in operant conditioning. A reinforcer is a stimulus of event that increases the likelihood of a behavior being repeated. Reinforcement can be positive of negative. Positive reinforcement occurs when a behavior is strengthened by adding a rewarding stimulus, while negative reinforcement occurs when a behavior is strengthened by removing an unpleasant stimulus. A punisher is a stimulus that decreases the likelihood of a behavior being repeated. Positive punishment occurs when a behavior is reduced in frequency by adding an unpleasant stimulus, while negative punishment occurs when a behavior is reduced in frequency by removing a pleasant stimulus.
Primary reinforcers are instinctual desires such as food, water, social approval, and sex. Secondary reinforcers, also known as conditioned reinforcers, are not innately appreciated and people have to learn to like them through classical conditioning of other methods. Secondary reinforcers include things such as money. Different patterns of reinforcement have different influences on the response. There are five main reinforcement schedules: fixed interval, variable interval, fixed ratio, variable ratio, and random. Variable ratio schedules are most resistant to extinction.
Shaping and chaining are techniques used when an exact behavior cannot be performed and so cannot be rewarded. Shaping involves rewarding successive, increasingly accurate approximations to the behavior, while chaining involves breaking a complex task into smaller, more manageable sections. Escape conditioning refers to a situation whereby an aversive situation is removed after a response. It is a form of negative reinforcement. Habituation refers to the phenomenon whereby there is a decrease in response to a stimulus over time. Covert sensitization is a technique used whereby someone learns to use mental imagery to associate a behavior with a negative consequence.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 8
Correct
-
Which statement about modafinil is accurate?
Your Answer: It does not tend to lead to dependence
Explanation:Modafinil shares similarities in its mechanism of action with amphetamine, and its effects are relatively brief with a half-life of approximately 8-12 hours. Additionally, the side effects of modafinil are comparable to those of amphetamine.
Modafinil: A Psychostimulant for Wakefulness and Attention Enhancement
Modafinil is a type of psychostimulant that is known to improve wakefulness, attention, and vigilance. Although it is similar to amphetamines, it does not produce the same euphoric effects and is not associated with dependence of tolerance. Additionally, it does not seem to cause psychosis. Modafinil is approved for the treatment of narcolepsy, obstructive sleep apnea, and chronic shift work. It is also suggested as an adjunctive treatment for depression by the Maudsley. Recently, it has gained popularity as a smart drug due to its potential to enhance cognitive functioning in healthy individuals.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 9
Correct
-
Which condition is characterized by microcephaly?
Your Answer: Fetal alcohol syndrome
Explanation:Microcephaly is a characteristic of fetal alcohol syndrome, while macrocephaly is associated with all the other options except for Asperger’s, which is not typically linked to any abnormality in head size.
Microcephaly: A Condition of Small Head Size
Microcephaly is a condition characterized by a small head size. It can be a feature of various conditions, including fetal alcohol syndrome, Down’s syndrome, Edward’s syndrome, Patau syndrome, Angelman syndrome, De Lange syndrome, Prader-Willi syndrome, and Cri-du-chat syndrome. Each of these conditions has its own unique set of symptoms and causes, but they all share the common feature of microcephaly. This condition can have a range of effects on a person’s development, including intellectual disability, seizures, and motor problems. Early diagnosis and intervention can help manage the symptoms and improve outcomes for individuals with microcephaly.
-
This question is part of the following fields:
- Genetics
-
-
Question 10
Correct
-
A student attends a disciplinary hearing. When asked about the behavior that led to their suspension, they argue that it was due to external factors and that they were not entirely responsible for their actions. However, the disciplinary panel disagrees and places more emphasis on the student's personal traits, such as their lack of self-control and tendency towards defiance.
What is suggested by the perspective of the disciplinary panel?Your Answer: Fundamental attribution error
Explanation:The most appropriate explanation for this scenario is the fundamental attribution error. It is important to note that this is distinct from the actor-observer bias, which requires evidence of a difference in how situational factors are considered for others versus ourselves. The actor-observer bias typically involves overemphasizing personality traits for others’ behaviors and situational factors for our own behaviors.
Attribution Theory: Understanding How We Explain Events
Attribution theory provides a framework for understanding how individuals explain events in their environment. It examines how people use information to arrive at causal explanations for events and what factors influence their judgments. Fritz Heider first proposed a theory of attribution in 1958.
However, attribution is prone to biases such as the Fundamental Attribution Error (FAE), which overemphasizes dispositional factors over situational causes when making attributions about others’ behavior. The Actor-Observer Bias, on the other hand, undervalues dispositional explanations and overvalued situational explanations of our own behavior. Correspondence bias is the tendency to draw inferences about a person’s unique and enduring dispositions from behaviors that can be entirely explained by the situations in which they occur. Self-serving bias refers to people’s tendency to attribute their successes to internal factors but attribute their failures to external factors. Hostile Attribution Bias (HAB) is an interpretive bias where individuals interpret ambiguous behavior as hostile, leading to aggression. Finally, the False Consensus Effect is the tendency for people to project their way of thinking onto others, assuming that everyone else thinks the same way they do.
Overall, attribution theory helps us understand how people make sense of events in their environment, but it is important to be aware of the biases that can influence our judgments.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 11
Correct
-
Which of the following drugs can cause the 'cheese reaction'?
Your Answer: Phenelzine
Explanation:The ‘cheese reaction’ is a potential adverse effect of phenelzine, a type of medication known as a monoamine oxidase inhibitor (MAOI). When a person takes phenelzine, foods that contain high levels of tyramine are not broken down properly due to the inhibition of MAO. This causes tyramine to enter the bloodstream and trigger the release of noradrenaline, which can lead to dangerous spikes in blood pressure.
The term ‘cheese reaction’ comes from the fact that many types of cheese are particularly high in tyramine. While early MAOIs irreversibly inhibit monoamine oxidase, newer medications like moclobemide are reversible and considered to be safer.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 12
Correct
-
Which of the following statements most accurately defines tangentiality?
Your Answer: It is a disorder of the form of thought
Explanation:Karl Jaspers, a German psychiatrist and philosopher, first described tangentiality as a formal thought disorder where the patient deviates from the topic at hand and introduces new but related words. Although the examiner can usually follow the patient’s train of thought, the patient often loses track of the interviewer’s question. While tangentiality is not specific to any particular mental disorder, it can be present in conditions such as mania, hypomania, and schizophrenia. Other examples of formal thought disorder include loosening of associations, circumstantiality, thought block, perseveration, and flight of ideas.
-
This question is part of the following fields:
- Descriptive Psychopathology
-
-
Question 13
Correct
-
What is proposed by the theory of the bystander effect?
Your Answer: A small number of witnesses predicts a higher chance of intervention
Explanation:The Bystander Effect: Theory and Examples
The bystander effect, also known as the Genovese effect, suggests that the likelihood of someone helping in a situation is inversely related to the number of people present. This means that a person is more likely to help if there are fewer witnesses. The term Genovese effect comes from the case of Kitty Genovese, who was sexually assaulted and killed in front of a large apartment building. Despite 38 neighbors hearing her screams, no one called the police. However, the facts of this story have been largely shown to be inaccurate.
Bystanders are less likely to help if there are many other people present, if the perpetrator is present, if the costs of intervention are physical, and if the situation is perceived as dangerous. On the other hand, bystanders are more likely to help if they are male and if they know the person in need of help. Overall, the bystander effect has been shown to be a valid concept, as demonstrated by research studies.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 14
Correct
-
Which hypothalamic nucleus plays the most significant role in establishing the set point for daily circadian rhythms?
Your Answer: Suprachiasmatic
Explanation:Functions of the Hypothalamus
The hypothalamus is a vital part of the brain that plays a crucial role in regulating various bodily functions. It receives and integrates sensory information about the internal environment and directs actions to control internal homeostasis. The hypothalamus contains several nuclei and fiber tracts, each with specific functions.
The suprachiasmatic nucleus (SCN) is responsible for regulating circadian rhythms. Neurons in the SCN have an intrinsic rhythm of discharge activity and receive input from the retina. The SCN is considered the body’s master clock, but it has multiple connections with other hypothalamic nuclei.
Body temperature control is mainly under the control of the preoptic, anterior, and posterior nuclei, which have temperature-sensitive neurons. As the temperature goes above 37ºC, warm-sensitive neurons are activated, triggering parasympathetic activity to promote heat loss. As the temperature goes below 37ºC, cold-sensitive neurons are activated, triggering sympathetic activity to promote conservation of heat.
The hypothalamus also plays a role in regulating prolactin secretion. Dopamine is tonically secreted by dopaminergic neurons that project from the arcuate nucleus of the hypothalamus into the anterior pituitary gland via the tuberoinfundibular pathway. The dopamine that is released acts on lactotrophic cells through D2-receptors, inhibiting prolactin synthesis. In the absence of pregnancy of lactation, prolactin is constitutively inhibited by dopamine. Dopamine antagonists result in hyperprolactinemia, while dopamine agonists inhibit prolactin secretion.
In summary, the hypothalamus is a complex structure that regulates various bodily functions, including circadian rhythms, body temperature, and prolactin secretion. Dysfunction of the hypothalamus can lead to various disorders, such as sleep-rhythm disorder, diabetes insipidus, hyperprolactinemia, and obesity.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 15
Correct
-
Which statement accurately describes the CATIE study?
Your Answer: Olanzapine was found to be more effective than the other atypical antipsychotics used in phase I
Explanation:Olanzapine was found to have the highest duration of treatment before discontinuation due to inadequate efficacy, the longest period of successful treatment, and the lowest number of hospitalizations caused by worsening of schizophrenia among the patients.
CATIE Study: Comparing Antipsychotic Medications for Schizophrenia Treatment
The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study, funded by the National Institute of Mental Health (NIMH), was a nationwide clinical trial that aimed to compare the effectiveness of older and newer antipsychotic medications used to treat schizophrenia. It is the largest, longest, and most comprehensive independent trial ever conducted to examine existing therapies for schizophrenia. The study consisted of two phases.
Phase I of CATIE compared four newer antipsychotic medications to one another and an older medication. Participants were followed for 18 months to evaluate longer-term patient outcomes. The study involved over 1400 participants and was conducted at various treatment sites, representative of real-life settings where patients receive care. The results from CATIE are applicable to a wide range of people with schizophrenia in the United States.
The medications were comparably effective, but high rates of discontinuation were observed due to intolerable side-effects of failure to adequately control symptoms. Olanzapine was slightly better than the other drugs but was associated with significant weight gain as a side-effect. Surprisingly, the older, less expensive medication (perphenazine) used in the study generally performed as well as the four newer medications. Movement side effects primarily associated with the older medications were not seen more frequently with perphenazine than with the newer drugs.
Phase II of CATIE sought to provide guidance on which antipsychotic to try next if the first failed due to ineffectiveness of intolerability. Participants who discontinued their first antipsychotic medication because of inadequate management of symptoms were encouraged to enter the efficacy (clozapine) pathway, while those who discontinued their first treatment because of intolerable side effects were encouraged to enter the tolerability (ziprasidone) pathway. Clozapine was remarkably effective and was substantially better than all the other atypical medications.
The CATIE study also looked at the risk of metabolic syndrome (MS) using the US National Cholesterol Education Program Adult Treatment Panel criteria. The prevalence of MS at baseline in the CATIE group was 40.9%, with female patients being three times as likely to have MS compared to matched controls and male patients being twice as likely.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 16
Correct
-
What was the first neurotransmitter to be recognized?
Your Answer: Acetylcholine
Explanation:Henry Dale was the first to identify acetylcholine in 1915 through its effects on cardiac tissue, and he was awarded the Nobel Prize in Medicine in 1936 alongside Otto Loewi for their work. Arvid Carlsson discovered dopamine as a neurotransmitter in 1957, while von Euler discovered noradrenaline (also known as norepinephrine) as both a hormone and neurotransmitter in 1946. Oxytocin is typically classified as a hormone, while substance P is a neuropeptide that functions as both a neurotransmitter and neuromodulator and was first discovered in 1931.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 17
Correct
-
What is the term used in classical conditioning to describe an unlearned, inborn reaction to an unconditioned stimulus?
Your Answer: An unconditioned response
Explanation:Classical Conditioning: A Learning Theory by Ivan Pavlov
Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.
Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 18
Correct
-
Which of the following adverse effects caused by antipsychotic medications is not influenced by dopaminergic receptors?
Your Answer: Ejaculatory failure
Explanation:Antipsychotics: Common Side Effects and Relative Adverse Effects
Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.
Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.
Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.
Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.
Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.
The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.
Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
Amisulpride – + + + – – +++
Aripiprazole – +/- – +/- – – –
Asenapine + + +/- +/- – – +/-
Clozapine +++ +++ +++ – +++ +++ –
Flupentixol + ++ + ++ ++ + +++
Fluphenazine + + + +++ ++ + +++
Haloperidol + + +/- +++ + + +++
Olanzapine ++ +++ +++ +/- + + +
Paliperidone + ++ + + + ++ +++
Pimozide + + – + + + +++
Quetiapine ++ ++ ++ – + ++ –
Risperidone + ++ + + + ++ +++
Zuclopenthixol ++ ++ + ++ ++ + +++Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 19
Incorrect
-
What is the primary metabolic pathway for benzodiazepines?
Your Answer: CYP2B6
Correct Answer: CYP3A4
Explanation:CYP3A4 is responsible for metabolizing the majority of benzodiazepines in the liver.
Benzodiazepines: Effective but Addictive
Benzodiazepines are a class of drugs that are commonly used to treat anxiety. They are divided into two categories: hypnotics, which have a short half-life, and anxiolytics, which have a long half-life. While they can be effective in reducing anxiety symptoms, they are also highly addictive and should not be prescribed for more than one month at a time.
Benzodiazepines are particularly effective as hypnotics, but they do have some negative effects on sleep. They suppress REM sleep, and when they are discontinued, a rebound effect is often seen. This means that people may experience more vivid dreams and nightmares when they stop taking the medication. It is important for doctors to carefully monitor patients who are taking benzodiazepines to ensure that they are not becoming addicted and that they are not experiencing any negative side effects.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 20
Correct
-
What is the culture bound syndrome observed in Eskimos?
Your Answer: Piblokto
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 21
Correct
-
Which medication, prescribed for individuals with Alzheimer's disease, functions as an NMDA antagonist?
Your Answer: Memantine
Explanation:Memantine is an NMDA antagonist that reduces glutamate mediated excitotoxicity and is recommended by NICE guidelines for managing Alzheimer’s disease in patients with moderate of severe disease who are intolerant of of have a contraindication to acetylcholinesterase inhibitors. Donepezil and galantamine are reversible acetylcholinesterase inhibitors, while rivastigmine is both a reversible acetylcholinesterase inhibitor and butyrylcholinesterase inhibitor. Tacrine, which is not licensed in the UK, has been associated with hepatotoxicity and limited cognitive benefits. Treatment should only be initiated and continued by specialists in dementia care, with regular reviews and assessments of patient benefits. Specialists include psychiatrists, neurologists, and care of the elderly physicians.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 22
Correct
-
What is the condition that occurs when there is a deletion of the paternal chromosome 15q?
Your Answer: Prader-Willi syndrome
Explanation:Genetic Conditions and Their Features
Genetic conditions are disorders caused by abnormalities in an individual’s DNA. These conditions can affect various aspects of a person’s health, including physical and intellectual development. Some of the most common genetic conditions and their features are:
– Downs (trisomy 21): Short stature, almond-shaped eyes, low muscle tone, and intellectual disability.
– Angelman syndrome (Happy puppet syndrome): Flapping hand movements, ataxia, severe learning disability, seizures, and sleep problems.
– Prader-Willi: Hyperphagia, excessive weight gain, short stature, and mild learning disability.
– Cri du chat: Characteristic cry, hypotonia, down-turned mouth, and microcephaly.
– Velocardiofacial syndrome (DiGeorge syndrome): Cleft palate, cardiac problems, and learning disabilities.
– Edwards syndrome (trisomy 18): Severe intellectual disability, kidney malformations, and physical abnormalities.
– Lesch-Nyhan syndrome: Self-mutilation, dystonia, and writhing movements.
– Smith-Magenis syndrome: Pronounced self-injurious behavior, self-hugging, and a hoarse voice.
– Fragile X: Elongated face, large ears, hand flapping, and shyness.
– Wolf Hirschhorn syndrome: Mild to severe intellectual disability, seizures, and physical abnormalities.
– Patau syndrome (trisomy 13): Severe intellectual disability, congenital heart malformations, and physical abnormalities.
– Rett syndrome: Regression and loss of skills, hand-wringing movements, and profound learning disability.
– Tuberous sclerosis: Hamartomatous tumors, epilepsy, and behavioral issues.
– Williams syndrome: Elfin-like features, social disinhibition, and advanced verbal skills.
– Rubinstein-Taybi syndrome: Short stature, friendly disposition, and moderate learning disability.
– Klinefelter syndrome: Extra X chromosome, low testosterone, and speech and language issues.
– Jakob’s syndrome: Extra Y chromosome, tall stature, and lower mean intelligence.
– Coffin-Lowry syndrome: Short stature, slanting eyes, and severe learning difficulty.
– Turner syndrome: Short stature, webbed neck, and absent periods.
– Niemann Pick disease (types A and B): Abdominal swelling, cherry red spot, and feeding difficulties.It is important to note that these features may vary widely among individuals with the same genetic condition. Early diagnosis and intervention can help individuals with genetic conditions reach their full potential and improve their quality of life.
-
This question is part of the following fields:
- Genetics
-
-
Question 23
Correct
-
A middle-aged woman with early onset dementia believes that she is living in a flat identical to her own which has been built in another city. She is very worried that she will have to pay two sets of rent and that her other flat will be robbed. What symptom is she exhibiting?
Your Answer: Reduplicative paramnesia
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 24
Correct
-
Which individual is linked to the structural approach in family therapy?
Your Answer: Minuchin
Explanation:Family therapy has been shaped by various influential figures, each with their own unique approach. Salvador Minuchin is known for his structural model, which emphasizes the importance of family hierarchy, rules, and boundaries. Gregory Bateson, on the other hand, is associated with paradoxical therapy. Murray Bowen is linked to the family systems approach, while Jay Haley is known for his strategic systemic therapy. Finally, the Milan systemic approach is associated with Mara Selvini Palazzoli. Each of these figures has contributed to the development of family therapy, and their approaches continue to be used and adapted by therapists today.
-
This question is part of the following fields:
- Advanced Psychological Processes And Treatments
-
-
Question 25
Incorrect
-
What EEG alterations are observed in individuals with Creutzfeldt-Jakob disease?
Your Answer: Generalised periodic triphasic waves
Correct Answer: Periodic sharp wave complexes
Explanation:The typical EEG pattern for CJD includes periodic sharp wave complexes, which is a diagnostic criterion. Lewy body dementia may show generalized slow wave activity, but if it is more prominent in the temporal and parietal regions, it may indicate Alzheimer’s disease. Toxic encephalopathies, such as lithium toxicity, may show periodic triphasic waves on EEG. For more information, see Smith SJ’s article EEG in neurological conditions other than epilepsy: when does it help, what does it add? (2005).
-
This question is part of the following fields:
- Neurosciences
-
-
Question 26
Correct
-
What kind of hallucination is it when a man hears a woman scream every time the light turns on?
Your Answer: Reflex
Explanation:Functional refers to the use of the same type of sensory input.
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
-
-
Question 27
Correct
-
What should be avoided in individuals with hepatic impairment?
Your Answer: Duloxetine
Explanation:Duloxetine undergoes hepatic metabolism and its clearance is significantly decreased even in cases of mild impairment. There have been documented cases of hepatocellular injury and, although rare, jaundice. A single case of fulminant hepatic failure has also been reported. Therefore, individuals with hepatic impairment should not take duloxetine as it is contraindicated (as stated in the Maudsley 14th Ed).
Hepatic Impairment: Recommended Drugs
Patients with hepatic impairment may experience reduced ability to metabolize drugs, toxicity, enhanced dose-related side effects, reduced ability to synthesize plasma proteins, and elevated levels of drugs subject to first-pass metabolism due to reduced hepatic blood flow. The Maudsley Guidelines 14th Ed recommends the following drugs for patients with hepatic impairment:
Antipsychotics: Paliperidone (if depot required), Amisulpride, Sulpiride
Antidepressants: Sertraline, Citalopram, Paroxetine, Vortioxetine (avoid TCA and MAOI)
Mood stabilizers: Lithium
Sedatives: Lorazepam, Oxazepam, Temazepam, Zopiclone 3.75mg (with care)
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 28
Correct
-
What can be said about alterations in dopamine transporter levels observed in individuals with ADHD?
Your Answer: Elevated due to psychostimulant treatment
Explanation:The density of striatal dopamine transporters in individuals with ADHD is influenced by their prior exposure to psychostimulants. ADHD is a complex disorder that involves dysfunction in multiple neurotransmitter systems, including dopamine, adrenergic, cholinergic, and serotonergic systems. Dopamine systems have received significant attention due to their role in regulating psychomotor activity, motivation, inhibition, and attention. Psychostimulants increase dopamine availability by blocking striatal dopamine transporters. Individuals with untreated ADHD have lower levels of dopamine transporters, while those who have received psychostimulants have higher levels.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 29
Correct
-
How can a form of cultural assimilation be described?
Your Answer: Melting pot
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
-
-
Question 30
Correct
-
What is a true statement about Broca's aphasia?
Your Answer: Main areas affected are Brodmann areas 44 and 45
Explanation:Aphasia is a language impairment that affects the production of comprehension of speech, as well as the ability to read of write. The areas involved in language are situated around the Sylvian fissure, referred to as the ‘perisylvian language area’. For repetition, the primary auditory cortex, Wernicke, Broca via the Arcuate fasciculus (AF), Broca recodes into articulatory plan, primary motor cortex, and pyramidal system to cranial nerves are involved. For oral reading, the visual cortex to Wernicke and the same processes as for repetition follows. For writing, Wernicke via AF to premotor cortex for arm and hand, movement planned, sent to motor cortex. The classification of aphasia is complex and imprecise, with the Boston Group classification and Luria’s aphasia interpretation being the most influential. The important subtypes of aphasia include global aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, anomic aphasia, transcortical motor aphasia, and transcortical sensory aphasia. Additional syndromes include alexia without agraphia, alexia with agraphia, and pure word deafness.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 31
Correct
-
Which symptom is not considered one of Bleuler's primary symptoms?
Your Answer: Anhedonia
Explanation:Historical Classification of Schizophrenia
The classification of schizophrenia has evolved over time, with various individuals contributing to its development. In 1801, Phillippe Pinel used the term ‘demencé’ to describe the loss of mental abilities in chronically ill patients. Benedict Morel coined the term ‘demencé precocé’ in 1852 to describe young patients with premature dementia. Kahlbaum was the first to describe ‘paraphrenia hebetica’ in the 1860s, which was later elaborated as ‘hebephrenia’ by Hecker in 1871.
In 1893, Emil Kraepelin used the term dementia praecox to describe the condition, emphasizing the importance of delusions, hallucinations, impaired attention, thought incoherence, stereotyped movements and expressions, deterioration of emotional life, and a loss of drive as key symptoms. In 1908, Eugen Bleuler coined the term ‘schizophrenia’ to replace dementia praecox, denoting ‘a splitting of the psychic functions.’ Bleuler expanded the concept to include presentations that did not include a ‘terminal state.’
Bleuler introduced a distinction between basic and accessory symptoms and primary and secondary symptoms. Basic symptoms are necessarily present in any case of schizophrenia, while accessory symptoms may of may not occur. The fundamental features of schizophrenia were loosening of associations, disturbances of affectivity, ambivalence, and autism. The alteration of associations is the only symptom that Bleuler regarded as both basic and primary, and can thus be described as the core disturbance in the Bleulerian conception of schizophrenia.
In 1939, Langfeldt introduced the term ‘schizophreniform psychosis’ to describe patients with Bleulerian schizophrenia who did not follow a progressively deteriorating course. In the 1960s, Rado/Meehl introduced the term ‘schizotypy’ to recognize the concept of a continuum of spectrum of schizophrenia-related phenotypes. In the 1980s, Crow proposed a subclassification of schizophrenia, dividing patients into types I and II. Type I patients present with positive symptoms such as delusions and hallucinations, while type II patients present with negative symptoms such as affective flattening and poverty of speech.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 32
Incorrect
-
A cohort study aimed to determine the likelihood of postoperative bleeding in elderly patients undergoing surgery while taking anticoagulant medication.
Anticoagulants were categorized into direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs).
What were the results of the study?Your Answer: Increased risk of bleeding with SSRIs but not other antidepressants
Correct Answer: Increased risk of bleeding with all antidepressants
Explanation:The use of selective serotonin reuptake inhibitors (SSRIs) can lead to a decrease in platelet aggregation, potentially increasing the risk of bleeding. However, the discovery that other types of antidepressants may also increase the risk of bleeding was unexpected and requires further investigation.
A recent cohort study followed women who were currently using antidepressants, had used them within the past month, had used them within the past 1-5 months, of had never used them. The study found that women who had any current of recent exposure to antidepressants were at a slightly increased risk of experiencing postpartum hemorrhage (with a relative risk of 1.4-1.9).
The study was conducted in the United States and focused on women who received Medicaid, which represents approximately 40% of the US population and includes a higher proportion of economically disadvantaged and minority populations.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 33
Incorrect
-
A parent with a child who has ADHD has been researching stimulant medications online and wants to know your thoughts on the validity of a specific article. What statement in the article do you believe is the most accurate?
Your Answer: Amitriptyline is licensed for treatment of nerve pain
Correct Answer: Clomipramine is recommended as a second line agent in OCD
Explanation:Clomipramine as a Second-Line Treatment for OCD
Paragraph: Clomipramine is a tricyclic antidepressant (TCA) that has a high affinity for serotonin receptors, making it the most serotonergic TCA. The National Institute for Health and Care Excellence (NICE) guidelines recommend clomipramine as a second-line treatment for obsessive-compulsive disorder (OCD). However, patients may find antimuscarinic side effects, such as dry mouth and constipation, difficult to tolerate. It is worth noting that using TCAs for nerve and chronic pain is not an approved indication.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 34
Correct
-
Which drug is most likely to cause porphyria to occur?
Your Answer: Diazepam
Explanation:Porphyria: The Little Imitator
Porphyria is a medical condition that is often referred to as the little imitator because it can mimic various common psychiatric presentations. This condition can be triggered by the use of certain psychotropic drugs, including barbiturates, benzodiazepines, sulpiride, and some mood stabilizers.
Porphyria can manifest in different ways, and it is important to be aware of the symptoms. These may include abdominal pain, mental state changes, constipation, vomiting, and muscle weakness.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 35
Correct
-
What is the truth about medication absorption in elderly individuals?
Your Answer: The first pass metabolism tends to be reduced
Explanation:The circulation of blood to the organs of the abdominal gastrointestinal system, such as the stomach, liver, spleen, pancreas, small intestine, and large intestine, is referred to as the splanchnic circulation.
Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.
In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 36
Incorrect
-
The campaign Changing Minds was initiated by the Royal College of Psychiatry to address the issue of stigmatizing individuals with mental health conditions. What was the launch date of this campaign?
Your Answer: 1995
Correct Answer: 1998
Explanation:The Changing Minds Campaign had a five-year run from 1998 to 2003. Its primary objective was to raise awareness and understanding of six prevalent mental health issues, namely anxiety, depression, schizophrenia, dementia, alcohol and drug addiction, and eating disorders. These conditions affect a significant portion of the population, with anxiety affecting over 10% of individuals, depression affecting 25%, schizophrenia affecting 1%, dementia affecting 20% of those over 80, alcohol and drug addiction affecting about one-third of people, and eating disorders affecting 1 in 50 individuals.
-
This question is part of the following fields:
- Stigma And Culture
-
-
Question 37
Correct
-
Which condition has the highest estimate of heritability among the options provided?
Your Answer: Schizophrenia
Explanation:Heritability: Understanding the Concept
Heritability is a concept that is often misunderstood. It is not a measure of the extent to which genes cause a condition in an individual. Rather, it is the proportion of phenotypic variance attributable to genetic variance. In other words, it tells us how much of the variation in a condition seen in a population is due to genetic factors. Heritability is calculated using statistical techniques and can range from 0.0 to 1.0. For human behavior, most estimates of heritability fall in the moderate range of .30 to .60.
The quantity (1.0 – heritability) gives the environment ability of the trait. This is the proportion of phenotypic variance attributable to environmental variance. The following table provides estimates of heritability for major conditions:
Condition Heritability estimate (approx)
ADHD 85%
Autism 70%
Schizophrenia 55%
Bipolar 55%
Anorexia 35%
Alcohol dependence 35%
Major depression 30%
OCD 25%It is important to note that heritability tells us nothing about individuals. It is a population-level measure that helps us understand the relative contributions of genetic and environmental factors to a particular condition.
-
This question is part of the following fields:
- Genetics
-
-
Question 38
Incorrect
-
What hormone is produced by the posterior pituitary gland?
Your Answer: Prolactin (PRL)
Correct Answer: Antidiuretic hormone (ADH)
Explanation:The posterior pituitary secretes antidiuretic hormone (ADH) and oxytocin, while the anterior pituitary secretes human growth hormone (HGH), adrenocorticotropic hormone (ACTH), prolactin (PRL), thyroid-stimulating hormone (TSH), luteinising hormone (LH), and follicle-stimulating hormone (FSH).
-
This question is part of the following fields:
- Neurosciences
-
-
Question 39
Correct
-
A middle-aged individual reports regularly wearing their partner's clothing without feeling sexually aroused, maintaining a positive relationship with their partner, and having no desire to permanently identify as the opposite gender. What diagnosis would be most appropriate for this individual's situation?
Your Answer: Dual-role transvestism
Explanation:Types of Gender and Sexual Identity
Dual-role transvestism refers to the act of wearing clothing typically associated with the opposite sex without experiencing discomfort with one’s biological gender of a desire to permanently live as the opposite sex. This behavior is not accompanied by sexual arousal, which distinguishes it from fetishistic transvestism. Fetishistic transvestism, on the other hand, involves wearing clothing of the opposite sex for the purpose of sexual arousal. Transsexualism is a desire to live as a member of the opposite sex, often accompanied by discomfort with one’s biological gender and a desire for gender reassignment. Sexual dysfunction encompasses a range of difficulties with sexual desire and performance.
-
This question is part of the following fields:
- Diagnosis
-
-
Question 40
Correct
-
What is the precursor amino acid for dopamine synthesis?
Your Answer: Tyrosine
Explanation:Tyrosine is converted to L-DOPA by the enzyme tyrosine hydroxylase. L-DOPA is then converted to dopamine by the enzyme dopa decarboxylase.
Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 41
Correct
-
Which compound in the list below is a secondary amine?
Your Answer: Nortriptyline
Explanation:Tricyclic Antidepressants: First and Second Generation
Tricyclic antidepressants are classified into two generations: first generation of tertiary amines, and second generation of secondary amines. The secondary amines are known to have fewer side effects and primarily affect noradrenaline, while the tertiary amines are believed to enhance both serotonin and noradrenaline.
Secondary amines include Desipramine, Nortriptyline, Protriptyline, and Amoxapine. On the other hand, tertiary amines include Amitriptyline, Lofepramine, Imipramine, Clomipramine, Dosulepin (Dothiepin), Doxepin, Trimipramine, and Butriptyline.
By understanding the differences between the two generations of tricyclic antidepressants, healthcare professionals can better tailor their treatment plans to their patients’ needs.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 42
Correct
-
Which inheritance pattern is not consistent with Mendelian genetics?
Your Answer: All are types of Mendelian inheritance
Explanation:The Law of Segregation and the Law of Independent Assortment are two fundamental principles of Mendelian inheritance. The Law of Segregation states that during gamete formation, the two alleles of a gene separate from each other so that each gamete receives only one allele. This means that offspring inherit one allele from each parent. The Law of Independent Assortment states that the inheritance of one gene does not affect the inheritance of another gene. This means that the alleles of different genes are distributed randomly into gametes. These laws are essential in understanding the inheritance patterns of single gene disorders. By following these laws, scientists can predict the likelihood of certain traits of disorders being passed down from one generation to the next.
-
This question is part of the following fields:
- Genetics
-
-
Question 43
Correct
-
Which of the following is not a requirement for a characteristic to be considered an endophenotype?
Your Answer: An endophenotype must not be present during remission
Explanation:Understanding Endophenotypes in Psychiatry
Endophenotypes are measurable components that are not visible to the naked eye, but are present along the pathway between disease and distal genotype. These components may be neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, of neuropsychological. They provide simpler clues to genetic underpinnings than the disease syndrome itself, making genetic analysis more straightforward and successful.
Endophenotypes are important in biological psychiatry research as they specifically require heritability and state independence. They must segregate with illness in the general population, be heritable, manifest whether illness is present of in remission, cosegregate with the disorder within families, be present at a higher rate within affected families than in the general population, and be a characteristic that can be measured reliably and is specific to the illness of interest.
Understanding endophenotypes is crucial in delineating the pathophysiology of mental illness, as genes are the biological bedrock of these disorders. By identifying and measuring endophenotypes, researchers can gain insight into the underlying genetic causes of mental illness and develop more effective treatments.
-
This question is part of the following fields:
- Genetics
-
-
Question 44
Correct
-
Which cranial nerve travels through the cribriform plate of the ethmoid bone on its way to the brain?
Your Answer: Olfactory nerve
Explanation:The olfactory nerves are responsible for the sense of smell. They originate in the upper part of the nose’s mucous membrane and travel through the ethmoid bone’s cribriform plate. From there, they reach the olfactory bulb, where nerve cells synapse and transmit the impulse to a second neuron. Finally, the nerves travel to the temporal lobe of the cerebrum, where the perception of smell occurs.
Overview of Cranial Nerves and Their Functions
The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.
The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.
The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.
The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.
The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.
The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.
The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.
The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 45
Correct
-
A doctor wants to collect evidence of her patients' satisfaction with their medical treatment. She gives each patient a form after their appointment and asks them to complete it. The form consists of just one statement which reads 'the medical treatment I received today was very effective'. Underneath the statement is a list of options to select from which reads 'strongly agree' agree' 'neutral', 'disagree', 'strongly disagree'.
What type of scale has the doctor used?Your Answer: Likert Scale
Explanation:Attitude scales are used to measure a person’s feelings and thoughts towards something. There are several types of attitude scales, including the Thurstone scale, Likert scale, semantic differential scale, and Gutman scale. The Thurstone scale involves creating a list of statements and having judges score them based on their negativity of positivity towards an issue. Respondents then indicate whether they agree of disagree with each statement. The Likert scale asks respondents to indicate their degree of agreement of disagreement with a series of statements using a five-point scale. The semantic differential scale presents pairs of opposite adjectives and asks respondents to rate their position on a five- of seven-point scale. The Gutman scale involves a list of statements that can be ordered hierarchically, with each statement having a corresponding weight. Respondents’ scores on the scale indicate the number of statements they agree with.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 46
Correct
-
A pediatrician who sees a child with asthma prescribes them the treatment which they believe is best based on their knowledge of the likely effectiveness of the medication. They fail to take into account the individual circumstances of the child. Which approach to doctor-patient relationships does the pediatrician adopt?
Your Answer: Paternalistic
Explanation:Models of Doctor-Patient Relationship
There are four distinct models of doctor-patient relationship that have been identified. The first is the paternalistic of autocratic model, which assumes that the doctor knows best and makes all decisions regarding treatment. The patient is expected to simply comply with the doctor’s orders. The second model is the informative model, where the doctor provides information to the patient and leaves the decision-making process entirely up to them. The third model is the interpretive model, where the doctor takes the time to understand the patient’s circumstances and helps them make a decision based on their unique situation. This model involves shared decision-making and active participation from the patient. Finally, the deliberative model involves the doctor acting as a friend to the patient and attempting to steer them in a particular course of action that they believe is in the patient’s best interest. However, ultimately, the choice is left up to the patient. Understanding these different models can help doctors and patients work together more effectively to achieve the best possible outcomes.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 47
Correct
-
What is a true statement about Erikson's theory of human development?
Your Answer: It accords with the 'epigenetic principle'
Explanation:Erik Erikson and Daniel Levinson expanded the understanding of adult development. Erikson proposed a life-span model of human development consisting of eight successive psychosocial stages, each associated with an inherent conflict of crisis that the individual must encounter and successfully resolve to proceed with development. Levinson proposed a developmental theory consisting of universal stages of phases that extend from the infancy state to the elderly state, based on biographical interviews of 40 men in America. Both theorists maintained that personality develops in a predetermined order and builds upon each previous stage, and that failure to successfully negotiate a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self. However, Levinson’s theory is age-based rather than event-based, and his model proposed a ‘life sequence’ consisting of a series of alternating stable (structure-building) periods and cross-era transitional (structure-changing) periods, with transitional periods typically lasting 5 years.
-
This question is part of the following fields:
- Psychological Development
-
-
Question 48
Correct
-
What is the most common cause of SIADH?
Your Answer: Stroke
Explanation:It is crucial to recognize that SIADH can have various physical origins that could be the primary cause in a patient who has been given psychotropic medication and develops the condition. The hypothalamus can be affected by brain-related conditions such as stroke, leading to the development of SIADH. Additionally, it is important to remain vigilant for any underlying cancer.
Hyponatremia in Psychiatric Patients
Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 49
Correct
-
Which of the following is not classified as a distinct personality disorder in the DSM-5?
Your Answer: Multiple personality disorder
Explanation:Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 50
Correct
-
How can association tracts be defined in relation to white matter?
Your Answer: Cingulum
Explanation:White matter is the cabling that links different parts of the CNS together. There are three types of white matter cables: projection tracts, commissural tracts, and association tracts. Projection tracts connect higher centers of the brain with lower centers, commissural tracts connect the two hemispheres together, and association tracts connect regions of the same hemisphere. Some common tracts include the corticospinal tract, which connects the motor cortex to the brainstem and spinal cord, and the corpus callosum, which is the largest white matter fiber bundle connecting corresponding areas of cortex between the hemispheres. Other tracts include the cingulum, superior and inferior occipitofrontal fasciculi, and the superior and inferior longitudinal fasciculi.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 51
Correct
-
A client in their senior years has recently been prescribed an SSRI. What signs of symptoms would be most indicative of hyponatremia?
Your Answer: Muscle cramps
Explanation:Hyponatremia in Psychiatric Patients
Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 52
Correct
-
What product has been taken off the UK market because of its impact on the QTc interval?
Your Answer: Thioridazine
Explanation:The UK market no longer offers thioridazine and droperidol due to their impact on the QTc interval.
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
-
-
Question 53
Correct
-
What is a true statement about valproate?
Your Answer: The risk of congenital malformations is dose dependent
Explanation:Valproate can pass through the placenta, increasing the likelihood of birth defects. The extent of risk during pregnancy is not fully understood, but it is believed to be influenced by the dosage. Children who were exposed to valproate in the womb may have a lower IQ, with those aged 6 showing an average decrease of 7-10 points compared to those exposed to other antiepileptic medications.
Valproate: Forms, Doses, and Adverse Effects
Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.
Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.
Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 54
Correct
-
Can you provide an instance of a pareidolic illusion?
Your Answer: An elderly man is able to see the face of his grandchild in the clouds as they pass over him
Explanation:The man’s longing for his girlfriend and the traveller’s thirst create affect illusions, distorting their perceptions. The woman who hears her mother when she sees the door open experiences a reflex hallucination, while the man who hears his wife’s voice describing something outside of his surroundings experiences an extracampine hallucination.
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
-
-
Question 55
Incorrect
-
What is a pathological characteristic observed in individuals with Alzheimer's disease?
Your Answer: Balloon cells
Correct Answer: Hyperphosphorylated tau
Explanation: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
-
-
Question 56
Correct
-
A 65-year-old woman passed away unexpectedly due to a heart attack. She had been experiencing significant difficulties with her short-term memory, which had been impacting her daily activities. Upon conducting an autopsy of her brain, it was discovered that she had widespread cerebral atrophy, as well as numerous neurofibrillary tangles and neuritic plaques. What is the probable diagnosis?
Your Answer: Alzheimer's disease
Explanation:Neurofibrillary tangles and neuritic (senile) plaques are commonly found in the brains of elderly individuals, but they are not present in Lewy body dementia. Pick’s disease is characterized by the presence of Pick’s bodies and knife blade atrophy. Creutzfeldt-Jakob disease (CJD) is identified by the spongy appearance of the grey matter in the cerebral cortex due to multiple vacuoles. If an individual experiences short-term memory problems that affect their daily life, it may indicate the presence of dementia. Alzheimer’s disease is characterized by extensive tangles and plaques in the brain.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 57
Correct
-
What percentage of Caucasians have a deficiency in the cytochrome P450 enzyme 2D6?
Your Answer: 6%
Explanation:Debrisoquine hydroxylase is the primary enzyme responsible for metabolizing several antidepressants, such as tricyclics, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and others. Approximately 5 out of 100 individuals are poor metabolisers, which can lead to increased side effects from medications that rely on CYP2D6 for metabolism. Conversely, ultra-rapid metabolisers may require higher than average doses of these medications due to their highly active forms of the enzyme.
The Cytochrome P450 system is a group of enzymes that metabolize drugs by altering their functional groups. The system is located in the liver and small intestine and is involved in drug interactions through enzyme induction of inhibition. Notable inducers include smoking, alcohol, and St John’s Wort, while notable inhibitors include grapefruit juice and some SSRIs. CYP2D6 is important due to genetic polymorphism, and CYP3A4 is the most abundant subfamily and is commonly involved in interactions. Grapefruit juice inhibits both CYP1A2 and CYP3A4, while tobacco smoking induces CYP1A2. The table summarizes the main substrates, inhibitors, and inducers for each CYP enzyme.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 58
Correct
-
A 50-year-old woman comes to the clinic with complaints of memory problems, frequent falls, and disrupted REM sleep. What is the most probable diagnosis?
Your Answer: Lewy body dementia
Explanation:In addition to fluctuating cognition and visual hallucinations, Lewy body dementia often involves sensitivity to neuroleptics. Patients may also experience falls and REM sleep disorder as common symptoms.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 59
Incorrect
-
A young girl who has had herpes encephalitis develops a severe carbohydrate craving and weight gain. What would be your suspicion?
Your Answer: Prader Willi syndrome
Correct Answer: Klüver-Bucy syndrome
Explanation:Kluver-Bucy Syndrome: Causes and Symptoms
Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.
The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 60
Correct
-
A young adult taking clozapine is struggling with significant weight gain and is considering discontinuing the medication despite significant improvements in their mental health. What has been observed to result in weight loss when used alongside clozapine?
Your Answer: Aripiprazole
Explanation:Antipsychotic drugs are known to cause weight gain, but some more than others. The reason for this is not due to a direct metabolic effect, but rather an increase in appetite and a decrease in activity levels. The risk of weight gain appears to be linked to clinical response. There are several suggested mechanisms for this, including antagonism of certain receptors and hormones that stimulate appetite. The risk of weight gain varies among different antipsychotics, with clozapine and olanzapine having the highest risk. Management strategies for antipsychotic-induced weight gain include calorie restriction, low glycemic index diet, exercise, and switching to an alternative antipsychotic. Aripiprazole, ziprasidone, and lurasidone are recommended as alternative options. Other options include aripiprazole augmentation, metformin, orlistat, liraglutide, and topiramate.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 61
Incorrect
-
A psychology graduate student is interested in studying the psychosocial factors related to alcohol misuse. They decide to use the health belief model as a framework for their research. One of the constructs of the health belief model pertains to the severity of the illness and its outcomes. How can this construct be applied to the study of alcohol abuse?
Your Answer: Perceived susceptibility
Correct Answer: Perceived severity
Explanation:The health belief model is a social cognition model that aims to predict and understand health-related behaviors. It consists of four main constructs: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. Perceived severity refers to an individual’s understanding of the seriousness of a disease. Perceived susceptibility, also known as perceived vulnerability, refers to an individual’s perception of their risk of contracting the disease if they continue with their current behavior. Perceived benefits refer to an individual’s perception of the advantages of adopting a different course of action, including the extent to which it reduces the risk of the disease of its severity. Perceived barriers refer to an individual’s perception of the disadvantages of adopting the recommended action, as well as any obstacles that may hinder its successful implementation.
-
This question is part of the following fields:
- Advanced Psychological Processes And Treatments
-
-
Question 62
Correct
-
What are the eosinophilic inclusion bodies observed in Alzheimer's Disease?
Your Answer: Hirano bodies
Explanation:Pathology Findings in Psychiatry
There are several pathology findings that are associated with various psychiatric conditions. Papp-Lantos bodies, for example, are visible in the CNS and are associated with multisystem atrophy. Pick bodies, on the other hand, are large, dark-staining aggregates of proteins in neurological tissue and are associated with frontotemporal dementia.
Lewy bodies are another common pathology finding in psychiatry and are associated with Parkinson’s disease and Lewy Body dementia. These are round, concentrically laminated, pale eosinophilic cytoplasmic inclusions that are aggregates of alpha-synuclein.
Other pathology findings include asteroid bodies, which are associated with sarcoidosis and berylliosis, and are acidophilic, stellate inclusions in giant cells. Barr bodies are associated with stains of X chromosomes and are inactivated X chromosomes that appear as a dark staining mass in contact with the nuclear membrane.
Mallory bodies are another common pathology finding and are associated with alcoholic hepatitis, alcoholic cirrhosis, Wilson’s disease, and primary-biliary cirrhosis. These are eosinophilic intracytoplasmic inclusions in hepatocytes that are made up of intermediate filaments, predominantly prekeratin.
Other pathology findings include Schaumann bodies, which are associated with sarcoidosis and berylliosis, and are concentrically laminated inclusions in giant cells. Zebra bodies are associated with Niemann-Pick disease, Tay-Sachs disease, of any of the mucopolysaccharidoses and are palisaded lamellated membranous cytoplasmic bodies seen in macrophages.
LE bodies, also known as hematoxylin bodies, are associated with SLE (lupus) and are nuclei of damaged cells with bound anti-nuclear antibodies that become homogeneous and loose chromatin pattern. Verocay bodies are associated with Schwannoma (Neurilemoma) and are palisades of nuclei at the end of a fibrillar bundle.
Hirano bodies are associated with normal aging but are more numerous in Alzheimer’s disease. These are eosinophilic, football-shaped inclusions seen in neurons of the brain. Neurofibrillary tangles are another common pathology finding in Alzheimer’s disease and are made up of microtubule-associated proteins and neurofilaments.
Kayser-Fleischer rings are associated with Wilson’s disease and are rings of discoloration on the cornea. Finally, Kuru plaques are associated with Kuru and Gerstmann-Sträussler syndrome and are sometimes present in patients with Creutzfeldt-Jakob disease (CJD). These are composed partly of a host-encoded prion protein.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 63
Incorrect
-
What class of antidepressants was developed through research on the treatment of tuberculosis?
Your Answer: Tricyclics
Correct Answer: MAOIs
Explanation:History and Classification of Antidepressants
Antidepressants have a diverse history and classification. The first two monoamine oxidase inhibitors (MAOIs), isoniazid and iproniazid, were originally used to treat tuberculosis. However, it was discovered that some patients became elated, leading to the drugs being used to treat depression from 1957. Due to toxicity concerns, they were withdrawn in 1961, but other MAOIs were subsequently developed.
Amphetamines, on the other hand, are not classified as antidepressants. They are related to the plant derivative ephedrine. Tetracyclics, on the other hand, are closely related to the tricyclics.
The first drug of the tricyclics class, chlorpromazine, was initially identified following research on anaesthetic agents. Overall, the history and classification of antidepressants are complex and varied, with different drugs being developed for different purposes and with different mechanisms of action.
-
This question is part of the following fields:
- History Of Psychiatry
-
-
Question 64
Incorrect
-
What is a defining trait of Kohlberg's stage of conventional morality?
Your Answer: Punishment
Correct Answer: Authority principle
Explanation:Kohlberg’s Six Stages of Moral Development
Kohlberg’s theory of moral development consists of six stages that can be categorized into three levels. The first level is the preconventional stage, which is characterized by obedience and punishment orientation, where the focus is on the direct consequences of actions and unquestioning deference to power. The second stage is the self-interest orientation, where right behavior is defined purely by what is in the individual’s own interest.
The second level is the conventional stage, which is characterized by interpersonal accord and conformity, where the focus is on how the individual will appear to others. The behavior should accord with a consensus view on what is good. The second stage is the authority and social order obedience driven, where what is lawful is judged to be morally right. Right behavior is dictated by societal rules, and there is a greater respect for social order and the need for laws.
The third level is the postconventional stage, which is characterized by the social contract orientation, where individual rights determine behavior. The individual views laws and rules as flexible tools for improving human purposes. The fourth stage is the universal ethical principles orientation, where the right action is the one that is consistent with abstract reasoning using universal ethical principles.
It is important to note that the age ranges for Kohlberg’s developmental stages are rough guides, and sources vary widely. Kohlberg developed his stage theory following an experiment he conducted on 72 boys aged 10-16. However, the theory is criticized as sexist as it only included boys.
-
This question is part of the following fields:
- Psychological Development
-
-
Question 65
Incorrect
-
Which of the following symptoms in the PANSS scale for schizophrenia is classified as a positive symptom?
Your Answer: Disturbance of volition
Correct Answer: Conceptual disorganisation
Explanation:The Positive and Negative Syndrome Scale (PANSS) is a tool used to measure the severity of symptoms in patients with schizophrenia. The scale is divided into three categories: positive symptoms, negative symptoms, and general psychopathology symptoms. Each category has several items that are scored on a seven-point severity scale. The positive symptoms include delusions, hallucinations, and hyperactivity, while the negative symptoms include blunted affect and lack of spontaneity. The general psychopathology symptoms include anxiety, depression, and poor impulse control. The PANSS is a valuable tool for clinicians to assess the severity of symptoms in patients with schizophrenia and to monitor their progress over time.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 66
Correct
-
After a teenager mentions that they smoke cigarettes, and have been struggling to quit, the counselor says, "I know this must be hard for you." This is an example of:
Your Answer: Validation
Explanation:Symptom exaggeration is a method of suggesting a behavior that is more problematic than expected to help the patient feel less guilty and provide a more truthful response.
Confrontation involves the doctor pointing out something that the patient may be denying or missing.
Clarification is used to clarify something the patient has said.
Open-ended questions encourage the patient to respond in their own words and cannot be answered with a simple yes of no.
Validation is used to make the patient’s thoughts, feelings, of behaviors seem more acceptable by normalizing them.
-
This question is part of the following fields:
- History And Mental State
-
-
Question 67
Correct
-
You are requested to conduct a liaison psychiatry evaluation on a 78-year-old woman admitted to a medical ward with a COPD flare-up and suspected depression.
What are some characteristics of depression in the elderly?Your Answer: Hypochondriacal symptoms may be more frequently reported than sadness of low mood
Explanation:There is a lower likelihood of elderly patients reporting feelings of sadness compared to younger patients with depression, and they may instead present with physical complaints. Depression rates in the elderly are often linked to physical health issues rather than just aging. There is no evidence to suggest that elderly depressed patients have a higher risk of developing dementia. The prognosis for depression in the elderly is similar to that of younger patients, and venlafaxine is safe to use in this population.
-
This question is part of the following fields:
- Epidemiology
-
-
Question 68
Correct
-
Which of the following do not describe the features of REM sleep?
Your Answer: K complexes on the EEG
Explanation:During REM sleep, the EEG patterns resemble those observed during wakefulness, characterized by numerous beta-rhythms that are fast.
Sleep Stages
Sleep is divided into two distinct states called rapid eye movement (REM) and non-rapid eye movement (NREM). NREM is subdivided into four stages.
Sleep stage
Approx % of time spent in stage
EEG findings
CommentI
5%
Theta waves (4-7 Hz)
The dozing off stage. Characterized by hypnic jerks: spontaneous myoclonic contractions associated with a sensation of twitching of falling.II
45%
Theta waves, K complexes and sleep spindles (short bursts of 12-14 Hz activity)
Body enters a more subdued state including a drop in temperature, relaxed muscles, and slowed breathing and heart rate. At the same time, brain waves show a new pattern and eye movement stops.III
15%
Delta waves (0-4 Hz)
Deepest stage of sleep (high waking threshold). The length of stage 3 decreases over the course of the night.IV
15%
Mixed, predominantly beta
High dream activity.The percentage of REM sleep decreases with age.
It takes the average person 15-20 minutes to fall asleep, this is called sleep latency (characterised by the onset of stage I sleep). Once asleep one descends through stages I-II and then III-IV (deep stages). After about 90 minutes of sleep one enters REM. The rest of the sleep comprises of cycles through the stages. As the sleep progresses the periods of REM become greater and the periods of NREM become less. During an average night’s sleep one spends 25% of the sleep in REM and 75% in NREM.
REM sleep has certain characteristics that separate it from NREM
Characteristics of REM sleep
– Autonomic instability (variability in heart rate, respiratory rate, and BP)
– Loss of muscle tone
– Dreaming
– Rapid eye movements
– Penile erectionDeafness:
(No information provided on deafness in relation to sleep stages)
-
This question is part of the following fields:
- Neurosciences
-
-
Question 69
Incorrect
-
In which area of the skull is the structure located in the anterior cranial fossa?
Your Answer: Optic canal
Correct Answer: Cribriform plate
Explanation:The ethmoid bone contains the cribriform plate, which acts as a barrier between the nasal cavity and the brain.
Cranial Fossae and Foramina
The cranium is divided into three regions known as fossae, each housing different cranial lobes. The anterior cranial fossa contains the frontal lobes and includes the frontal and ethmoid bones, as well as the lesser wing of the sphenoid. The middle cranial fossa contains the temporal lobes and includes the greater wing of the sphenoid, sella turcica, and most of the temporal bones. The posterior cranial fossa contains the occipital lobes, cerebellum, and medulla and includes the occipital bone.
There are several foramina in the skull that allow for the passage of various structures. The most important foramina likely to appear in exams are listed below:
– Foramen spinosum: located in the middle fossa and allows for the passage of the middle meningeal artery.
– Foramen ovale: located in the middle fossa and allows for the passage of the mandibular division of the trigeminal nerve.
– Foramen lacerum: located in the middle fossa and allows for the passage of the small meningeal branches of the ascending pharyngeal artery and emissary veins from the cavernous sinus.
– Foramen magnum: located in the posterior fossa and allows for the passage of the spinal cord.
– Jugular foramen: located in the posterior fossa and allows for the passage of cranial nerves IX, X, and XI.Understanding the location and function of these foramina is essential for medical professionals, as they play a crucial role in the diagnosis and treatment of various neurological conditions.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 70
Correct
-
What is the truth about the discontinuation symptoms that are linked to antidepressants?
Your Answer: Suicidal thoughts are associated with discontinuation of paroxetine
Explanation:Discontinuation symptoms are common when stopping most antidepressants, typically appearing within 5 days of treatment cessation. However, these symptoms are more likely to occur with short half-life drugs like paroxetine, especially when doses are missed. It’s important to note that discontinuing paroxetine may lead to suicidal thoughts, so patients should be informed of the potential risks associated with poor compliance.
Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 71
Correct
-
What is a true statement about microglia?
Your Answer: It is mesodermal in origin
Explanation:Glial Cells: The Support System of the Central Nervous System
The central nervous system is composed of two basic cell types: neurons and glial cells. Glial cells, also known as support cells, play a crucial role in maintaining the health and function of neurons. There are several types of glial cells, including macroglia (astrocytes and oligodendrocytes), ependymal cells, and microglia.
Astrocytes are the most abundant type of glial cell and have numerous functions, such as providing structural support, repairing nervous tissue, nourishing neurons, contributing to the blood-brain barrier, and regulating neurotransmission and blood flow. There are two main types of astrocytes: protoplasmic and fibrous.
Oligodendrocytes are responsible for the formation of myelin sheaths, which insulate and protect axons, allowing for faster and more efficient transmission of nerve impulses.
Ependymal cells line the ventricular system and are involved in the circulation of cerebrospinal fluid (CSF) and fluid homeostasis in the brain. Specialized ependymal cells called choroid plexus cells produce CSF.
Microglia are the immune cells of the CNS and play a crucial role in protecting the brain from infection and injury. They also contribute to the maintenance of neuronal health and function.
In summary, glial cells are essential for the proper functioning of the central nervous system. They provide structural support, nourishment, insulation, and immune defense to neurons, ensuring the health and well-being of the brain and spinal cord.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 72
Incorrect
-
What is the main component of pick bodies?
Your Answer: Amyloid
Correct Answer: Tau
Explanation:Pyramidal cell neurons known as Betz cells are situated in the grey matter of the motor cortex.
Frontotemporal Lobar Degeneration (FTLD) is a pathological term that refers to a group of neurodegenerative disorders that affect the frontal and temporal lobes of the brain. FTLD is classified into several subtypes based on the main protein component of neuronal and glial abnormal inclusions and their distribution. The three main proteins associated with FTLD are Tau, TDP-43, and FUS. Each FTD clinical phenotype has been associated with different proportions of these proteins. Macroscopic changes in FTLD include atrophy of the frontal and temporal lobes, with focal gyral atrophy that resembles knives. Microscopic changes in FTLD-Tau include neuronal and glial tau aggregation, with further sub-classification based on the existence of different isoforms of tau protein. FTLD-TDP is characterized by cytoplasmic inclusions of TDP-43 in neurons, while FTLD-FUS is characterized by cytoplasmic inclusions of FUS.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 73
Correct
-
Which area of the brain is most likely to be damaged in order to result in prosopagnosia?
Your Answer: Fusiform gyrus
Explanation:Understanding Prosopagnosia: The Inability to Recognize Faces
Prosopagnosia, also known as face blindness, is a condition where individuals are unable to recognize faces. This complex process involves various areas of the brain, with the fusiform gyrus in the temporal lobe being the most significant. The inability to recognize faces can be caused by damage to this area of the brain of can be a result of a developmental disorder.
The condition can be challenging for individuals as it can affect their ability to recognize familiar faces, including family members and friends. It can also impact their social interactions and make it difficult to navigate social situations. While there is no cure for prosopagnosia, individuals can learn to use other cues such as voice, clothing, and context to recognize people.
Understanding prosopagnosia is crucial in providing support and accommodations for individuals who experience this condition. It is essential to raise awareness and promote research to develop effective interventions to help individuals with face blindness.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 74
Correct
-
If a man experiences a severe road traffic accident resulting in substantial damage to his frontal lobe, what symptoms would you anticipate him to exhibit?
Your Answer: Contralateral hemiplegia
Explanation:Cerebral Dysfunction: Lobe-Specific Features
When the brain experiences dysfunction, it can manifest in various ways depending on the affected lobe. In the frontal lobe, dysfunction can lead to contralateral hemiplegia, impaired problem solving, disinhibition, lack of initiative, Broca’s aphasia, and agraphia (dominant). The temporal lobe dysfunction can result in Wernicke’s aphasia (dominant), homonymous upper quadrantanopia, and auditory agnosia (non-dominant). On the other hand, the non-dominant parietal lobe dysfunction can lead to anosognosia, dressing apraxia, spatial neglect, and constructional apraxia. Meanwhile, the dominant parietal lobe dysfunction can result in Gerstmann’s syndrome. Lastly, occipital lobe dysfunction can lead to visual agnosia, visual illusions, and contralateral homonymous hemianopia.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 75
Correct
-
In 1908, Bleuler coined the term schizophrenia. What is the exact definition of the term schizophrenia?
Your Answer: Split mind
Explanation:In 1908, during the yearly gathering of the German Psychiatric Association in Berlin, Bleuler proposed the term schizophrenia as a more suitable replacement for Kraepelin dementia praecox. Bleuler’s reasoning was that the term schizophrenia better captured the idea of a division of fragmentation in mental functioning. Additionally, he believed that the term could be more effectively used as an adjective.
-
This question is part of the following fields:
- History Of Psychiatry
-
-
Question 76
Correct
-
Which of the options below indicates a strong urge of need to perform a certain behavior repeatedly?
Your Answer: Repeating certain phrases in your mind that you feel driven to perform
Explanation:The act of repeating phrases that one feels compelled to perform is considered a compulsion. Compulsions are actions, either physical or mental, that one feels driven to perform. Obsessions, on the other hand, are recurrent and intrusive thoughts, urges, of images. The urge to hoard, for example, is an obsession rather than a compulsion. Compulsions are not inherently pleasurable and are performed to reduce anxiety. It is important to note that in order to qualify as a compulsion under DSM-5, the behavior must be time-consuming (taking more than 1 hour per day) of cause significant distress of impairment in important areas of functioning. Therefore, the behavior that is most suggestive of a compulsion is one that meets these criteria.
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by the presence of either obsessions or compulsions, and often both. Obsessions are repetitive and persistent thoughts, images, of impulses that are intrusive and unwanted, while compulsions are repetitive behaviors of rituals that an individual feels driven to perform in response to an obsession of according to rigid rules. The symptoms can cause significant functional impairment and/of distress. To diagnose OCD, the essential features include the presence of persistent obsessions and/of compulsions that are time-consuming of result in significant distress of impairment in important areas of functioning. The symptoms cannot be attributed to another medical condition of the effects of a substance of medication on the central nervous system.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 77
Correct
-
Which statement accurately describes neurofibrillary tangles?
Your Answer: They are also seen in dementia pugilistica
Explanation:Amyloid protein is the primary component of amyloid plaques, although they are most commonly linked to Alzheimer’s disease.
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
-
-
Question 78
Correct
-
What is the accurate statement about night terrors in children?
Your Answer: Violent behaviour has been reported
Explanation:Night terrors typically occur during deep sleep in stage 4. Upon waking, there is no memory of the experience. These episodes can be considered a dissociative state and may involve automatic behaviors. In some cases, violent behavior may occur during night terrors, but the individual cannot be held accountable for their actions. Family history is not a common factor in the occurrence of night terrors.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 79
Correct
-
What is a distinguishing characteristic of normal pressure hydrocephalus?
Your Answer: Incontinence
Explanation:Headache, nausea, vomiting, papilledema, and ocular palsies are symptoms of increased intracranial pressure, which are not typically present in cases of normal pressure hydrocephalus.
Normal Pressure Hydrocephalus
Normal pressure hydrocephalus is a type of chronic communicating hydrocephalus, which occurs due to the impaired reabsorption of cerebrospinal fluid (CSF) by the arachnoid villi. Although the CSF pressure is typically high, it remains within the normal range, and therefore, it does not cause symptoms of high intracranial pressure (ICP) such as headache and nausea. Instead, patients with normal pressure hydrocephalus usually present with a classic triad of symptoms, including incontinence, gait ataxia, and dementia, which is often referred to as wet, wobbly, and wacky. Unfortunately, this condition is often misdiagnosed as Parkinson’s of Alzheimer’s disease.
The classic triad of normal pressure hydrocephalus, also known as Hakim’s triad, includes gait instability, urinary incontinence, and dementia. On the other hand, non-communicating hydrocephalus results from the obstruction of CSF flow in the third of fourth ventricle, which causes symptoms of raised intracranial pressure, such as headache, vomiting, hypertension, bradycardia, altered consciousness, and papilledema.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 80
Incorrect
-
Whenever a certain student receives a good grade from a teacher, they believe it is because they did well and met high standards. But when the same student receives a bad grade, they assume the teacher must be in a bad mood of doesn't like them. What is this reaction an example of?
Your Answer: Dunning-Kruger effect
Correct Answer: Self-serving bias
Explanation:A fundamental attribution error refers to the tendency to overemphasize dispositional factors and underestimate situational factors when explaining other people’s behavior. The correct term for making false assumptions about other people’s behavior is actually the fundamental attribution error.
Attribution Theory: Understanding How We Explain Events
Attribution theory provides a framework for understanding how individuals explain events in their environment. It examines how people use information to arrive at causal explanations for events and what factors influence their judgments. Fritz Heider first proposed a theory of attribution in 1958.
However, attribution is prone to biases such as the Fundamental Attribution Error (FAE), which overemphasizes dispositional factors over situational causes when making attributions about others’ behavior. The Actor-Observer Bias, on the other hand, undervalues dispositional explanations and overvalued situational explanations of our own behavior. Correspondence bias is the tendency to draw inferences about a person’s unique and enduring dispositions from behaviors that can be entirely explained by the situations in which they occur. Self-serving bias refers to people’s tendency to attribute their successes to internal factors but attribute their failures to external factors. Hostile Attribution Bias (HAB) is an interpretive bias where individuals interpret ambiguous behavior as hostile, leading to aggression. Finally, the False Consensus Effect is the tendency for people to project their way of thinking onto others, assuming that everyone else thinks the same way they do.
Overall, attribution theory helps us understand how people make sense of events in their environment, but it is important to be aware of the biases that can influence our judgments.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 81
Incorrect
-
Who was the first person to use the term 'learning disability'?
Your Answer: Watts
Correct Answer: Kirk
Explanation:Historical Terminology and Figures in Psychiatry
Paragraph 1: The term ‘learning disability’ was first used by Samuel Kirk in 1963 during a conference in Chicago. It is important for trainees to understand the history of terminology in psychiatry, including phrases like mental handicap, retardation, and intellectual disability, as they are associated with attitudes and concepts that have shaped care styles over the last century.
Paragraph 2: James Watts was a prominent practitioner and advocate of psychosurgery, a controversial treatment that involved surgical intervention in the brain to treat mental illness. His work has had a lasting impact on the field of psychiatry.
Paragraph 3: Wilhelm Griesinger, a German psychiatrist, is credited with describing ‘primary insanity’ (primäre verrücktheit), a term used to describe mental illness that arises without any apparent physical cause.
Paragraph 4: Johann Christian Reil, another German psychiatrist, is known for coining the term ‘psychiatry’ in the late 18th century. His work helped to establish psychiatry as a distinct field of medicine.
Paragraph 5: Charles Perry, an English physician, published ‘A mechanical account and explication of the hysterical passion’ in the 17th century. This work helped to shape early understandings of hysteria, a condition that was once believed to be caused by a ‘wandering womb’ in women.
-
This question is part of the following fields:
- History Of Psychiatry
-
-
Question 82
Correct
-
What is the essential enzyme involved in the process of transcription?
Your Answer: Polymerase
Explanation:Enzymes known as RNA polymerases are responsible for transcribing RNA from DNA. The role of RNA is crucial in the process of protein synthesis. Messenger RNA, a specific type of RNA, carries genetic information from DNA to ribosomes. Ribosomes are composed of ribosomal RNAs and proteins, and they function as a molecular apparatus that can interpret messenger RNAs and convert the information they contain into proteins.
Genomics: Understanding DNA, RNA, Transcription, and Translation
Deoxyribonucleic acid (DNA) is a molecule composed of two chains that coil around each other to form a double helix. DNA is organised into chromosomes, and each chromosome is made up of DNA coiled around proteins called histones. RNA, on the other hand, is made from a long chain of nucleotide units and is usually single-stranded. RNA is transcribed from DNA by enzymes called RNA polymerases and is central to protein synthesis.
Transcription is the synthesis of RNA from a DNA template, and it consists of three main steps: initiation, elongation, and termination. RNA polymerase binds at a sequence of DNA called the promoter, and the transcriptome is the collection of RNA molecules that results from transcription. Translation, on the other hand, refers to the synthesis of polypeptides (proteins) from mRNA. Translation takes place on ribosomes in the cell cytoplasm, where mRNA is read and translated into the string of amino acid chains that make up the synthesized protein.
The process of translation involves messenger RNA (mRNA), transfer RNA (tRNA), and ribosomal RNA (rRNA). Transfer RNAs, of tRNAs, connect mRNA codons to the amino acids they encode, while ribosomes are the structures where polypeptides (proteins) are built. Like transcription, translation also consists of three stages: initiation, elongation, and termination. In initiation, the ribosome assembles around the mRNA to be read and the first tRNA carrying the amino acid methionine. In elongation, the amino acid chain gets longer, and in termination, the finished polypeptide chain is released.
-
This question is part of the following fields:
- Genetics
-
-
Question 83
Correct
-
Which receptors does clozapine have a high affinity for?
Your Answer: D4
Explanation:Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 84
Incorrect
-
Which manual for diagnosing mental disorders popularized the use of operational criteria in psychiatric diagnosis?
Your Answer: ICD-8
Correct Answer: DSM III
Explanation:The implementation of operational criteria in diagnosis was a significant feature of DSM III, which was a response to the criticism of the previous versions of the DSM that relied heavily on psychodynamic concepts. This shift in approach is often praised for revitalizing the field of psychiatry.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 85
Incorrect
-
What is the most frequently observed endocrine abnormality in sick euthyroid syndrome?
Your Answer: Low TSH
Correct Answer: Low T3
Explanation:Sick Euthyroid Syndrome: Abnormal Thyroid Function in Non-Thyroidal Illness
Sick euthyroid syndrome, also known as low T3 syndrome, is a condition where thyroid function tests show abnormal results, typically low T3 levels, while T4 and TSH levels remain normal. This condition is commonly observed in patients with non-thyroidal illness. For instance, individuals with anorexia who have undergone prolonged starvation may develop this syndrome.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 86
Correct
-
A 65-year-old man who suffered a head injury is unable to retrieve previously learned information from his memory. What specific aspect of memory function is impaired?
Your Answer: Retrieval
Explanation:Long term memory can be categorized into five functions: Registration, Retention, Retrieval, Recall, and Recognition. Memory issues can arise in any of these areas. Retrieval refers to the ability to retrieve stored information from memory, and its loss indicates an organic cause. Registration involves the ability to add new information to the memory store, which can occur through repeated exposure of a single presentation. Retention refers to the ability to store information that can be retrieved later. Recall is the act of bringing stored information back into consciousness at a specific time. Recognition is the feeling of familiarity that accompanies the retrieval of stored information, and while it is related to memory, it is not strictly a part of the memory process.
-
This question is part of the following fields:
- Descriptive Psychopathology
-
-
Question 87
Correct
-
What is a true statement about confidence intervals?
Your Answer: The confidence level of confidence intervals does not describe any single sample
Explanation:Confidence intervals become wider as the level of variance increases. Typically, researchers report confidence intervals at the 95% level. The level of confidence is predetermined by the researcher and reflects a significance level of 0.05. The range within which the true value of a parameter is likely to fall given repeated sampling is described by the confidence intervals.
-
This question is part of the following fields:
- Description And Measurement
-
-
Question 88
Correct
-
What factor is most likely to worsen a patient's psoriasis?
Your Answer: Lithium
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
-
-
Question 89
Correct
-
What factor is most likely to cause an elderly patient with dementia to exhibit aggressive and hostile behavior?
Your Answer: Lorazepam
Explanation:Disinhibitory Drug Reactions: Understanding Paradoxical Reactions to Benzodiazepines
Benzodiazepines are commonly prescribed for anxiety and sleep disorders, but they are also associated with paradoxical reactions, also known as disinhibitory reactions. These reactions are unexpected increases in aggressive behavior, sexual disinhibition, hyperactivity, vivid dreams, and hostility. However, the prevalence of these reactions is difficult to determine, as study findings vary widely from 1% to 58%.
Certain factors increase the risk of paradoxical reactions, including a history of aggression of poor impulse control, extremes of age (elderly of young), benzodiazepines with short half-lives, high doses of benzodiazepines, and intravenous administration of benzodiazepines. It is important to record these reactions, and if they are severe, it is advisable to avoid future use of benzodiazepines.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 90
Correct
-
What is the term used to describe the process of replacing gaps in memory with inaccurate details?
Your Answer: Confabulation
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 91
Correct
-
What food item is rich in choline?
Your Answer: Egg yolk
Explanation:Choline, which is essential for the synthesis of the neurotransmitter acetylcholine, can be obtained in significant quantities from vegetables, seeds, egg yolk, and liver. However, it is only present in small amounts in most fruits, egg whites, and many beverages.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 92
Correct
-
Which of the following sleep disruptions is not commonly linked to depression?
Your Answer: Increased total sleep time
Explanation:Depression and Sleep Architecture
Major depression has been extensively studied using polysomnography, a technique that records brain waves, eye movements, and muscle activity during sleep. The results of these studies have consistently shown that individuals with depression experience significant disruptions in their sleep architecture.
Specifically, depression is associated with decreased sleep continuity, meaning that individuals may wake up frequently throughout the night. Additionally, depression is characterized by prolonged sleep onset latency, of the amount of time it takes to fall asleep, as well as increased wake time after sleep onset, which refers to the amount of time spent awake during the night.
Other sleep disturbances commonly observed in individuals with depression include decreased sleep efficiency, of the amount of time spent asleep relative to the amount of time spent in bed, and decreased total sleep time. Early morning awakenings are also common in depression, as are reductions in slow wave sleep, which is the deepest stage of sleep.
Interestingly, depression is also associated with changes in REM sleep, the stage of sleep during which dreaming occurs. Specifically, individuals with depression tend to have reduced REM sleep onset latency, meaning they enter REM sleep more quickly, as well as increased REM density, of the amount of eye movements during REM sleep. Additionally, individuals with depression may spend a prolonged amount of time in the first REM sleep period.
Overall, the disruptions in sleep architecture observed in depression may contribute to the development and maintenance of depressive symptoms. Understanding these sleep disturbances may therefore be an important target for the treatment of depression.
-
This question is part of the following fields:
- Classification And Assessment
-
-
Question 93
Correct
-
In which part of the body is the nucleus of Meynert situated?
Your Answer: Substantia innominata
Explanation:The nucleus of Meynert, located in the substantia innominata of the basal forebrain beneath the thalamus and lentiform nucleus, is a cluster of neurons that serves as the primary source of acetylcholine in the brain. In Alzheimer’s disease, the nucleus of Meynert undergoes atrophy, resulting in a decrease in acetylcholine levels. This explains why cholinesterase inhibitors, which increase acetylcholine levels, are effective in treating Alzheimer’s.
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
-
-
Question 94
Incorrect
-
A 9-year-old child with emerging evidence of a learning disability is referred by the paediatricians. They have an unusual facial appearance consisting of a broad, flat nasal bridge and a high forehead. The paediatrician describes this as a 'Greek warrior helmet' appearance. The eyes are widely spaced and may be protruding.
The child had recurrent seizures as a child, but this have begun to resolve.
Which of the following chromosomal abnormalities do you most suspect?Your Answer: Mutations in the FMR1 gene
Correct Answer: A deletion near the end of 4p
Explanation:Wolf-Hirschhorn syndrome, also referred to as 4p deletion syndrome, is caused by the loss of genetic material located towards the end of the short arm (p) of chromosome 4. This condition is often characterized by a distinct facial appearance resembling a Greek warrior helmet.
Chromosomal location is an important factor in understanding genetic conditions. As a candidate for the MRCPsych, it is essential to be able to link specific disorders to their corresponding chromosomes. For instance, Presenilin 2 is associated with Alzheimer’s disease and is located on chromosome 1. Similarly, DISC-1 and DISC-2 are linked to schizophrenia and are located on chromosome 1 and 6, respectively. RGS-4, which interacts with neuregulin, is also associated with schizophrenia and is located on chromosome 1.
Other disorders linked to specific chromosomes include Huntington’s disease (chromosome 4), Cri-du-Chat syndrome (chromosome 5), and Prader-Willi and Angelman syndromes (chromosome 15). Chromosome 17 is associated with familial frontotemporal dementia, Smith-Magenis syndrome, and neurofibromatosis 1. Chromosome 21 is linked to Down’s syndrome, while chromosome X/Y is associated with Fragile X, Lesch-Nyhan syndrome, Turners syndrome, and Klinefelter’s syndrome.
In summary, understanding the chromosomal location of genetic disorders is crucial for psychiatrists and other medical professionals. It helps in the diagnosis, treatment, and management of these conditions.
-
This question is part of the following fields:
- Genetics
-
-
Question 95
Correct
-
Which combination of organs is primarily responsible for the first pass effect?
Your Answer: Liver and bowel
Explanation:The First Pass Effect in Psychiatric Drugs
The first-pass effect is a process in drug metabolism that significantly reduces the concentration of a drug before it reaches the systemic circulation. This phenomenon is related to the liver and gut wall, which absorb and metabolize the drug before it can enter the bloodstream. Psychiatric drugs are not exempt from this effect, and some undergo a significant reduction in concentration before reaching their target site. Examples of psychiatric drugs that undergo a significant first-pass effect include imipramine, fluphenazine, morphine, diazepam, and buprenorphine. On the other hand, some drugs undergo little to no first-pass effect, such as lithium and pregabalin.
Orally administered drugs are the most affected by the first-pass effect. However, there are other routes of administration that can avoid of partly avoid this effect. These include sublingual, rectal (partly avoids first pass), intravenous, intramuscular, transdermal, and inhalation. Understanding the first-pass effect is crucial in drug development and administration, especially in psychiatric drugs, where the concentration of the drug can significantly affect its efficacy and safety.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 96
Correct
-
Who is the author of 'The Psychopathology of Everyday Life'?
Your Answer: Sigmund Freud
Explanation:History of major works in psychiatry
Michel Foucault – Madness and civilization
Sigmund Freud – The interpretation of dreams, Beyond the Pleasure Principle, The Psychopathology of everyday life
Thomas Szasz – The myth of mental illness
Erving Goffman – Asylums, The Presentation of Self in Everyday Life
Ronald Laing – The divided self
Emile Durkheim – Le suicide. Durkheim proposed social causes for suicide. Until his work was published, suicide had been thought of as an individual act only.
Tom Main – The Ailment
Jerome Frank – Persuasion and Healing
George Brown and Tirril Harris – Social origins of depression -
This question is part of the following fields:
- Social Psychology
-
-
Question 97
Incorrect
-
What is a true statement about cerebrovascular accidents?
Your Answer: The combined oral contraceptive pill is a protective factor for stroke
Correct Answer: Cerebral infarction commonly occurs during sleep
Explanation:During sleep, strokes are more likely to occur as blood pressure decreases and areas of the brain with poor blood flow (caused by arterial damage in arteriopaths) become oxygen-deprived. Women with pre-existing cardiovascular disease should avoid taking oral contraceptives as they can raise the risk of stroke and DVTs.
Cerebrovascular accidents (CVA), also known as strokes, are defined by the World Health Organization as a sudden onset of focal neurological symptoms lasting more than 24 hours and presumed to be of vascular origin. Strokes can be caused by either infarction of hemorrhage, with infarction being more common. Hemorrhagic strokes tend to be more severe. Intracranial hemorrhage can be primary, caused mainly by hypertension, of subarachnoid, caused by the rupture of an aneurysm of angioma. Primary intracranial hemorrhage is most common in individuals aged 60-80 and often occurs during exertion. Infarction can be caused by thrombosis of embolism, with thrombosis being more common. Atherosclerosis, often caused by hypertension, is the main cause of infarction. CT scanning is the preferred diagnostic tool during the first 48 hours after a stroke as it can distinguish between infarcts and hemorrhages. Recovery from embolism is generally quicker and more complete than from thrombosis due to the availability of collateral channels.
-
This question is part of the following fields:
- Neurosciences
-
-
Question 98
Correct
-
What is the probable identity of the drug used in the treatment arm of the clinical trial for schizophrenia that showed a statistically significant reduction in negative symptoms as measured by PANSS?
Your Answer: Minocycline
Explanation:The effectiveness of minocycline, a tetracycline antibiotic, in providing neuroprotection has been observed in vitro. This study aimed to evaluate the impact of minocycline on negative symptoms in individuals diagnosed with schizophrenia at the beginning of the trial and after one year of follow-up. Minocycline is recognized for its ability to be well-tolerated in acne treatment and its capacity to cross the blood-brain barrier. Preliminary findings have indicated that it may be effective in preventing the onset of negative symptoms in schizophrenia. There have been no clinical trials conducted on the other antibiotics.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 99
Correct
-
What was the conditioned stimulus in Pavlov's conditioning experiments?
Your Answer: The ringing of the bell
Explanation:Classical Conditioning: A Learning Theory by Ivan Pavlov
Classical conditioning is a learning theory developed by Ivan Pavlov. It suggests that events that occur together are associated and acquire a similar meaning. Unlike operant conditioning, which focuses on responses to behavior, classical conditioning looks at responses to stimuli. In classical conditioning, animals behave as if they have learned to associate a stimulus with a significant event. Pavlov demonstrated that innate responses, such as a dog salivating when it sees food, can be associated with a neutral stimulus, such as ringing a bell, so that ringing the bell can cause salivation even in the absence of food.
Important terms used in classical conditioning include stimulus generalization and discrimination, higher order conditioning, spontaneous recovery, and aversive conditioning. Extinction is the laboratory analogue of exposure therapy for anxiety disorders, while Counterconditioning involves pairing a feared conditioned stimulus with a positive outcome. Incubation occurs in fear responses, and reciprocal inhibition is a technique that aims to replace an undesired response with a desired one by counterconditioning. Some stimuli are more prone to conditioning than others, which is referred to as stimulus/biological preparedness.
-
This question is part of the following fields:
- Social Psychology
-
-
Question 100
Correct
-
Which cognitive function is primarily assessed by the intersecting pentagons task in the MMSE?
Your Answer: Constructional praxis
Explanation:Mini Mental State Exam (MMSE)
The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.
-
This question is part of the following fields:
- Classification And Assessment
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)