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Question 1
Correct
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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.
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This question is part of the following fields:
- Psychopharmacology
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Question 2
Correct
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Which type of injury of damage typically leads to utilization behaviour?
Your Answer: Frontal lobe
Explanation:Abnormal Motor Behaviours Associated with Utilization Behaviour
Utilization behaviour (UB) is a condition where patients exhibit exaggerated and inappropriate motor responses to environmental cues and objects. This behaviour is automatic and instrumentally correct, but not contextually appropriate. For instance, a patient may start brushing their teeth when presented with a toothbrush, even in a setting where it is not expected. UB is caused by frontal lobe lesions that result in a loss of inhibitory control.
Other motor abnormalities associated with UB include imitation behaviour, where patients tend to imitate the examiner’s behaviour, and the alien hand sign, where patients experience bizarre hand movements that they cannot control. Manual groping behaviour is also observed, where patients automatically manipulate objects placed in front of them. The grasp reflex, which is normal in infants, should not be present in children and adults. It is an automatic tendency to grip objects of stimuli, such as the examiner’s hand.
Environmental Dependency Syndrome is another condition associated with UB. It describes deficits in personal control of action and an overreliance on social and physical environmental stimuli to guide behaviour in a social context. For example, a patient may start commenting on pictures in an examiner’s office, believing it to be an art gallery.
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This question is part of the following fields:
- Neurosciences
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Question 3
Correct
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Which of the following may be considered a leading question?
Your Answer: Do you find your mood is worse in the morning?
Explanation:It may be more effective to ask open-ended questions at the beginning of an interview to gather as much information as possible. Closed questions can be used later in the interview to clarify specific points. However, it is important to avoid leading questions that may influence the patient’s response. For example, instead of asking if the patient feels worse in the morning, a more open question such as Can you describe your mood throughout the day? may be more appropriate.
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This question is part of the following fields:
- History And Mental State
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Question 4
Incorrect
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Mandatory sterilization of people with cognitive impairments during the Nazi regime is an instance of what kind of genetic alteration of a society?
Your Answer: Epigenetics
Correct Answer: Negative eugenics
Explanation:Understanding Eugenics, Dysgenics, and Epigenetics
‘Eugenics’ was first coined by Francis Galton in 1883 and is based on Mendelian inheritance. Negative eugenics involves reducing the reproduction of individuals with undesirable traits, which was widely practiced in Nazi Germany. On the other hand, positive eugenics promotes the increased reproduction of those with desirable traits.
Dysgenics, on the other hand, refers to the idea that the IQ of a population is decreasing as individuals with higher intelligence have fewer children. This concept is a cause for concern in the modern world.
Epigenetics is a term used to describe changes in gene activity that are not linked to changes in DNA. These changes are influenced by other factors and can have a significant impact on an individual’s health and well-being.
Understanding these concepts is crucial in the field of genetics and can help us make informed decisions about the future of our society.
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This question is part of the following fields:
- History Of Psychiatry
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Question 5
Incorrect
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In which phase does the process of genetic recombination occur?
Your Answer: Anaphase II
Correct Answer: Prophase I
Explanation:Cytokinesis: The Final Stage of Cell Division
Cytokinesis is the final stage of cell division, where the cell splits into two daughter cells, each with a nucleus. This process is essential for the growth and repair of tissues in multicellular organisms. In mitosis, cytokinesis occurs after telophase, while in meiosis, it occurs after telophase I and telophase II.
During cytokinesis, a contractile ring made of actin and myosin filaments forms around the cell’s equator, constricting it like a belt. This ring gradually tightens, pulling the cell membrane inward and creating a furrow that deepens until it reaches the center of the cell. Eventually, the furrow meets in the middle, dividing the cell into two daughter cells.
In animal cells, cytokinesis is achieved by the formation of a cleavage furrow, while in plant cells, a cell plate forms between the two daughter nuclei, which eventually develops into a new cell wall. The timing and mechanism of cytokinesis are tightly regulated by a complex network of proteins and signaling pathways, ensuring that each daughter cell receives the correct amount of cytoplasm and organelles.
Overall, cytokinesis is a crucial step in the cell cycle, ensuring that genetic material is equally distributed between daughter cells and allowing for the growth and development of multicellular organisms.
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This question is part of the following fields:
- Genetics
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Question 6
Correct
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Which of the following examination findings is not consistent with chronic alcohol abuse?
Your Answer: Pretibial myxoedema
Explanation:Thyroid disease is typically linked with pretibial myxoedema.
Hepatomegaly
Chronic alcohol abuse can lead to hepatomegaly, which is an enlargement of the liver. This can be detected on physical examination by palpating the liver below the right ribcage. Hepatomegaly can also be associated with other signs of liver disease, such as jaundice, spider naevi, and caput medusa. It is important for psychiatrists to be aware of these physical findings in patients with alcohol use disorder, as they may indicate the need for further medical evaluation and treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 7
Correct
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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.
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This question is part of the following fields:
- Epidemiology
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Question 8
Correct
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A client with schizoaffective disorder who takes olanzapine is concerned about the weight they have gained since beginning treatment. Is there evidence to suggest that switching to a different medication can help reduce weight?
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 9
Incorrect
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What is the accurate statement about the effect of naloxone?
Your Answer: It has no affinity for delta receptors
Correct Answer: It displaces both opioid agonists and partial antagonists
Explanation:Naloxone hydrochloride is a morphine derivative that acts as a specific opioid antagonist by competitively binding to opioid receptors. It has a strong affinity for these receptor sites and can displace both opioid agonists and partial antagonists. Despite being administered at high doses (up to 10 times the usual therapeutic dose), naloxone does not produce significant analgesia, respiratory depression, psychotomimetic effects, circulatory changes, of miosis. In the absence of opioids of other agonistic effects of opioid antagonists, naloxone has no pharmacologic activity. It is a competitive antagonist at the mu, kappa, and delta receptors, with a high affinity for the mu receptor but lacking any mu receptor efficacy.
Opioid Pharmacology and Treatment Medications
Opioids work by binding to opioid receptors in the brain, specifically the µ, k, and δ receptors. The µ receptor is the main target for opioids and mediates euphoria, respiratory depression, and dependence. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, leading to the reward and euphoria that drives repeated use. However, with repeated exposure, µ receptors become less responsive, leading to dysphoria and drug craving.
There are several medications used in opioid treatment. Methadone is a full agonist targeting µ receptors, with some action against k and δ receptors, and has a half-life of 15-22 hours. However, it carries a risk of respiratory depression, especially when used with hypnotics and alcohol. Buprenorphine is a partial agonist targeting µ receptors, as well as a partial k agonist of functional antagonist and a weak δ antagonist. It has a high affinity for µ receptors and a longer half-life of 24-42 hours, making it safer than methadone. Naloxone is an antagonist targeting all opioid receptors and is used to reverse opioid overdose, with a half-life of 30-120 minutes. However, it can cause noncardiogenic pulmonary edema in some cases. Naltrexone is a reversible competitive antagonist at µ and ĸ receptors, with a half-life of 4-6 hours, and is used as an adjunctive prophylactic treatment for detoxified formerly opioid-dependent people.
Alpha2 adrenergic agonists, such as clonidine and lofexidine, can ameliorate opioid withdrawal symptoms associated with the noradrenaline system, including sweating, shivering, and runny nose and eyes. The locus coeruleus, a nucleus in the pons with a high density of noradrenergic neurons possessing µ-opioid receptors, is involved in wakefulness, blood pressure, breathing, and overall alertness. Exposure to opioids results in heightened neuronal activity of the nucleus cells, and if opioids are not present to suppress this activity, increased amounts of norepinephrine are released, leading to withdrawal symptoms. Clonidine was originally developed as an antihypertensive, but its antihypertensive effects are problematic in detox, so lofexidine was developed as an alternative with less hypotensive effects.
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This question is part of the following fields:
- Psychopharmacology
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Question 10
Incorrect
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Which brain system enables the integration of emotional sensory information between the cortex and hypothalamus?
Your Answer: Nucleus accumbens
Correct Answer: Papez circuit
Explanation:In 1937, James Papez proposed a neural circuit that explained how emotional experiences occur in the brain. According to Papez, sensory messages related to emotional stimuli are first received by the thalamus, which then directs them to both the cortex (stream of thinking) and hypothalamus (stream of feeling). The cingulate cortex integrates this information from the hypothalamus and sensory cortex, leading to emotional experiences. The output via the hippocampus and hypothalamus allows cortical control of emotional responses. This circuit has since been reconceptualized as the limbic system.
The medial longitudinal fasciculus carries fibres from cranial nerves III, IV and IV. The nucleus accumbens plays a major role in the reward circuit, while the somatosensory cortex is involved in processing pain. The basal ganglia are involved in voluntary motor control.
Overall, the Papez circuit theory provides a framework for understanding the functional neuroanatomy of emotion. It highlights the importance of the limbic system in emotional experiences and the role of various brain regions in processing different aspects of emotional stimuli.
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This question is part of the following fields:
- Neurosciences
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Question 11
Incorrect
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What is the term used to describe a medication that has its own distinct effects but does not provide any benefits for the intended condition?
Your Answer: A restricted placebo
Correct Answer: An active placebo
Explanation:Understanding the Placebo Effect
In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.
Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.
The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.
It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.
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This question is part of the following fields:
- Classification And Assessment
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Question 12
Incorrect
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Which component is not considered a key element in Link and Phelan's stigma model?
Your Answer: Stereotyping
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.
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This question is part of the following fields:
- Social Psychology
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Question 13
Incorrect
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What signs of symptoms are indicative of Fragile X syndrome?
Your Answer: Hypogonadism
Correct Answer: Elongated face
Explanation:Fragile X Syndrome: A Genetic Disorder Causing Learning Disability and Psychiatric Symptoms
Fragile X Syndrome is a genetic disorder that causes mental retardation, an elongated face, large protruding ears, and large testicles in men. Individuals with this syndrome tend to be shy, avoid eye contact, and have difficulties reading facial expressions. They also display stereotypic movements such as hand flapping. Fragile X Syndrome is the most common inherited cause of learning disability.
The speech of affected individuals is often abnormal, with abnormalities of fluency. This disorder is caused by the amplification of a CGG repeat in the 5 untranslated region of the fragile X mental retardation 1 gene (FMR1). These CGG repeats disrupt synthesis of the fragile X protein (FMRP), which is essential for brain function and growth. The gene is located at Xq27. The greater number of repeats, the more severe the condition, as with other trinucleotide repeat disorders.
The fragile X phenotype typically involves a variety of psychiatric symptoms, including features of autism, attention deficit/hyperactivity disorder, anxiety, and aggression. Both males and females can be affected, but males are more severely affected because they have only one X chromosome. The prevalence estimate of Fragile X Syndrome is 1/3600-4000.
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This question is part of the following fields:
- Genetics
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Question 14
Correct
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In comparison to which method of administration, is bioavailability defined as the proportion of a drug that enters the systemic circulation after being administered through a specific route?
Your Answer: Intravenous
Explanation:Understanding Bioavailability in Drug Trials
Bioavailability is a crucial factor in drug trials, as it determines the percentage of a drug that reaches the systemic circulation after administration. This can be affected by factors such as absorption and metabolic clearance. For example, if a drug called X is administered orally and only 60% reaches the systemic circulation, its bioavailability is 0.6 of 60%. However, if the same drug is administered intravenously, plasma levels may reach 100%.
One way to potentially increase bioavailability is through the rectal route, which bypasses around two thirds of the first-pass metabolism. This is because the rectum’s venous drainage is two thirds systemic (middle and inferior rectal vein) and one third portal (superior rectal vein). As a result, drugs administered rectally may reach the circulatory system with less alteration and in greater concentrations. Understanding bioavailability and exploring different administration routes can help optimize drug efficacy in clinical trials.
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This question is part of the following fields:
- Psychopharmacology
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Question 15
Correct
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A couple in their 30s, where one partner has an autosomal recessive condition and the other is a carrier for the same condition, are planning to have a child. What is the likelihood of their child inheriting the condition?
Your Answer: 50%
Explanation:Mendelian Inheritance (Pedigrees)
Mendelian inheritance refers to the transmission patterns of genetic conditions caused by a mutation in a single gene. There are four types of Mendelian inheritance patterns: autosomal dominant, autosomal recessive, X-linked recessive, and X-linked dominant. Each pattern follows a predictable inheritance pattern within families.
Autosomal dominant conditions are expressed in individuals who have just one copy of the mutant allele. Affected males and females have an equal probability of passing on the trait to offspring. In contrast, autosomal recessive conditions are clinically manifest only when an individual has two copies of the mutant allele. X-linked recessive traits are fully evident in males because they only have one copy of the X chromosome, while women are rarely affected by X-linked recessive diseases. X-linked dominant disorders are clinically manifest when only one copy of the mutant allele is present.
Common examples of conditions with specific inheritance patterns include neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, Noonan’s syndrome for autosomal dominant; phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, cystic fibrosis for autosomal recessive; vitamin D resistant rickets, Rett syndrome for X-linked dominant; and cerebellar ataxia, Hunter’s syndrome, Lesch-Nyhan for X-linked recessive.
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This question is part of the following fields:
- Genetics
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Question 16
Incorrect
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Which of the following indicates evidence of linkage based on the LOD score?
Your Answer: Zero
Correct Answer: > 3
Explanation:Linkage and LOD Scores in Genetics
In genetics, when genes are located close to each other on a chromosome, they tend to be inherited together and are referred to as linked genes. Conversely, genes that are far apart of located on different chromosomes are inherited independently and are said to follow independent assortment. To determine the relative distance between two genes, scientists can analyze the offspring of an organism that displays two strongly linked traits and calculate the percentage of offspring where the traits do not co-segregate.
To determine if there is evidence for linkage between two genes, scientists use a statistical method called the LOD score (logarithm of the odds). A LOD score of >3 is considered significant evidence for linkage, while a LOD score of <-2 excludes linkage. The LOD score is calculated by comparing the likelihood of the observed data under the assumption of linkage to the likelihood of the data under the assumption of independent assortment. The LOD score provides a measure of the strength of evidence for linkage between two genes and is widely used in genetic research.
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This question is part of the following fields:
- Genetics
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Question 17
Correct
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Which of the following is not an example of glial cells?
Your Answer: Purkinje cells
Explanation:The initial exam question erroneously included neurons as a potential answer instead of Purkinje cells. However, this was deemed too simplistic and was subsequently revised. It is important to note that glial cells serve as support cells for neurons, whereas Purkinje cells are a specific type of neuron and therefore cannot be classified as glial cells.
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.
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This question is part of the following fields:
- Neurosciences
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Question 18
Incorrect
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Which TCA is commonly linked to discontinuation symptoms?
Your Answer:
Correct Answer: Imipramine
Explanation: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).
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This question is part of the following fields:
- Psychopharmacology
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Question 19
Incorrect
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What gene is thought to be abnormal in individuals diagnosed with tuberous sclerosis?
Your Answer:
Correct Answer: TSC1
Explanation:Rett syndrome is caused by mutations in the MeCP2 gene.
Tuberous Sclerosis: A Neurocutaneous Syndrome with Psychiatric Comorbidity
Tuberous sclerosis is a genetic disorder that affects multiple organs, including the brain, and is associated with significant psychiatric comorbidity. This neurocutaneous syndrome is inherited in an autosomal dominant pattern with a high penetrance rate of 95%, but its expression can vary widely. The hallmark of this disorder is the growth of multiple non-cancerous tumors in vital organs, including the brain. These tumors result from mutations in one of two tumor suppressor genes, TSC1 and TSC2. The psychiatric comorbidities associated with tuberous sclerosis include autism, ADHD, depression, anxiety, and even psychosis.
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This question is part of the following fields:
- Genetics
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Question 20
Incorrect
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What is the accomplishment of the concrete operational stage in human development, as per Piaget's theory?
Your Answer:
Correct Answer: Syllogistic reasoning
Explanation:Piaget’s Stages of Development and Key Concepts
Piaget developed four stages of development that describe how children think and acquire knowledge. The first stage is the Sensorimotor stage, which occurs from birth to 18-24 months. In this stage, infants learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment.
The second stage is the Preoperational stage, which occurs from 2 to 7 years. During this stage, children use symbols and language more extensively, but they are unable to think logically of deductively. They also use a type of magical thinking and animistic thinking.
The third stage is the Concrete Operational stage, which occurs from 7 to 11 years. In this stage, egocentric thought is replaced by operational thought, which involves dealing with a wide array of information outside the child. Children in this stage begin to use limited logical thought and can serialise, order, and group things into classes on the basis of common characteristics.
The fourth and final stage is the Formal Operations stage, which occurs from 11 through the end of adolescence. This stage is characterized by the ability to think abstractly, to reason deductively, to define concepts, and also by the emergence of skills for dealing with permutations and combinations.
Piaget also developed key concepts, including schema, assimilation, and accommodation. A schema is a category of knowledge and the process of obtaining that knowledge. Assimilation is the process of taking new information into an existing schema, while accommodation involves altering a schema in view of additional information.
Overall, Piaget’s stages of development and key concepts provide a framework for understanding how children learn and acquire knowledge.
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This question is part of the following fields:
- Psychological Development
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