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What is the most commonly used neuroleptic agent in the intensive care unit?

['A. Risperidone', 'B. Haloperidol', 'C. Olanzapine', 'D. Chlorpromazine']

Answer: E. Symptoms of hypopituitarism generally fully resolve with treatment. There is an increased rate of lethargy and depression in hypopituitarism. Libido is reduced in acromegaly, and psychosis is not common.

To prove malpractice, the plaintiff must prove all of the following except A. There was a duty of care.

['B. There was a deviation from the standard of care.', 'C. The patient died.', 'D. The deviation caused the damage.']

Answer: B. Vitamin B12 deficiency can cause macrocytosis, polyneuropathy, dementia, and memory impairment. Its association with depression is not established.

What is the duty to protect a potential victim of a patient called?

['A. Tarasoff I', 'B. Tarasoff II', 'C. M’Naughten Rule', 'D. Model Penal Code', 'E. Durham Rule']

Answer: B. Wilson’s disease is a rare autosomal recessive disorder that occurs between the first and third decades of life. It is characterized by the excess deposition of copper in the liver and brain. It tends to present as liver disease in adolescence and neuropsychiatric disease in young adults. The neurologic manifestations are related to basal ganglia dysfunction and include resting, postural, or kinetic tremor; rigidity; and dystonia of the bulbar musculature with dysarthria and dysphagia. Psychiatric features include behavioral and personality changes and emotional lability. The pathognomonic sign is the brownish Kayser-Fleischer ring in the cornea.

All of the following are criteria used to determine competency except A. Understanding the information

['B. Communication of choice', 'C. Appreciation of risks and benefits', 'D. Rational decision making', 'E. Agreement with the doctor']

Answer: C. The essential features required for a diagnosis of premenstrual dysphoric disorder (PMDD) are symptoms of marked and persistent anger or irritability, depressed mood, anxiety, and affective lability that have occurred regularly during the last week of luteal phase in most menstrual cycles during the last year. Premenstrual dysphoric disorder diagnosis requires that symptoms be present for a minimum of 2 consecutive months. PMDD must also be differentiated from premenstrual exacerbation or magnification of other conditions.

Which of the following is the term that denotes decision making by a substitute acting on behalf of an individual unable to act on his or her own behalf?

['A. Power of attorney', 'B. Parenting', 'C. Guardianship', 'D. Befriending', 'E. Substituted judgment']

Answer: D. A number of studies have consistently demonstrated an important role for serotonin in the pathophysiology of PMDD. Patients have lower whole-blood serotonin levels and lower platelet serotonin uptake during the premenstrual phase. Estimates of prevalence vary with severe symptoms reported in 4–7% of women. The presence of PMDD does not indicate abnormal ovarian function, and women with PMDD show no consistent differences in basal levels of ovarian hormones. Younger age has been associated with more severe symptoms. It is also associated with low levels of education. Past sexual abuse is reported by a significant proportion of women seeking treatment for PMDD.

What is the intent to commit a crime or a guilty mind called?

['A. Actus reus', 'B. Mens rea', 'C. Haggis', 'D. Habeus corpus', 'E. Respondeat superior']

Answer: B. Acute intermittent porphyria is the most common form of porphyria. It is an autosomal dominant condition. Clinical illness usually develops in women. Many drugs may precipitate attacks including alcohol, barbiturates, carbamazepine, tricyclic antidepressants, phenytoin, and valproic acid. Patients present with abdominal pain, autonomic and peripheral neuropathy, seizures, psychosis, and abnormalities of the basal ganglia. Benzodiazepines are generally considered to be safe for use in porphyria.

Which of the following renders a person incompetent to stand trial?

['A. Presence of mental illness', 'B. Diagnosis of schizophrenia', 'C. Mental retardation', 'D. Acceptance of guilt', 'E. Inability to understand the charges 7. All of the following are elements of the insanity defense except A. Presence of a mental disorder', 'B. Denial of guilt', 'C. Presence of defect of reason', 'D. Inability to refrain from the act', 'E. Not knowing that it was wrong']

Answer: B. Lesch-Nyhan syndrome is an X-linked recessive condition that affects boys exclusively. Infants with Lesch-Nyhan syndrome develop attacks of hypertonia within a few weeks of birth. They also develop spasticity with ataxia and choreoathetosis. Most children have severe mental retardation and become wheelchair bound. They also show verbal and physical aggression and self-injurious behavior. The condition is not treated by dietary control. Treatment by dietary modification is a part of the treatment for homocystinuria, phenylketonuria, and galactosemia.

All of the following substances are associated with violence in nonpsychotic patients except

['A. Alcohol', 'B. Amphetamines', 'C. Caffeine', 'D. Marijuana', 'E. Nicotine']

Answer: A. Prion diseases are called subacute spongiform encephalopathies. They are associated with the accumulation in the brain of abnormal partially protease-resistant glycoproteins known as prion proteins. The human prion diseases can be divided into inherited, sporadic, and acquired forms. CJD is a rapidly progressive multifocal dementia with myoclonus. Onset occurs between 45 and 75 years of age. The clinical progression is typically over weeks, progressing to akinetic mutism and death within 2 to 3 months. Patients with progressive dementia and two or more of the following signs in the setting of an EEG finding of pseudoperiodic sharp wave activity nearly always have CJD: myoclonus; cortical brightness; pyramidal, cerebellar, or extrapyramidal signs; or akinetic mutism. The familial form of prion disease, called Gerstmann-Sträussler-Scheinker syndrome, has an onset in the third and fourth decades of life and is characterized by cerebellar ataxia with pyramidal features and dementia. It is an autosomal dominant disorder.

All of the following are important in the risk assessment of violent offenders with schizophrenia except

['A. Treatment compliance', 'B. Index offense', 'C. Number of first-rank symptoms', 'D. A past history of offense', 'E. Insight']

Answer: B. The most common psychiatric diagnoses in patients on renal dialysis are adjustment disorders (30%), mood disorders (24%), and organic mental disorders. Symptoms useful in identifying major depressive disorders are low mood, reduced interest, feelings of worthlessness, excess guilt, anorexia, weight loss, and slow thoughts. Symptoms not useful in making a diagnosis are lack of energy, insomnia, and reduced libido, because these occur in end-stage renal disease. Behavioral problems such as self-neglect, social withdrawal, and noncompliance with treatment are common and can affect physical outcome.

All of the following are management strategies for stalkers that are associated with a favorable outcome except

['A. Management of comorbid substance use B. Treatment of underlying mental disorder C. Understanding the motivation of the stalker D. Mediation sessions between stalker and victim E. Increased empathy for the victim 11. All of the following are true about violence associated with schizophrenia except', 'A. It increases with comorbid substance use.', 'B. It occurs in about 20% of patients before their first admission.', 'C. It is always psychotically motivated.', 'D. It can result in homicide followed by suicide.']

Answer: D. Cognitive therapy can be used in the treatment of psychological problems related to physical illness. Patients’ attitude about their illness is of considerable importance to the outcome. The less control patients perceive themselves as having in a situation, the more depressed they are likely to be. Therapy involves the patient and therapist understanding the patient’s perception of problems. As well as assessing cognition, it is important to target physical symptoms and problems that can be assessed and baselines accorded to measure future change. Therapy should improve patients’ sense of control over their physical state and educate them in techniques they can use to deal with problems in the future.

Which of the following is a short-term predictor of violence?

['A. Dementia', 'B. Obsessive-compulsive personality traits C. Female gender', 'D. Compliance with the treatment', 'E. Alcohol intoxication']

Answer: B. Denial is a defense mechanism often used by patients with end-stage illness. Some patients may use this more than others. Patients with low denial scores have been found to have greater interpersonal sensitivity and greater mood and sleep dysfunction than those with high denial scores. Automatic thoughts in patients with low denial tend to focus on their losses, leading to affective disturbance. Therefore, denial may be adaptive in complementing a patient’s ability to break the cycle of automatic thoughts that may lead to affective problems, allowing gradual adjustment to occur.

For an adult who lacks the capacity to make healthcare decisions, which of the following is true?

['A. The doctor cannot do anything.', 'B. The patient’s parents can give consent.', 'C. The patient’s children can give consent.', 'D. The doctor can lawfully proceed with treatment if it is in the best interest of the patient.', 'E. An advance directive is useless in such a situation.']

Answer: D. Depression is more difficult to diagnose in patients with physical illness. Depressed mood, hopelessness, and morning depression have been shown to be effective as differentiating symptoms to distinguish depression from the effects of physical illness. Sleep disturbance, anorexia, lethargy, and psychomotor retardation may be due to physical illness.

Which of the following is true regarding most criminal offenders with mental disorders?

['A. They commit offenses directly related to their symptoms.', 'B. They should receive treatment rather than punishment.', 'C. They have committed serious offenses.', 'D. They suffer from a personality disorder.', 'E. They require examination by a specialist forensic psychiatrist.']

Answer: D. SSRIs can reduce serum glucose by up to 30% and cause appetite suppression resulting in weight loss. Fluoxetine should be avoided owing to its increased potential for hypoglycemia. Tricyclic antidepressants can increase serum glucose levels, increase appetite, and decrease the metabolic rate. These are generally safe unless the diabetes mellitus is poorly controlled or is associated with significant cardiac or renal disease. Amitriptyline and imipramine can be used to treat painful diabetic neuropathy. Sodium valproate may give false-positive results on urine tests for glucose in patients with diabetes mellitus. Lithium can be used safely in patients without renal disease.

All of the following are associated with criminal behavior except A. Personality disorder

['B. Social anxiety disorder', 'C. Alcohol and drug dependence', 'D. Mental retardation', 'E. Schizophrenia']

Answer: B. Antidepressants are predominantly metabolized in the liver and so have increased half-lives with reduced clearance. As the dose of drug toxicity increases with disease severity, lower starting and total doses of medications are recommended. Paroxetine prescribed at the lower end of the dose range is probably the safest option. The sedative and constipating side effect of tricyclic antidepressants may unmask or precipitate hepatic encephalopathy. MAOIs are hepatotoxic and may precipitate coma. As lithium undergoes minimal hepatic metabolism, it is the mood stabilizer of choice in liver disease.

What is the most common offense committed by women?

['A. Homicide', 'B. Infanticide', 'C. Assault', 'D. Shoplifting', 'E. Hit and run']

Answer: D. Delirium is a constellation of physical, biological, and psychological disturbances. Impaired attention is considered the core cognitive disturbance. In addition, most patients experience disturbances of memory, orientation, language, mood, thinking, perception, motor behavior, and the sleep–wake cycle. Although individual delirium symptoms are nonspecific, their pattern is highly characteristic with acute onset, fluctuant course, and transient nature. Delirium is commonly seen in general hospital settings with a point prevalence of 10–30%. It is more frequent among older patients and those with preexisting cognitive impairment and medical or surgical problems.

Which of the following is true?

['A. Most criminals are of markedly low intelligence.', 'B. The majority of delinquent youth are mentally retarded.', 'C. Sexual offenses are overly represented in people with mental retardation.', 'D. People with mental retardation who commit crimes are less likely to be caught.', 'E. People with mental retardation rarely indulge in arson.']

Answer: D. Wernicke’s encephalopathy is characterized by confusion, ataxia, nystagmus, and ophthalmoplegia. Ophthalmoplegia responds rapidly to treatment with high-dose vitamins. These features are also associated with a peripheral neuropathy. Dysphasia is not a feature of Wernicke’s encephalopathy.

Which psychiatric disorder is most commonly associated with homicide followed by suicide?

['A. Schizophrenia', 'B. Personality disorder', 'C. Heroin dependence', 'D. Depression', 'E. Pathological jealousy']

Answer: A. Korsakoff syndrome is caused by thiamine deficiency, the most common cause of which is alcohol abuse. Continuous vomiting can also cause it. Confabulation is a feature and may be present. Patient is usually not disoriented and retains a clear consciousness. There is usually an anterograde memory loss.

Which of the following is not true regarding fitness to plead?

['A. The defendant should understand the nature of the charge.', 'B. Defendants should understand that what they did was wrong.', 'C. The defendants should be able to instruct counsel.', 'D. The defendant understands the difference between pleading guilty and pleading not guilty.', 'E. The defendant can follow the evidence presented in court.']

Answer: B. HIV can manifest as dementia. However Alzheimer’s is a distinct type of dementia and is not due to HIV.

What is the most useful predictor of future violence?

['A. Lack of regret', 'B. Morbid jealousy', 'C. Past history of suicide attempts', 'D. History of past violence', 'E. History of alcohol dependence']

Answer: C. Insight is characteristically preserved in AIDS encephalitis until late in the course of the disease. The EEG is normal from an early stage. Frank dysphoria is uncommon. Cognitive deficits may be apparent fairly early on in the illness. Treatment has a favorable impact on the outcome of the disease.

Which of the following is false regarding the mental competency of persons making their wills?

['A. Persons making their wills should know the extent of their property.', 'B. They should understand that they are making a will.', 'C. They should be able to identify their natural beneficiaries.', 'D. They should bequeath their property to their natural beneficiaries.']

Answer: C. Most terminally ill people do not develop depressive disorder and suicidal thoughts. Anger is an important factor in suicide. Suicides are usually committed by medically ill patients who have morbid, often unrecognized, psychiatric illnesses.

Which of the following is the term denoting a person’s performing actions for another’s benefit without that person’s consent?

['A. Paternalism', 'B. Autonomy', 'C. Beneficence', 'D. Justice', 'E. Utilitarianism']

Answer: D. History of suicide attempts is an important predictor of future suicide. One of every hundred persons who survive a suicide attempt will die by suicide within one year of their index attempt, a risk that is 100 times that for the general population. Of those who complete suicide, 25% to 50% have tried it before.

Which of the following is the most common role of a psychiatrist in court?

['A. Witness of fact', 'B. Expert witness', 'C. Cross-examiner', 'D. Attorney', 'E. Court-mandated evaluator']

Answer: D. Once the doctor–patient relationship is created, the clinician assumes a duty to safeguard the patient’s disclosures. This duty is not absolute and in some circumstances, breaking confidentiality is both ethical and legal.

Which of the following is known as the “right–wrong test”?

['A. M’Naughten Rule', 'B. Model Penal Code', 'C. Durham Rule', 'D. Irresistible impulse', 'E. Guilty but insane']

Answer: E. The presence of mental illness or cognitive impairment does not necessarily render the person incompetent. Competency is a legal decision, whereas capacity is a clinical determination. Competency is not a sci-entifically determinable state and it is situation specific. The person must be examined to determine whether specific functional incapacities render the person incapable of making a particular kind of decision or performing a particular type of task.

Which of the following denotes the advance selection of a substitute decision maker to act on one’s behalf in the event that one should become incompetent?

['A. Power of attorney', 'B. Guardianship', 'C. Durable power of attorney', 'D. Advance directive']

Answer: A. Advanced directives provide a method for individuals, while competent, to choose alternative healthcare decision makers in the event of their future incompetency. An ordinary power of attorney becomes null and void if the person becomes incompetent. A durable power of attorney is constrained to empower an agent to make healthcare decisions. The healthcare proxy is a legal instrument akin to the durable power of attorney but specifically created for the delegation of healthcare decisions.

Which of the following is one of the diagnostic criteria for substance dependence?

['A. Absence from work', 'B. Use of the substance in hazardous situations C. Substance-related legal problems', 'D. Withdrawal symptoms', 'E. Neglect of children because of substance use 2. Which of the following is true?', 'A. Withdrawal symptoms are needed for a diagnosis of dependence.', 'B. Withdrawal is seen only when the substance used is stopped.', 'C. The signs and symptoms of withdrawal are the same for all drugs.', 'D. The severity of withdrawal is not related to the amount of substance used.', 'E. The severity of withdrawal is related to the duration and pattern of use.']

Answer: A. Restraints and seclusion are appropriate only when a patient presents a risk of harm to self or others and less restrictive alternatives are not available. Restraints are contraindicated in patients with extremely unstable medical or psychiatric conditions, in patients with severe drug reactions, in those with delirium or dementia who are unable to tolerate reduced stimulation, for punishment of the patient, or for the convenience of the healthcare staff.

Which of the following is associated with use of illicit drugs?

['A. High socioeconomic status', 'B. Low availability of drugs', 'C. High crime rate', 'D. Low unemployment', 'E. Good schools']

Answer: C. Depression secondary to medical illness has some distinct clinical features. It is more likely to begin at a later age, respond to ECT, and present with impaired cognition. It is less likely to be associated with a family history of alcoholism or dependence and is less likely to result in suicide.

Which of the following is a risk factor for alcoholism?

['A. Female sex', 'B. Identical twin with alcoholism', 'C. Adoptive father with alcoholism', 'D. Family history of schizophrenia', 'E. Family history of ADHD']

Answer: C. The incidence of psychiatric illness is high in patients with cancer, and about half of them develop a diagnosable psychiatric disorder. The prevalence of adjustment disorder is highest, at more than 25%. The next most common is depression, which occurs in approximately 8–14% of patients. Suicide is rare among patients with cancer. Men with head and neck cancer may be at the highest risk of suicide.

In women, which of the following is the most common comorbid condition seen with drug abuse and dependence?

['A. Antisocial personality disorder', 'B. Phobic disorder', 'C. Alcohol abuse or dependence', 'D. Major depression', 'E. Dysthymia']

Answer: D. Mania is rarely related to cancer itself. Corticosteroids are the most frequent cause of mania in patients with cancer. Diencephalic tumors and cerebral metastasis can rarely cause mania.

What is the most common comorbid psychiatric disorder in prisoners with addictive disorders?

['A. Antisocial personality disorder', 'B. Schizophrenia', 'C. Depression', 'D. Bipolar disorder', 'E. Phobic disorder']

Answer: C. The association between lesion location and depression following a stroke is controversial. Some studies support the contention that the risk of depression is higher the closer the lesion is to the left frontal pole, with left anterior frontal lesions being the most highly associated with depression. There is also evidence that left frontal cortical and left basal ganglia strokes produce depression to a greater degree than do lesions in the right side of the brain.

Alcoholism is associated with all of the following personality types except A. Low self-directedness

['B. High novelty seeking', 'C. High harm avoidance', 'D. Low reward dependence', 'E. Low cooperativeness']

Answer: B. The dementia associated with HIV is typically a subcortical dementia with difficulties with attention and concentration and speed of processing.

Severe alcohol withdrawal is associated with all the following medical complications except

['A. Magnesium deficiency', 'B. Wernicke’s encephalopathy', 'C. Hypertension', 'D. Hyperglycemia', 'E. Seizures']

Answer: E. Delirium is the neuropsychiatric complication that occurs frequently in hospitalized patients with AIDS. Patients with advanced systemic disease and HIV dementia are at high risk for delirium. In the management of delirium, the primary goal is identification and treatment of underlying factors. Specific medications associated with delirium include narcotics, benzodiazepines, anticholinergics, antihistamines, and steroids. Symptomatic treatment with neuroleptics may be necessary to control agitation and help resolve confusion.

Which of the following is a good first-line drug for alcohol detoxification?

['A. Chlorpromazine', 'B. Chlordiazepoxide', 'C. Carbamazepine', 'D. Clonidine', 'E. Barbiturates']

Answer: D. AIDS dementia complex (ADC) is characterized by cognitive, affective, behavioral, and motor dysfunction. Patients describe short-term memory loss, word-finding difficulties, and difficulty with sequential tasks. They also report depressed mood, social withdrawal, and reduced energy. Patients also describe slowing of their movements, clumsiness, and gait disturbances. Aphasia and agnosia are rare, as is psychosis except in end-stage AIDS dementia complex.

When depression and anxiety are prominent before detoxification, which of the following is true?

['A. Treatment with an antidepressant should be started.', 'B. Their presence indicates the need for inpatient detoxification.', 'C. Their presence predicts dropout from detoxification.', 'D. Symptoms usually disappear in about 3 to 4 weeks.', 'E. A DSM-IV Axis I diagnosis should be made immediately.']

Answer: D. Substance-related disorders occur frequently in patients with HIV disease. The prevalence of substance-related disorders in ambulatory patients with HIV who are referred for psychiatric evaluations may be about 45%. Noninjection psychoactive drugs impair the use of judgment and may lead to recidivism due to behavioral changes toward low HIV risk behaviors. Some studies have shown such an effect with alcohol use. Crack cocaine and inhalant abuse are commonly associated with high HIV risk behaviors.

Which of the following does not predict a risk of suicide in patients with alcoholism?

['A. Comorbid depression', 'B. Severity of alcoholism', 'C. Parental alcoholism', 'D. Early age of onset of drinking', 'E. Previous self-harm']

Answer: C. About 25% of people with chronic pain also have an axis I disorder. Despite the psychiatric morbidity associated with chronic pain, emotional symptoms are more often a consequence of pain than an antecedent to pain.

Which of the following is not useful in the assessment of a patient with alcoholism?

['A. CAGE', 'B. AUDIT', 'C. CAMCOG', 'D. MCV', 'E. CDT']

Answer: A. Patients with concurrent psychiatric illness and epilepsy may be safely treated with ECT. Patients should continue to receive their anticonvulsant medication during ECT; higher stimulus settings are typically necessary. ECT is effective for the mood and motor symptoms in patients with Parkinson’s disease. Cardiac complications are the most common cause of death in patients who receive ECT. The use of unilateral electrodes is associated with reduced cognitive deficits. ECT may be used as a first-line treatment in patients with catatonia and should be considered the treatment of choice once the diagnosis of catatonia is made and the patient does not respond to lorazepam.

Which of the following is a stage in the theory of change?

['A. Revision', 'B. Contemplation', 'C. Realism', 'D. Denial', 'E. Shock']

Answer: B. Haloperidol is the most commonly used neuroleptic in the intensive care unit. It is also safe and effective when administered intravenously. Pharmacologic treatment can usually be safely discontinued once the patient is symptom-free for 24 to 48 hours.

Which of the following is a feature of Cloninger’s type 1 alcoholism?

['A. Early onset', 'B. Incidence in both men and women', 'C. Impulsivity', 'D. Antisocial personality traits', 'E. Positive family history']

Answer: C. To prove malpractice, the plaintiff must establish by a preponderance of evidence that there existed a duty of care, there was a deviation from the standard of care, the patient was damaged, and the deviation directly caused the damage.

Which of the following is the origin of motivation-enhancing techniques in treating substance abuse?

['A. Cognitive-behavioral therapy', 'B. Operant conditioning', 'C. Psychodynamic theories', 'D. Milan school of family therapy', 'E. Theory of change']

Answer: B. Tarasoff I is the duty to warn. Tarasoff II is the duty to protect.

Which of the following is associated with withdrawal from alcohol?

['A. Elevated dopaminergic function', 'B. Reduced dopaminergic function', 'C. Increased GABA activity', 'D. Decreased glutaminergic activity', 'E. Increased serotonin function']

Answer: E. Agreement with the doctor is not used to determine competency.

Which of the following receptors is postulated to be essential for the development of opiate dependence?

['A. Kappa', 'B. Delta', 'C. Mu', 'D. Serotonin', 'E. Dopamine']

Answer: C. Guardianship is a method of substitute decision making for people unable to act on their own behalf.

Which of the following receptors associated with ion channel activities is inhibited by alcohol?

['A. 5-HT3', 'B. Glutamate', 'C. GABA-A', 'D. Acetylcholine']

Answer: B. Mens rea is evil intent. Actus reus is voluntary conduct. Both of them must be present to determine if a crime has been committed.

You are asked to see a 42-year-old male patient on a surgical ward who had a major operation 2 days ago and is now exhibiting bizarre behavior. He expresses fears that aliens are coming to take him away and appears to be responding to hallucinations. On examination he is tremulous and sweating but appears oriented and denies any hallucinations. His laboratory workup is subnormal with increased MCV and GGT. What is the most likely cause of his symptoms?

['A. Alcohol withdrawal', 'B. Schizophrenia', 'C. Severe depression', 'D. Delirium tremens', 'E. Alcoholic hallucinosis']

Answer: E. To be able to stand trial, individuals have to understand and appreciate the charges against them, be able to appraise the legal defense available, understand court procedure, have the capacity to challenge prose-cution witnesses realistically, and have the capacity to testify relevantly.

Which of the following is not true of delirium tremens?

['A. If untreated, it has a high mortality rate.', 'B. Hallucinations may involve the patient’s occupation.', 'C. Aphasia is common.', 'D. Patients are highly suggestible.', 'E. The delusions are fragmented and unsystematized.']

Answer: B. Denial of guilt is not an element of the insanity defense.

Which of the following is a characteristic feature of alcohol dependence?

['A. Rapid reinstatement after abstinence B. Absenteeism on Fridays', 'C. Tendency to exaggerate drinking', 'D. Drinking only in the company of others E. Ability to control drinking when interpersonal problems increase 22. Which of the following is not true of alcohol withdrawal?', 'A. It is associated with increased autonomic activity.', 'B. Mild cases can be treated at home.', 'C. Severity of symptoms peaks on the day that the drinking stops.', 'D. Benzodiazepines are effective in suppressing hallucinations.', 'E. Home detoxification is contraindicated if patient has a history of seizure disorder.']

Answer: E. Nicotine or cigarette smoking is not associated with increased rates of violence.

Alcohol dependence is associated with A. Maternal separation in childhood

['B. Family history of depression', 'C. Paranoid personality disorder', 'D. Family history of alcoholism', 'E. Alcohol dehydrogenase deficiency']

Answer: C. The number of first-rank symptoms does not bear a direct relationship to the risk a person poses. Command hallucinations are associated with an increased risk of violence. The severity and nature of the index offense, a history of past offenses, noncompliance with treatment, lack of insight, and psychopathy all correlate with risk.

Alcohol withdrawal is associated with all the following except A. Affect-laden dreams

['B. Absence seizures', 'C. Coarse tremors', 'D. Auditory hallucinations', 'E. Hypersomnolence']

Answer: D. Mediation sessions between stalker and victim are not useful in the management of stalking.

Which of the following is not a complication of alcohol abuse?

['A. Decreased serum testosterone', 'B. Carcinoma esophagus', 'C. Hypertension', 'D. Cardiomyopathy', 'E. Parkinson’s disease']

Answer: C. Violence in patients at schizophrenia is not always due to psychosis. There’s an increased incidence of violence with comorbid substance use that can be predicted to some degree.

Which of the following is an effect of alcohol on sleep?

['A. Increased sleep latency', 'B. Decreased sleep fragmentation', 'C. Decreased episodes of waking', 'D. Decreased REM sleep', 'E. Increased stage IV sleep']

Answer: E. Alcohol intoxication is a good short-term predictor of violence.

Methyl alcohol poisoning can cause all of the following except A. Blindness

['B. Metabolic alkalosis', 'C. Convulsions', 'D. Vomiting', 'E. Death']

Answer: D. In an adult patient deemed to be incompetent, the doctor can proceed to treat the patient if treatment is in the patient’s best interests.

All of the following arouse a suspicion of alcohol dependence except A. Unexplained absence from work

['B. Smell of alcohol on breath', 'C. Hypnogogic hallucination', 'D. Morning nausea', 'E. Morning tremors']

Answer: B. Most offenders with mental disorders do not commit offenses directly related to the symptoms. They are more often likely to commit petty offenses and can be treated by a general psychiatrist. The majority of such offenders do not have a personality disorder, though a higher percentage than average do. They should receive treatment rather than punishment.

Which of the following is true of Korsakoff syndrome?

['A. Disorientation is usually present.', 'B. Confabulation is essential for diagnosis.', 'C. Immediate memory is affected.', 'D. It can be caused by continuous vomiting.', 'E. Clouding of consciousness is a characteristic feature.']

Answer: B. The presence of personality disorder, alcohol and drug use, mental retardation, schizophrenia, and depression are all associated with criminal behavior.

Which of the following is not seen in chronic alcoholism?

['A. Hypoglycemia', 'B. Hemochromatosis', 'C. Campbell de Morgan spots', 'D. Marchiafava-Bignami syndrome', 'E. Optic atrophy']

Answer: D. Shoplifting and other kinds of theft are the most common offenses committed by women.

Alcohol dependence is more common in A. African Americans than in Whites

['B. Jews than in non-Jews', 'C. Married persons than in unmarried', 'D. Middle-class persons than in persons of other socioeconomic classes E. Doctors than in the general population 32. Which of the following symptoms favors a diagnosis of amphetamine-induced psychotic disorder rather than schizophrenia?', 'A. Predominance of auditory hallucinations B. Inappropriate affect', 'C. Little or no evidence of disordered thinking D. Marked affective flattening', 'E. Alogia']

Answer: C. Sexual offenses are overrepresented in people with mental retardation. This may be because of their ignorance or unawareness of social mores or taboos and because of the high likelihood of their being caught. People with mental retardation are also more likely to indulge in arson. The majority of delinquent youth are not mentally retarded, and criminals are not necessarily of low intelligence.

Which of the following is true regarding alcoholic hallucinosis?

['A. It’s caused by thiamine deficiency.', 'B. Some patients progress to develop schizophrenia.', 'C. Auditory hallucinations are generally pleasant.', 'D. Patients are confused and disoriented.', 'E. Hallucinations are usually in the third person.']

Answer: E. Pathological jealousy is the most common psychiatric disorder associated with homicide that is followed by suicide. Killing of an elderly spouse in poor health, killing of a child, and multiple murders by a depressed, paranoid, or intoxicated person are also seen. Twenty to twenty-five percent of all jealous men who killed their spouses also committed suicide.

What is the primary goal of treatment for most alcoholics?

['A. Increased productivity', 'B. Increased self-awareness', 'C. Increased relationships', 'D. Total abstinence', 'E. Participation in AA']

Answer: B. To be fit to plead, defendants need not understand that what they did was wrong. They only need to understand the charges.

All of the following are features of alcohol withdrawal tremors except A. Abducens nerve palsy

['B. Visual hallucinations', 'C. Disorientation', 'D. Tremors', 'E. Tachycardias']

Answer: D. A history of violence in the past is the most powerful indicator of violence in the future. Lack of regret, morbid jealousy, and alcohol and drug abuse are also predictors of violence.

A 45-year-old man who drinks a quart of whisky a day reports feelings of hopelessness, suicidal thoughts, sleeplessness, and weight loss. What is the most appropriate diagnosis?

['A. Major depression', 'B. Adjustment disorder', 'C. Alcohol withdrawal', 'D. Dysthymia', 'E. Alcohol-induced mood disorder']

Answer: D. The competence to make a will, called testamentary capacity, requires that patients know the nature and extent of their property, the fact that they’re making a bequest, and the identities of their natural beneficiaries. The property need not be given to the natural beneficiaries.

Complications in pregnancy of an opiate-addicted mother include all of the following except

['A. Low birth weight', 'B. Cleft palate in the fetus', 'C. Intrauterine death', 'D. Abruptio placentae', 'E. Neonatal opioid withdrawal']

Answer: A. Autonomy is the patient’s right to self-determination. Beneficence is the duty of the physician to act in the best interests of the patient.

Which of the following is true about LSD?

['A. It results in hypotension and falls.', 'B. Pinpoint pupils are a reliable indicator of LSD use.', 'C. It can cause neuroleptic malignant syndrome.', 'D. Hallucinations are usually tactile.']

Answer: B. The most common role of a psychiatrist in court is that of an expert witness.

Which of the following is not a complication of amphetamine use?

['A. Hypotension', 'B. Weight loss', 'C. Depression', 'D. Paranoid psychosis']

Answer: B. In its Model Penal Code, the American Law Institute (ALI) recommended that “persons are not responsible for criminal conduct if, at the time of such conduct, as a result of mental disease or defect, they lacked substantial capacity either to appreciate the criminality of their conduct or to confirm their conduct to the requirement of the law.”

How do amphetamines cause euphoriant effects?

['A. By decreasing synaptic dopamine concentration B. By increasing 5 HT concentration', 'C. By increasing dopamine concentration D. By increasing noradrenaline concentration E. By binding to the mu receptors']

Answer: C. Durable power of attorney permits the advance selection of a substitute decision maker who can act without the necessity of court proceedings when the signatory becomes incompetent through illness or dementia.

Which of the following is not seen in heroin withdrawal?

['A. Rhinorrhea', 'B. Muscle cramps', 'C. Miosis', 'D. Diarrhea']

Answer: D. The diagnostic criteria for substance dependence require a presence of three or more of the following in a 12-month period: tolerance, withdrawal, use of substance in larger amounts and for longer periods than intended, persistent desire to control use or unsuccessful efforts to control use, spending a great deal of time in obtaining the substance, impairment of social occupational or recreational activities, and use of the substance despite knowledge that it is harmful.

Withdrawal seizures are not associated with A. Heroin

['B. Meprobamate', 'C. Phenobarbital', 'D. Diazepam', 'E. Alcohol']

Answer: E. The severity of withdrawal symptoms is related to the duration and pattern of use. It is also related to the amount of substance used. The signs and symptoms vary for different drugs and may emerge even on reduction of the dose. Withdrawal symptoms are one of the criteria to diagnose dependence, but are not essential.

A 40-year-old woman presents to the ER with confusion and drowsiness.

['A. Antidepressant overdose', 'B. Anticholinergic overdose', 'C. Barbiturate overdose', 'D. Benzodiazepine withdrawal', 'E. Opiate overdose']

Answer: C. Use of illicit substances is associated with low socioeconomic class, high availability of the substance, high unemployment, poor inner-city schools, and a high crime rate.

All of the following are physiologic effects of cocaine use except A. Vasoconstriction

['B. Tachycardia', 'C. Pupillary constriction', 'D. Hypertension', 'E. Decreased appetite']

Answer: B. Males are at increased risk of developing alcoholism. The rate of alcohol problems increases with the number of alcoholic relatives, the severity of their illness, and the closeness of their genetic relationship to the person. There is an enhanced risk of alcoholism in the offspring of alcoholic parents, even when the children are separated from the biological parents. The risk is not enhanced by being raised by an alcoholic adoptive family. A family history of ADHD or schizophrenia is not a risk factor for alcoholism although patients with this disorder and PTSD, social anxiety, etc. may use alcohol to excess sometimes as a means of self-medication.

Which of the following is not an early symptom of withdrawal from barbiturates?

['A. Coarse tremor', 'B. Nystagmus', 'C. Hypertension', 'D. Seizures', 'E. Anxiety']

Answer: C. Antisocial personality disorder, phobic disorder, major depression, dysthymia, social phobia, and PTSD are all comorbid with drugs of abuse. However, alcohol dependence and abuse is the most likely comorbidity to be seen with drug abuse and dependence.

When compared to withdrawal from heroin, withdrawal from methadone is more likely to be

['A. Delayed', 'B. Susceptible to delirium', 'C. Painful', 'D. Of shorter duration', 'E. Dangerous']

Answer: A. Antisocial personality disorder is a most common comorbid condition seen in prisoners with substance abuse.

Which of the following substances causes the highest number of deaths?

['A. Alcohol', 'B. Cocaine', 'C. Nicotine', 'D. Marijuana', 'E. Heroin']

Answer: C. Alcoholism is associated with low self-directedness, high novelty seeking (impulsivity), low reward dependence (aloofness), low cooperativeness, and low harm avoidance (risk-taking). Novelty seeking predicts early-onset alcoholism, criminality, and other substance use.

Which of the following is caused by cocaine toxicity?

['A. Bradycardia', 'B. Hypothermia', 'C. Hypersomnia', 'D. Hypotension', 'E. Intracranial hemorrhage']

Answer: D. Alcohol withdrawal is sometimes associated with hypoglycemia. It can also cause withdrawal seizures, delirium, tremors, insomnia, vomiting, hallucinations, agitation, anxiety, and autonomic hyperactivity. Magnesium deficiency, Wernicke’s encephalopathy, and hypertension may also be seen as sequelae of heavy drinking and even withdrawal.

Why is methadone used as a substitute for heroin in the treatment of heroin dependence?

['A. It reduces addiction to other drugs.', 'B. It has less potential to cause dependence than heroin.', 'C. It prevents psychotic symptoms.', 'D. It blocks mu opioid receptors in the brain.', 'E. It suppresses opioid withdrawal symptoms for a longer time.']

Answer: B. Various benzodiazepines, including lorazepam, chlordiazepoxide, or diazepam, can be used to enable patients to withdraw from alcohol over a period of 4 to 7 days. Antipsychotics like haloperidol can be used in severe withdrawal. Carbamazepine, clonidine, and beta-blockers are also used. However, most clinicians prefer to use benzodiazepines as first-line agents.

A 26-year-old patient without any cardiac risk factors suffers a myocardial infarction. What substance is most likely to be the cause?

['A. PCP', 'B. Sedative', 'C. Hallucinogen', 'D. Stimulant', 'E. Alcohol']

Answer: D. Depressive symptoms are present in about 40–80% of people with heavy alcohol intake. However, after about 3 to 4 weeks of abstinence, only about 5–10% of patients continue to have depressive symptoms, even without any treatment. Hence, such patients should not be diagnosed with major depression without a fair period of abstinence. The presence of depression does not indicate the need for inpatient detoxification, nor does it predict dropout from detoxification.

Hallucinations, elevated blood pressure, and minimal pain when skin folds are squeezed are most likely to be associated with A. Amphetamines

['B. PCP', 'C. LSD', 'D. Marijuana', 'E. Alcohol']

Answer: B. Civility of alcoholism has not been shown to be predictive of suicide in patients with alcoholism (Berglund & Ojehagen 1998). The other factors mentioned are known risk factors.

On which of the following does PCP have an antagonistic effect?

['A. Glycine', 'B. GABA', 'C. Dopamine', 'D. Serotonin', 'E. Glutamate']

Answer: C. CAMCOG is used in the assessment of dementia in the elderly. CAGE is a four-item questionnaire to screen for a problem with alcohol use. AUDIT (Alcohol Use Disorders Identification Test) is a standardized questionnaire regarding quantity and frequency of drinking. MCV (mean corpus-cular volume) is increased in patients with alcoholism. CDT (carbohydrate-deficient transferrin) is a reasonably sensitive and specific marker of heavy drinking and may be used in monitoring abstinence during treatment.

What neurotransmitter is associated with benzodiazepine withdrawal?

['A. Acetylcholine', 'B. GABA', 'C. Norepinephrine', 'D. Serotonin', 'E. Dopamine']

Answer: B. Assessing the patient’s motivation for change using the motivational interview (Miller & Rollinck 1991) involves gaining an understanding of the patient’s reasons for seeking treatment. The stages may be classified along a continuum from precontemplation to contemplation to determination to action to maintenance.

Which of the following is true about opiate use?

['A. The majority of people who use opiates for nonmedical reasons develop opiate dependence.', 'B. Opiate addicts score high on “sensation-seeking” behavior.', 'C. The majority of opiate-addicted individuals carry a lifetime diagnosis of a psychiatric disorder.', 'D. Schizophrenia is the most common comorbid psychiatric disorder.']

Answer: B. Cloninger classified alcoholics into two distinct subtypes: type 1, or milieu limited alcoholism, and type 2, or male-limited alcoholism. Type 1 affects both male and females and has onset after age 25. Persons with this type of alcoholism do not have a strong family history of alcoholism or criminality and rarely engage in fights or are arrested while drinking. Type 2 alcoholism occurs only in men and is characterized by an inability to abstain from alcohol and heavy consumption rates. Dependence begins before the age of 25 and is associated with recurrent medical and social consequences of alcoholism as well as a personal and family history of criminality.

Which of the following substances is the most commonly used by persons with schizophrenia?

['A. Cocaine', 'B. Marijuana', 'C. Benzodiazepine', 'D. Alcohol', 'E. Nicotine']

Answer: E. Motivation-enhancing techniques (Miller & Rollinck) have their origins in the theories of change.

Which of the following mediates the effects of cocaine?

['A. Norepinephrine', 'B. Acetylcholine', 'C. Dopamine', 'D. Serotonin', 'E. GABA']

Answer: B. Withdrawal symptoms from alcohol are associated with reduced dopaminergic function. They are also associated with reduced GABA, increased glutaminergic function, and reduced 5-HT3 function.

Which of the following is true about heroin addiction?

['A. Inspection of the person’s limbs reliably excludes intravenous use.', 'B. HIV testing is mandatory.', 'C. Endocarditis is a common complication.', 'D. Urinary testing confirms the amount of drug consumed.', 'E. Withdrawal symptoms are rarely life threatening.']

Answer: C. The three major types of opioid receptors are mu, kappa, and delta. Most of the opioid drugs are mu agonists. They produce analgesia, altered mood, decreased anxiety, respiratory depression, and suppression of cough. Most of the new agonists are full agonists and produce maximal response in opioid responsive types. When any mu agonist is used chronically, tolerance and physical dependence develop.

A patient with alcohol dependence is ataxic, confused, and had a seizure after admission to a substance abuse clinic a day ago. He has no history of seizures. What is the most appropriate parenteral drug for this patient?

['A. Lorazepam', 'B. Phenytoin', 'C. Thiamine', 'D. Folate', 'E. Valproic acid']

Answer: B. Alcohol enhances ion channel activities associated with nico-tinic acetylcholine, serotonin 5-HT3, and GABA type A receptors, whereas it inhibits ion channel activities associated with glutamate receptors and voltage-gated calcium channels.

Which of the following triads of symptoms best describes Wernicke’s encephalopathy?

['A. Hallucinations, ataxia, and peripheral neuropathy B. Hallucinations, confabulation, and peripheral neuropathy C. Hallucinations, ataxia, and tremors D. Ophthalmoplegia, seizures, and confusion E. Ophthalmoplegia, ataxia, and global confusion 60. Which of the following is a feature of alcoholic blackouts?', 'A. Loosening of associations', 'B. Reaction to a traumatic event', 'C. Confabulation', 'D. Anterograde amnesia following intoxication E. Retrograde amnesia following intoxication 61. All of the following are physical features seen in alcoholism except A. Arcus senilis B. Palmar erythema', 'C. Peripheral neuropathy', 'D. Café au lait spots', 'E. Spider nevi']

Answer: D. The symptoms described are strongly suggestive of delirium tremens. Such symptoms can arise in patients being admitted to the hospital for an operation and hence abstaining from alcohol. The clinical features are clouding of consciousness, difficulty sustaining attention, disorientation, autonomic hyperactivity with tachycardia, excess sweating, and lability of blood pressure. Patients also have fleeting delusions and hallucinations. The symptoms should resolve with adequate treatment.

In which of the following is degeneration of the dorsal nucleus of the thalamus mamillary bodies found?

['A. Alzheimer disease', 'B. Wilson disease', 'C. Binswanger disease', 'D. Creutzfeldt-Jakob disease', 'E. Wernicke-Korsakoff syndrome']

Answer: C. Aphasia is not seen in delirium tremens. Patients are highly suggestible. Hallucinations may include any modality but typically are visual or auditory and are persecutory. Delusions are usually fragmented and unsystematized, unlike those of schizophrenia. The condition has a high mortality rate (15–20%) if untreated.

Which of the following is not seen in caffeine withdrawal?

['A. Depression', 'B. Hallucinations', 'C. Headache', 'D. Insomnia', 'E. Nervousness']

Answer: A. Rapid reinstatement to previous levels of tolerance after a period of abstinence is a feature of dependence. Absenteeism on Mondays is typically associated with alcoholism. Patients tend to minimize their drinking. Patients with alcoholism typically tend to drink alone. They also have an inability to control their drinking in the presence of increasing personal problems.

Which of the following is most useful in differentiating between schizophrenia and alcohol withdrawal delirium?

['A. Agitation', 'B. Hallucinations', 'C. Affect', 'D. Level of consciousness', 'E. Paranoid delusions']

Answer: C. Severe alcohol withdrawal may be characterized by a wide variety of symptoms, including autonomic instability. The symptoms peak 2 to 3 days after cessation of drinking. Mild cases may be treated at home. Patients with a history of seizure disorder should be treated in hospital because of the risk of reemergence of seizures. Hallucinations are seen in withdrawal, and the use of benzodiazepines to suppress withdrawal can help with the suppression of hallucinations.

Which of the following is true about disulfiram?

['A. It is contraindicated in people on antidepressants.', 'B. Treatment with it should not be started on an outpatient.', 'C. Its effects may persist for several days after it is discontinued.', 'D. It should routinely be given to all alcoholics.', 'E. It requires large quantities of alcohol to produce a reaction.']

Answer: D. A family history of alcoholism is strongly associated with development of alcoholism in the proband. The closer the affected relative ge-netically and the greater the number of affected relatives, the higher the risk of alcoholism.

Which of the following is not a cause of delirium and confusion in the elderly?

['A. Depressive disorder', 'B. Electrolyte imbalance', 'C. Urinary retention', 'D. Constipation', 'E. Medication toxicity']

Answer: B. Alcohol withdrawal is typically associated with tonic-clonic seizures. It does not cause petit mal seizures. Coarse tremors, auditory hallucinations, paranoid delusions, visual hallucinations, hypersomnolence, and insomnia may also be seen.

What should be the first step in management of a young adult with marital problems, depression, and alcohol dependence?

['A. Couple therapy', 'B. Antidepressant therapy', 'C. Insight-oriented psychotherapy', 'D. Treatment with disulfiram', 'E. Detoxification and encouragement of abstinence']

Answer: E. Long-term use of alcohol can affect a number of systems in the body and can cause blackouts, peripheral neuropathy, cerebellar degeneration, liver damage (including fatty liver and cirrhosis), carcinoma esophagus, pancreatitis, hypertension, hypercholesterolemia, alcoholic cardiomyopathy, reduced serum testosterone, and cancer of the liver and stomach. It does not cause Parkinson’s disease per se.

Which of the following is not a feature of fetal alcohol syndrome?

['A. Renal defects', 'B. Cardiac defects', 'C. Severe mental retardation', 'D. Growth retardation', 'E. Facial dysmorphism']

Answer: D. Alcohol consumed in the evening decreases sleep latency. It also causes a decrease in REM sleep and stage IV (deep) sleep. It causes more sleep fragmentation and more and longer episodes of awakening.

Which of the following is a psychological manifestation of sedative abstinence?

['A. Sweating', 'B. Lethargy', 'C. Shakiness', 'D. Impaired memory', 'E. Tremors']

Answer: B. Methyl alcohol consumption results in increased serum osmolality, severe anion gap metabolic acidosis, tachypnoea, confusion, convulsions, blindness, vomiting, and death.

Which of the following is not a feature of Korsakoff psychosis?

['A. Normal consciousness', 'B. Disturbance of affect', 'C. Disturbance of volition', 'D. Distress about memory impairment', 'E. Abulia']

Answer: C. Hypnagogic hallucination is a phenomenon that occurs in normal persons as they fall asleep. Unexplained absence from work, smell of alcohol on the breath, morning nausea, and tremors all arouse a suspicion of alcohol dependence.

What is the half-life of LAAM?

['A. 8 hours', 'B. 24–36 hours', 'C. 48 hours', 'D. 72–96 hours']

Answer: D. Korsakoff syndrome is characterized by anterograde and retrograde amnesia and impairment in visuospatial, abstract, and other types of learning. The level of recent memory is out of proportion to the global level of cognitive impairment. Immediate memory is usually preserved. Confabulation may be seen. The patient has a clear consciousness. In addition to alcohol use, prolonged severe vomiting can cause Korsakoff syndrome.

How long should alcohol be avoided following cessation of disulfiram?

['A. 24 hours', 'B. 3 days', 'C. 7 days', 'D. 1 month', 'E. 3 months']

Answer: C.

Which of the following is true of caffeinism?

['A. Withdrawal symptoms start after 48 hours.', 'B. Withdrawal symptoms can last up to 1 week.', 'C. Caffeine has a half-life of 12 hours.', 'D. Withdrawal symptoms can be life threatening.', 'E. Muscle relaxation occurs.']

Answer: E. Alcohol dependence is more common in doctors than the general population. It is more common in Whites than African Americans and Chinese and more common in non-Jews than in Jews. Jews have the highest proportion who consumes alcohol but the lowest number of persons with alcohol problems. Other groups, such as the Irish, have higher rates of severe alcohol problems and high rates of absenteeism. Unmarried persons and members of lower social economic groups are also more likely to abuse alcohol.

Which of the following is true regarding bulimia nervosa?

['A. Individuals with bulimia have enlargement of the parotid gland.', 'B. There is an increased frequency of depression in people with bulimia nervosa.', 'C. Persons with bulimia nervosa have a 30% prevalence of substance abuse or dependence.', 'D. Persons with bulimia nervosa exhibit mildly elevated levels of serum amylase.', 'E. All of the above']

Answer: C. Amphetamine-induced psychotic disorder can at times be in-distinguishable from schizophrenia. The hallmark of amphetamine-induced psychotic disorder is paranoia. It is also characterized by the predominance of visual hallucinations, appropriate affect, hyperactivity, hypersexuality, confusion and incoherence, little or no evidence of thought disorder, and lack of affective flattening and alogia.

Patients with bulimia nervosa are characterized by scars on the knuckles of their hands from constantly putting their hands into their mouths to induce vomiting. What is this sign called?

['A. Russell’s sign', 'B. Feingold’s sign', 'C. McCain’s sign', 'D. None of the above']

Answer: B. About 3% of patients have psychotic symptoms in the context of heavy drinking. In a very small number of patients, the symptoms may persist on cessation of alcohol use and later meet the criteria for schizophrenia. Auditory hallucinations in alcoholic hallucinosis are derogatory and in the second person. All this occurs on a background of clear consciousness.

An 18-year-old girl presents to the student guidance clinic at her school.

['A. Bulimia nervosa', 'B. Impulse control disorder', 'C. Binge eating disorder', 'D. None of the above']

Answer: D. Although increased productivity, self-awareness, better relationships, and participation in AA are all goals of treatment, total abstinence is the primary goal of most alcoholics.

Which of the following is not true for anorexia nervosa?

['A. It is more common in females.', 'B. It is more prevalent in developing countries.', 'C. Patients have a body weight less than 85% of that expected.', 'D. Patients have an intense fear of gaining weight.', 'E. In postmenarchal women, there is an absence of at least three consecutive menstrual cycles.']

Answer: A. Alcohol withdrawal does not cause abducens nerve palsy. All the other symptoms are well-known features of withdrawal.

For which of the following are hormone levels decreased in patients with anorexia nervosa?

['A. GnRH', 'B. FSH', 'C. LH', 'D. Estrogen', 'E. All of the above']

Answer: E. About 80% of persons who are currently drinking heavily report mood symptoms mimicking those of a depressive disorder. DSM-IV la-bels the symptoms as an alcohol-induced mood disorder in the context of heavy and repetitive use of any brain depressant, including alcohol.

Which of the following medical complications is seen with anorexia nervosa?

['A. Leucopenia', 'B. Hypokalemic alkalosis', 'C. Lanugo', 'D. Fatty degeneration of the liver', 'E. All of the above']

Answer: B. Opiate use in pregnancy is associated with decreased fetal growth and low birth weight but not with any teratogenic effects. It can also cause intrauterine death and abruptio placentae, and the infant may have withdrawal symptoms.

Patients with bulimia nervosa sometimes develop cardiac myopathy. What is the most common cause?

['A. Electrolyte disturbances', 'B. Starvation', 'C. Loss of cardiac muscle', 'D. Toxicity from ipecac', 'E. All of the above']

Answer: C. The onset of action of LSD occurs within 1 hour, peaks within 2 to 4 hours, and lasts 8 to 12 hours. The sympathomometic effects include tremors, tachycardia, hypertension, hyperthermia, sweating, blurring of vision, and mydriasis. Death can also occur. A syndrome similar to neuroleptic malignant syndrome can also occur with LSD. Hallucinations are usually visual, although auditory and tactile hallucinations are sometimes seen. Emotions may be unusually intense and change abruptly and often.

Which of the following is not a good prognostic indicator for anorexia nervosa?

['A. Early age of onset', 'B. Late age of onset', 'C. No purging behavior', 'D. No previous hospitalization for the illness E. Parents who are cooperative and willing to come for family therapy 9. What is considered the first line of treatment for bulimia nervosa?', 'A. Family therapy', 'B. Interpersonal therapy', 'C. Pharmacotherapy', 'D. Cognitive-behavioral therapy', 'E. Brief psychoanalytic therapy']

Answer: A. Amphetamine use can cause hypertension and result in intracranial hemorrhage, arrhythmias, and acute cardiac failure. It also can cause psychotic symptoms and mood symptoms including mania and depression on withdrawal. Amphetamines and cocaine can also cause anxiety disorders and symptoms similar to obsessive-compulsive disorder. High doses over a prolonged period cause impotence. Amphetamines also cause insomnia and sleep deprivation.