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Which of the following is true regarding the epidemiology of eating disorders?
['A. The incidence has been consistently increasing over the last 50', 'B. It is more prevalent in Western cultures.', 'C. Bulimia nervosa has a prevalence rate of 1%.', 'D. Anorexia nervosa has a mortality rate of around 5–15%.', 'E. All of the above']
Answer: C. Cocaine and amphetamines cause euphoriant effects by increasing dopamine concentrations. They increase synaptic dopamine levels by inhibiting the activity of dopamine transporters. Cocaine and amphetamines increase extracellular dopamine levels in the striatum; euphoria is related to the occupancy of dopamine transporters by cocaine and amphetamines.
Patients suffering from anorexia nervosa have a high incidence of which of the following psychiatric conditions?
['A. Obsessive-compulsive disorder', 'B. Major depression', 'C. Social phobia', 'D. Decreased sexual interest', 'E. All of the above']
Answer: C. Miosis is associated with opiate use and intoxication. Withdrawal results in mydriasis. All of the other features mentioned are seen in withdrawal.
What percentage of patients with anorexia eventually develops symptoms of bulimia?
['A. 10%', 'B. 30%', 'C. 40%', 'D. 50%', 'E. 70%']
Answer: A. Withdrawal from heroin is very distressing but not life threatening. It does not result in seizures. Withdrawal from diazepam, alcohol, phenobarbitone, or meprobamate can cause seizures.
What is the most commonly abused substance in bulimia nervosa patients?
['A. Amphetamines', 'B. Alcohol', 'C. Opioids', 'D. Benzodiazepines', 'E. None of the above']
Answer: D. The symptoms suggest withdrawal symptoms from a benzodiazepine following the cessation of use.
Which of the following medications has been found useful in the treatment of anorexia nervosa?
['A. Fluoxetine', 'B. Sertraline', 'C. Chlorpromazine', 'D. Cyprohepatidine', 'E. All of the above']
Answer: C. Cocaine use causes pupillary dilatation.
Which is the most common age of onset of anorexia nervosa?
['A. Between 14 and 15', 'B. 18', 'C. Both between 14 and 15 and at age 18 (a bimodal peak) D. 12–13', 'E. None of the above']
Answer: C. Physiologic dependence on barbiturates may result from a daily dose of 4 mg of pentobarbital for 3 months. Discontinuation results in anxiety, insomnia, anorexia, coarse tremors, muscle weakness, myoclonic jerks, orthostatic hypotension, vomiting, EEG changes, and seizures. At higher doses, delirium and disorientation, visual hallucinations, and frightening dreams may develop.
A 31-year-old man reports that he has to use women’s undergarments to get sexually aroused. He admits to spending an inordinate time searching for and acquiring these garments. This has led to significant distress to him. On questioning he reports that he is not sexually attracted to males and that his sexual fantasies always involve females. What condition does this person have?
['A. Fetishism', 'B. Transvestic fetishism', 'C. Frotteurism', 'D. Gender identity disorder', 'E. None of the above']
Answer: A. Withdrawal symptoms from methadone and levo-alpha-acetyl-methadol (LAAM) may be delayed for 1 to 3 days following the last dose, and peak symptoms may not occur until the third to eighth day. The symptoms may persist for several weeks because of the longer half-life of methadone as compared to heroin. With morphine and heroin, symptoms start as early as 8 to 12 hours after discontinuation of the drugs, peak at about 48 hours, and run their course in 7 to 10 days.
A 38-year-old divorced man presents to the outpatient clinic. He reports that the only way he can attain sexual arousal and gratification is by dressing in women’s clothes. He also reports that even his fantasies involve cross-dressing. He admits that his wife has frequently caught him wearing her clothes and that was one of the reasons she divorced him. What condition does this person have?
['A. Gender identity disorder', 'B. Transvestic fetishism', 'C. Exhibitionism', 'D. Fetishism', 'E. None of the above']
Answer: C. The substance that causes the highest number of deaths is nicotine. Smoking is also a risk factor for lung cancer, cardiovascular disease, COPD, and low birth weight.
Which of the following is characteristic of gender identity disorder?
['A. The person’s repeated desire to be, or insistence that he or she is, of the opposite sex', 'B. Persistent fantasies of being the other sex C. Intense desire to participate in the past experiences of the other sex D. Preference for playmates of the other sex during childhood E. All of the above 19. A 27-year-old prisoner serving time in a correctional facility for a sexual offense is seen by a psychiatrist. He reports that he gets intense sexual arousal from rubbing his genital area against the bodies of members of the opposite sex. What is the condition he describes called?', 'A. Exhibitionism', 'B. Frotteurism', 'C. Fetishism', 'D. Sadism', 'E. None of the above']
Answer: E. Cocaine intoxication and abuse can result in effects on a number of organ systems, including hypertension, intracranial hemorrhage, tachycardias and arrhythmias, MI, myocarditis, shock, sudden death, seizures, subarachnoid hemorrhage, cerebral infarction, pneumothorax, respiratory arrest, hyperthermia, abortion, and infections like AIDS, infective endocarditis, and hepatitis B.
Which of the following is true regarding pedophilia?
['A. The person with this disorder has recurrent sexually arousing fantasies, urges, or behavior involving sexual activity with a prepubescent child or children.', 'B. This behavior leads to frequent social and legal problems.', 'C. For a diagnosis of pedophilia, the perpetrator should be at least 16', 'D. There are two forms of pedophilia: exclusive and nonexclusive.', 'E. All of the above']
Answer: D. Methadone acts by blocking the mu opioid receptors in the brain. It thus reduces addiction to other drugs, but that is not the prime reason for its use in dependence. It is also addictive and does not have any effect on psychosis. Because of its long half-life, it only needs to be given once a day.
Which of the following is true about sexual masochism?
['A. The masochistic person has recurrent intense sexually arousing fantasies, urges, or behaviors involving the act of being humiliated, beaten, bound, or made to suffer in other ways.', 'B. It can involve being pinned and pierced.', 'C. Hypoxyphilia can lead to accidental death.', 'D. It can involve having the wish to be treated as an infant and dressed in diapers.', 'E. All of the above']
Answer: D. Stimulants like amphetamines and cocaine increase the risk of cardiovascular events, including intracranial hemorrhage, arrhythmias, MI, myocarditis, shock, and sudden death.
What is klismaphilia?
['A. Use of enemas to get sexual arousal B. Sexual arousal by defecating on a partner C. Concentrating sexual activity on one part of the body and excluding the rest of the body', 'D. Scatalogia', 'E. None of the above']
Answer: A. Amphetamines can result in hallucinations, hypertension, and altered pain sensation. The excess of dopamine accounts for the elevated threshold for self-stimulation and pain.
Which of the following is used to treat sexual offenders?
['A. Medroxyprogesterone', 'B. Fluoxetine', 'C. Cognitive-behavioral therapy', 'D. Leuprolide', 'E. All of the above']
Answer: C. Alcohol has various effects on the central nervous system, including amnesia. The condition of alcohol-induced persisting amnestic disorder is a result of a severe deficiency of thiamine. This results in Wernicke’s encephalopathy and Korsakoff syndrome. Long-term use can also result in alcohol-induced dementia.
Which of the following substances of abuse can lead to sexual dysfunction?
['A. Alcohol', 'B. Cocaine', 'C. Opioids', 'D. Amphetamines', 'E. All of the above']
Answer: A. Drugs that bind to PCP receptors also block N-methyl-D-aspartate (NMDA) activated channels. NMDA receptors process binding sites for glutamate and glycine. Glutamate is released from presynaptic nerve endings in a pulsatile manner and rapidly deactivated. The local glycine concentration sets the tonic levels of NMDA excitability, thus determining the degree to which presynaptic glutamate release leads to postsynaptic excitation.
Which of the following is true regarding the epidemiology of homosexuality in United States?
['A. Homosexual orientation is reported by 2.8% of men surveyed.', 'B. Homosexual orientation is reported by 1.4% of women surveyed.', 'C. Nine percent of men surveyed report having had at least one homosexual experience as an adult.', 'D. Five percent of women surveyed report having had at least one homosexual experience as an adult.', 'E. All of the above', 'Eating Disorders and Sexual Disorders']
Answer: B. Benzodiazepine withdrawal is mediated by GABA receptors. Withdrawal symptoms consist of disturbances of mood and cognition, disturbances of sleep, physical signs and symptoms, and perceptual disturbances. Symptoms appear within 24 hours and peak at about 48 hours. Symptoms of abrupt discontinuation of benzodiazepines with long half-lives may not peak until 2 weeks.
When did the American Psychiatric Association remove homosexuality from the list of mental disorders?
['A. 1953', 'B. 1963', 'C. 1973', 'D. 1983', 'E. 1993']
Answer: C. According to the National Comorbidity Survey, 7.5% of individuals who used opioids for nonmedical purposes and 23% of individuals who used heroin eventually developed opioid dependence. Opiate addicts tend to score low on “sensation seeking” and tend to avoid excess internal and external stimulation. Eighty to ninety percent of addicted persons carry a lifetime diagnosis of a psychiatric disorder. Major depressive disorder and antisocial personality disorder are the two most common psychiatric disorders.
Which of the following criteria is required for a diagnosis of mental retardation to be made?
['A. Onset before age 16', 'B. Onset before age 18', 'C. Deficit in at least one area of adaptive functioning D. IQ below 90', 'E. Absence of a mental illness']
Answer: E. Nicotine is the substance most commonly used by schizophrenics.
What is the mental age of an adult with moderate mental retardation?
['A. 3 years or less', 'B. 6 years or less', 'C. 9 years or less', 'D. 12 years or less', 'E. 15 years or less']
Answer: C. Amphetamines and cocaine act by increasing the release of dopamine.
Which of the following is true about mild mental retardation?
['A. It is diagnosed in persons with IQ less than 70 but more than 55.', 'B. Persons with this condition can only perform simple elementary tasks.', 'C. Most persons with this condition live in supported supervised care settings.', 'D. Persons with mild retardation constitute about 3–4% of those classified as mentally retarded.', 'E. Persons with this condition never learn to read or write.']
Answer: E. Withdrawal symptoms from heroin, although extremely distressing, are rarely life threatening. Inspection of the limbs, although useful in determining intravenous drug use, is not reliable. HIV testing is not mandatory and the patients have to consent to it like other patients. Endocarditis, although sometimes present, is not common. Urine testing can detect the presence of opiates but is not useful to quantify the amount used.
Which of the following conditions has an increased prevalence in persons with mental retardation?
['A. Visual impairment', 'B. Speech impediment', 'C. Hearing difficulty', 'D. Cerebral palsy', 'E. All of the above']
Answer: C. This patient is likely to have Wernicke’s encephalopathy, which is secondary to deficiency of thiamine, which is associated with long-term drinking. Many of the symptoms can be reversed fairly rapidly with parenteral thiamine.
What proportion of persons with severe mental condition have a seizure disorder?
['A. 5%', 'B. 15%', 'C. 25%', 'D. 33%', 'E. 75%']
Answer: E. Wernicke’s encephalopathy is characterized by ophthalmoplegia, ataxia, and confusion. There may be sixth nerve palsy.
What is the single most common cause of mental retardation?
['A. FragileX syndrome', 'B. Down syndrome', 'C. CNS trauma', 'D. Edward syndrome', 'E. Alcoholism in the mother']
Answer: D. Alcoholic blackouts are characterized by anterograde amnesia. This occurs with a blood alcohol concentration in the range of 200–300 mg per dl.
Which of the following is not a feature of Down syndrome?
['A. Hypothyroidism', 'B. Atlantoaxial instability', 'C. Long, thin hands', 'D. Early dementia', 'E. Oblique palpebral fissures']
Answer: D. Café au lait spots are seen in neurofibromatosis. Spider nevi and palmar erythemia can be seen in liver diseases resulting from alcohol use. Arcus senilis and peripheral neuropathy are also seen in alcoholism.
Which of the following is not seen in fragileX syndrome?
['A. Large head', 'B. Short stature', 'C. Hyperextensible joints', 'D. Macro-orchidism', 'E. Catlike cry']
Answer: E. The neuropathology of Wernicke-Korsakoff syndrome consists of neuronal loss, microhemorrhage, and gliosis in the paraventricular and periaqueductal gray matter. The medial dorsal nucleus of the thalamus, mamillary bodies, mamillothalamic tract, and anterior thalamus may also be affected.
Which of the following is a characteristic feature of Prader-Willi syndrome?
['A. Anorexia', 'B. Compulsive eating behavior', 'C. Tall stature', 'D. Hypertonic muscles', 'E. Large hands and feet']
Answer: B. Caffeine withdrawal begins 20–24 hours after the last use of caffeine. The symptoms reach their maximal intensity within 48 hours and resolve in 2 to 7 days. Headache is the most common feature. Other symptoms include sleepiness, reduced concentration, anxiety, insomnia, irritability, muscle aches, and yawning. Hallucinations are not characteristic.
Which of the following is not a feature of Rett disorder?
['A. Deterioration in communication skills B. Autistic traits', 'C. Characteristic hand movements', 'D. Equal prevalence in males and females E. Increased incidence of seizure disorder 11. Which of the following is a characteristic feature of Lesch-Nyhan syndrome?', 'A. Macrocephaly', 'B. Micrognathia', 'C. Self-mutilation', 'D. Compulsive overeating', 'E. Café au lait spots']
Answer: D. Patients with alcohol withdrawal delirium typically have impaired consciousness, whereas patients with schizophrenia have symptoms on a background of clear consciousness. Hallucinations, affective disturbance, agitation, and delusions may be present in both conditions.
Severe mental retardation is seen in which of the following conditions?
['A. Wilson disease', 'B. Prader-Willi syndrome', 'C. Klinefelter syndrome', 'D. Thalassemia', 'E. Turner syndrome']
Answer: C. Disulfiram is an aldehyde dehydrogenase inhibitor that causes the accumulation of acetaldehyde after ethanol consumption. This can result in severe reaction with respiratory depression, cardiovascular collapse, arrhythmias, coma, cerebral edema, convulsions, and death. Its effects persist for more than 6 days following cessation of use of alcohol. It is not contraindicated with antidepressants and may be given to patients with good support systems as an outpatient. All patients are not suitable and even small amounts of alcohol can precipitate a reaction.
Which of the following is not a feature of Asperger syndrome?
['A. Stilted speech', 'B. Eccentric lifestyle', 'C. Above average intelligence', 'D. Unusual speech', 'E. Restricted interests and behaviors']
Answer: A. Depressive disorder by definition occurs on a background of clear consciousness. A variety of causes can precipitate delirium and confusion in the elderly.
Which of the following conditions is less common in patients with mental retardation than in the general population?
['A. Anxiety', 'B. Behavioral problems', 'C. Schizophrenia', 'D. Anorexia nervosa', 'E. Epilepsy']
Answer: E. A wide variety of sequelae can result from alcohol use, including depression and marital problems. Many of these resolve with cessation of alcohol use. Hence, detoxification and abstinence are the first step before other issues are dealt with.
Which of the following is not true regarding seizure disorder in patients with mental retardation?
['A. It is difficult to control.', 'B. It frequently causes schizophreniform psychosis.', 'C. It causes intellectual deterioration.', 'D. It usually requires more than one drug for adequate control.', 'E. It rarely results in violence.']
Answer: C. Fetal alcohol syndrome is associated with facial dysmorphism with epicanthic folds, microcephaly, underdeveloped philtrum, and thin upper lip. Renal defects include renal hypoplasia and bladder diverticuli. Cardiac defects include atrial and ventricular septal defects. Mental retardation is usually mild when present and may be accompanied by behavioral difficulties including hyperactivity.
Which of the following may cause loss of skills in a person with Down syndrome?
['A. Depression', 'B. Hypothyroidism', 'C. Dementia', 'D. Hearing loss', 'E. All of the above']
Answer: D. Impaired memory is a psychological manifestation. All the others are somatic or physical manifestations.
Which of the following is true regarding children with mental retardation?
['A. They are at the same risk of being abused as children with normal intelligence.', 'B. They can be harmed by sex education.', 'C. They cannot benefit from psychotherapy.', 'D. They may not disclose whether they have been abused.', 'E. They should be discouraged from relating their abusive experiences.']
Answer: D. Patients with Korsakoff syndrome may have disturbance of affect, volition, abulia, and confabulation on a background of clear consciousness. Patients are seldom distressed by the memory impairment or even aware of it.
Which of the following is not a feature of sexual abuse in children with mental retardation?
['A. It can increase disruptive behavior.', 'B. It can result in stereotyped behaviors.', 'C. It presents in the same way as in children without mental retardation.', 'D. It can result in regression of abilities.', 'E. It can result in sophisticated sexualized behaviors.']
Answer: D. LAAM has a long half-life of 72 to 96 hours and is hence given three times a week.
All of the following are depressive features in persons with mental retardation except
['A. Increased self-injury', 'B. Diurnal behavioral changes', 'C. Talking to self and laughing', 'D. Crying', 'E. Appetite disturbance']
Answer: C. Following cessation of disulfiram, the restoration of alcohol dehydrogenase depends on de novo enzyme synthesis, which can take about 1 week.
Which of the following is true regarding the interview of patients with mental retardation?
['A. The interview should begin with leading questions.', 'B. Yes/no questions should be used.', 'C. Diagnostic overshadowing is a useful technique.', 'D. Use of pen and paper is helpful.', 'E. The interview should be terminated in as short a time as possible.']
Answer: B. Withdrawal symptoms from stopping caffeine use can last up to 1 week. They begin within about 12 to 24 hours. Symptoms are not life threatening, and muscle tension is a feature. Caffeine has a half-life of 3 to 6 hours.
In the treatment of aggression and behavior problems in patients with mental retardation, all of the following are true except A. A multidisciplinary approach is the most useful.
['B. Treatment may be provided in an inpatient or outpatient setting.', 'C. Pharmacotherapy should be avoided.', 'D. Simultaneous introduction of two treatment modalities should be avoided.', 'E. Treatment depends on the underlying etiology.']
Answer: E. The majority of the patients with bulimia nervosa remain within the normal weight range. Bulimia is associated with an increased incidence of depression, anxiety, and substance abuse. Enlargement of the parotid gland is common in bulimics and is associated with elevated serum amylase. Repeated vomiting can lead to erosion of the teeth by constant exposure of the enamel to gastric juices.
Which of the following is true of Asperger syndrome?
['A. Onset is after age 3 years.', 'B. Nonverbal deficits are more common than verbal deficits.', 'C. Relatives have an increased risk of schizophrenia.', 'D. Motor coordination problems may be seen.', 'E. Speech acquisition is normal.']
Answer: A. Patients with bulimia nervosa frequently induce vomiting by putting their fingers in their throats. This leads to scarring and calluses over the knuckles of the hand, which is known as Russell’s sign.
Which of the following statements is true regarding Asperger syndrome?
['A. It can easily be differentiated from autism.', 'B. It is less common than classic autism.', 'C. It has a major genetic component.', 'D. It resolves in adulthood.', 'E. It is associated with delayed cognitive development.']
Answer: C. Binge eating disorders are characterized by frequent episodes of binging (eating in a short time, say a 2-hour period, a large amount of food that is more than most people can or will eat). During these episodes patients have a sense of lack of control over eating and they report that they are unable to stop eating. According to the diagnostic criteria, episodes occur at least 2 days a week for 6 months and are not associated with purging behavior.
What is the approximate proportion of persons with Down syndrome who have neurofibrillary tangles in the brain by the age of 50?
['A. 5%', 'B. 35%', 'C. 50%', 'D. 75%', 'E. 100%']
Answer: B. Persons with anorexia nervosa characteristically refuse to maintain body weight above the low normal for age and height. They have an intense fear of gaining weight or becoming fat. The body weight is kept at less than 85% of the weight that is considered normal for age and height. Body mass index is usually less than 17.5. Eating disorders in general are more prevalent among females and in Western cultures.
What is the most common reason for psychiatric consultation in patients with mental retardation?
['A. Anxiety', 'B. Aggression', 'C. Depression', 'D. Psychosis']
Answer: E. Amenorrhea, which is defined as absence of three consecutive menstrual cycles, is one of the pathognomonic features of females suffering from anorexia nervosa. It is due to the decreased secretion of gonadotropin-releasing hormone (GnRH). Decreased secretion of GnRH also leads to decreased secretion of FSH, LH, and estrogen.
The following are true about night terrors except A. Episodes occur during stage 2 sleep.
['B. It is a dissociative state.', 'C. Violent behavior may occur.', 'D. Family history is rarely seen.', 'E. The person with night terrors usually has no recollection of the events.']
Answer: E. The following medical complications are associated with anorexia nervosa: leucopenia, hypokalemic alkalosis, electrolyte disturbances, cardiac arrhythmia, loss of cardiac muscle, fatty degeneration of the liver, elevated serum cholesterol levels, and amenorrhea. Lanugo is the fine, babylike hair present all over the body of anorexics.
Which of the following is true regarding somnambulism?
['A. It occurs toward early morning.', 'B. It is never familial.', 'C. It occurs during stage 3 and stage 4 sleep.', 'D. Criminal activity is common.', 'E. It is most common between the ages of 5 and 12 years.']
Answer: D. Patients with bulimia ingest ipecac to induce vomiting. Ipecac toxicity can lead to cardiomyopathy.
Which of the following is true regarding nightmares?
['A. Incidence is most common between the ages of 10 and 12 years.', 'B. They occur during REM sleep.', 'C. Nightmares can be caused by anxiety.', 'D. The person experiencing nightmares has no recollection of the dreams.', 'E. Persons subject to nightmares commonly sleepwalk after the nightmares.']
Answer: B. The following are considered good prognostic indicators in eating disorder patients: early age of onset (before 18), no previous hospitalization for the illness, and no purging behavior. Presence of parents who are willing to come for family therapy is also considered a good prognostic indicator.
Which of the following is true regarding narcolepsy?
['A. It begins in middle age.', 'B. It is more prevalent among women than men.', 'C. There is commonly a family history of narcolepsy.', 'D. It is associated with HLA DR2.', 'E. It is not commonly associated with cataplexy.']
Answer: D. Cognitive-behavioral therapy (CBT) is considered the first-line treatment for bulimia nervosa. It has been shown that at least 40% to 50% of patients receiving CBT abstain from binge eating and purging at the end of 16 to 20 weeks of the therapy. Antidepressants have also been used in the treatment of bulimia. The dosage is the same as that used for treatment of depression.
Which of the following is used to diagnose narcolepsy?
['A. Multiple Sleep Latency Test', 'B. Dexamethasone suppression test', 'C. NPT', 'D. Waking the patient', 'E. Observing the patient’s response to ECT']
Answer: E. The incidence of bulimia nervosa and anorexia nervosa has been shown to be increasing in the last 50 years. Both these disorders are more prevalent in Western cultures. The female-to-male ratio in eating disorders ranges from 10:1 to 20:1. Bulimia has a prevalence of 1%. Anorexics have a mortality rate of 5–15%. Bulimics have a lower mortality rate, 0–3%.
Which of the following medications has been found to be particularly effective for treating insomnia associated with depression?
['A. Sertraline', 'B. Mirtazepine', 'C. Trazodone', 'D. Venlafaxine', 'E. Escitalopram']
Answer: E. Patients suffering from anorexia nervosa have been shown to have a high comorbidity of major depression, obsessive-compulsive disorder, social anxiety, and decreased sexual interest. Patients with comorbid obsessive-compulsive disorder develop that disorder after the onset of anorexia.
Which of the following is a characteristic feature of REM sleep?
['A. Loss of muscle tone', 'B. K complexes', 'C. Sleep spindles', 'D. Alpha activity on EEG', 'E. Onset 30 minutes after sleep onset']
Answer: D. It has been shown that half of the patients with anorexia nervosa eventually develop signs of bulimia.
All the following are true about sleep in depression except A. Slow-wave sleep is increased.
['B. REM sleep rebound occurs after stopping treatment.', 'C. Antidepressants disturb REM sleep.', 'D. There is shortened REM latency.', 'E. REM activity in the first half of the night is increased.']
Answer: B. Substance abuse is common in patients with bulimia nervosa. Alcohol is the most commonly abused substance in this group of patients. Patients with bulimia are also known to abuse amphetamines to reduce their appetites.
All of the following are true of stage 2 sleep except A. It accounts for 24% of total sleep.
['B. K complexes occur.', 'C. Benzodiazepines promote this stage of sleep.', 'D. Sleep spindles occur.', 'E. Delta waves occur.']
Answer: E. Treatment of anorexia nervosa involves a multidisciplinary approach including medical management of the complications, psychoeducation, cognitive-behavioral therapy, and pharmacotherapy. The best use of medications is as an adjunct to psychoeducation and CBT. The medications that have been found useful in the treatment of anorexia nervosa are chlorpromazine, fluoxetine, and cyprohepatidine.
All of the following are true about psychophysiologic insomnia except A. The condition typically begins in early adulthood.
['B. Stress precipitates psychophysiologic insomnia.', 'C. Persons with this condition do not have any obvious psychiatry disorder.', 'D. This condition accounts for 50% of cases seen at a sleep center.', 'E. There is a possible genetic contribution.']
Answer: C. Anorexia nervosa has two peak times of onset. The first is between ages of 14 and 15. The second peak is at 18 years of age. However, anorexia has also been reported in prepubescent females and post-menopausal females.
A 55-year-old woman lives on her own. She wears odd clothes and pokes around in her neighbors’ garbage cans. She claims to have psychic powers but does not report hearing voices. What is the most likely diagnosis for her condition?
['A. Schizoid personality disorder', 'B. Schizotypal personality disorder', 'C. Asperger syndrome', 'D. Avoidant personality disorder']
Answer: A. Fetishism involves the use of nonliving objects (fetishes) to attain sexual arousal and gratification. It usually involves focusing on items like women’s lingerie, shoes, stockings, or gloves. The fetish is strongly preferred or required for sexual gratification. The disorder usually does not involve cross-dressing.
Which of the following is true about personality disorders?
['A. They rarely cause subjective distress.', 'B. They mellow with age.', 'C. They respond well to treatment.', 'D. They cause little or no impairment in functioning.']
Answer: B. Transvestic fetishism involves cross-dressing. This is more prevalent in males. The person dresses in the clothes of the opposite sex to attain sexual arousal. The person is almost always heterosexual and over the past 6 months has had recurrent fantasies or sexual urges and behavior involving cross-dressing.
Which of the following is true of borderline personality disorder?
['A. It is less common than antisocial personality disorder.', 'B. The majority of persons with this disorder are female.', 'C. The rate of suicide in persons with borderline personality disorder is the same as that of the general population.', 'D. Antidepressants are the treatment of choice.']
Answer: E. Gender identity disorder is characterized by a person’s strong and persistent desire to belong to the other sex or insistence that he or she belongs to the other sex. Men with this disorder have a preference for female attire, and women have a strong preference for male attire. The person also reports having persistent discomfort with his or her sex.
Which of the following is common in the childhood history of patients with borderline personality disorder?
['A. Shyness', 'B. Psychosis', 'C. Conduct disorder', 'D. Sexual abuse', 'E. Magical and odd beliefs']
Answer: B. Frotteurism involves sexual arousal by rubbing the genital areas against or by fondling a nonconsenting person. For a diagnosis according to DSM-IV, this behavior has to be present consistently for 6 months. Peak onset occurs in young men between 15 to 25 years of age; incidence declines in the population older than 25.
A 25-year-old woman begins to see a therapist because of loneliness and feelings of being unloved and unwanted with some mild depressive symptoms. She flirts constantly with the therapist and is hurt when the therapist does not reciprocate. Which of the following disorders is she is most likely to have?
['A. Antisocial personality disorder', 'B. Borderline personality disorder', 'C. Schizotypal personality disorder', 'D. Obsessive-compulsive personality disorder E. Histrionic personality disorder']
Answer: E. Pedophilia is characterized by recurrent fantasies, urges, and behaviors involving sexual activity with a prepubescent child or children. The perpetrator is at least 16 years of age and 5 years older than the victim. Pedophilia is either of the exclusive type, in which the person is attracted only to children, or the nonexclusive type.
Which of the following is characteristic of persons with paranoid personality disorder?
['A. Obsession', 'B. Psychotic behavior', 'C. Litigiousness', 'D. Anxiety']
Answer: E. Sexual masochism involves attaining sexual arousal and gratification by being humiliated, beaten, bound, or made to suffer in other ways. Among the methods used are self-mutilation, blindfolding, paddling, spanking, whipping, being urinated or defecated upon, and forced cross-dressing. Infantilism involves the desire to be treated as an infant and dressed in diapers. Hypoxyphilia involves sexual arousal by deprivation of oxygen by noose, ligature, plastic bag, or nitrites. Hypoxyphilia can lead to accidental death.
With which of the following personality disorders is social phobia most likely to be confused?
['A. Avoidant', 'B. Dependent', 'C. Schizoid', 'D. Paranoid']
Answer: A. Klismaphilia is the use of enemas to achieve sexual arousal. Coprophilia, interest in feces, in some individuals is associated with attaining sexual pleasure by defecating on a partner. Partialism involves concentrating sexual activity on one part of the body and excluding other parts totally. Telephone scatalogia involves making obscene telephone calls to attain sexual arousal.
Which of the following is true regarding factitious disorder?
['A. The goal of the person exhibiting the symptoms is to avoid unpleasant consequences at work.', 'B. It is easily diagnosed.', 'C. It is the same as malingering.', 'D. The goal of the person exhibiting the symptoms is to assume the sick role.']
Answer: E. Medroxyprogesterone and leuprolide can be used to reduce sexual drive. SSRIs can also reduce craving for sexual expression. Sexual offenders do not have the skills necessary for maintaining a regular sexual relationship. Cognitive-behavioral therapy is useful in treating sexual offenders.
Which of the following is true regarding narcissistic personality disorder?
['A. Narcissistic traits are common in adolescents.', 'B. It is more common in females.', 'C. Individuals with narcissistic personality disorder have very high self-esteem.', 'D. Individuals with this disorder are good at empathizing with others.']
Answer: E. For a diagnosis of substance-induced sexual function to be made, the dysfunction should occur during or within 1 month following substance indication. There should also be evidence from history, physical examination, and laboratory findings that the substance caused the sexual dysfunction. The following substances are known to cause sexual dysfunction: alcohol, amphetamines, cocaine, opioids, sedatives, hypnotics, and anxiolytics.
For which of the following purposes is the Thematic Apperception Test (TAT) most useful?
['A. As an aid in the differential diagnosis B. In assessment of motivational variables C. In assessment of a patient’s intellectual level D. In assessment of the risk of suicide in a patient']
Answer: E. In a study conducted by University of Chicago, 2.8% of the men and 1.4% of the women who were surveyed reported homosexual orientation; 9% of men and 5% of women reported that they had at least one homosexual experience as an adult.
All of the following are true except A. Gastric emptying is delayed by MAOIs.
['B. Food increases the absorption of diazepam.', 'C. Drugs must be ionized to be absorbed by passive diffusion.', 'D. In an acid pH, basic drugs will be poorly absorbed.', 'E. Rectal administration avoids first-pass metabolism.']
Answer: C. It was in 1973 that the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual (DSM).
Which of the following is true about receptors?
['A. 5-HT2A antagonists improve REM sleep.', 'B. 5-HT1A antagonists are anxiolytic.', 'C. Most antipsychotics are D2 antagonists.', 'D. D2 receptors are found in the limbic system.', 'E. Alpha-2 adrenergic antagonists can cause reduced norepinephrine release.']
Answer: B. Mental retardation is characterized by significantly subaverage intellectual functioning, with IQ approximately 70 or below, onset before age 18 years, and concurrent deficits in or impairment of functioning. The essential feature of mental retardation is significantly below-average general intellectual functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following skill areas: communication, self-care, home living, social interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.
What is the term for the process of hepatic extraction of orally administered drugs before they reach systemic circulation?
['A. Clearance', 'B. Elimination rate constant', 'C. First-pass effect', 'D. Half-life', 'E. Steady state']
Answer: C. Persons with mental retardation that is categorized by DSM-IV as moderate have the mental age of a 9-year-old; persons with Down syndrome function at this level. Moderate mental retardation constitutes about 10% of cases of mental retardation. Most individuals with this level of mental retardation acquire communication skills during early childhood years. They profit from vocational training and, with moderate supervision, can attend to their own personal care. They can also benefit from training in social and occupational skills and may learn to travel independently in familiar places. During adolescence their difficulties in recognizing social conventions may interfere with peer relationships. In their adult years the majority are able to perform unskilled or semiskilled work under supervision in sheltered workshops or in the general workforce. They adapt well to life in the community, usually in supervised settings.
Which of the following is true about lipophilic drugs?
['A. They are slowly absorbed.', 'B. They have a large volume of distribution.', 'C. They have a low first-pass aspect.', 'D. They cross the blood–brain barrier very slowly.', 'E. They are incompletely absorbed.']
Answer: A. Persons with mild mental retardation have an IQ of 55 to 70. Eighty-five percent of persons with mental retardation are in this category. They typically develop social and communication skills during the preschool years, have minimal sensorimotor impairment, and often are not distinguishable from children without mental retardation until a later age. By their late teens, they can acquire academic skills up to approximately the sixth grade level. During their adult years they usually achieve social and vocational skills adequate for minimum self-support but may need supervision, guidance, and assistance especially when under unusual social or economics stress. With appropriate supports, individuals with mild mental retardation can usually live successfully in the community either independently or in supervised settings.
Which of the following can inhibit the cytochrome P-450 system?
['A. Alcohol', 'B. Smoking', 'C. Anticonvulsants', 'D. SSRIs', 'E. Barbiturates']
Answer: E. All of the conditions mentioned have an increased prevalence in those with mental retardation. In addition, psychiatric conditions like ADHD, anxiety disorders, and psychosis are also more common than in the general population.
All of the following can cause an increase in the plasma drug concentration of tricyclic antidepressants except
['A. SSRIs', 'B. Carbamazepine', 'C. Disulfiram', 'D. Methadone', 'E. Methylphenidate']
Answer: D. The prevalence of seizure disorder in those with mental retardation varies with the severity of mental retardation. The prevalence is 15–20% in persons with mild mental retardation, whereas it ranges from 30% to as high as 50% in those with severe retardation.
All of the following in combination with MAOIs can cause serotonin syndrome except
['A. L-tryptophan', 'B. Fluoxetine', 'C. Clomipramine', 'D. Tyramine', 'E. St. John’s wort']
Answer: B. Down syndrome is the most common cause of mental retardation. The risk increases with increasing maternal age. Fragile X is the most common inherited cause of mental retardation.
Which of the following is not a lipophilic drug?
['A. Lithium', 'B. Haloperidol', 'C. Nortryptiline', 'D. Propranolol', 'E. Diazepam']
Answer: C. Down syndrome is characterized by short stature, round skull, brachycephaly, epicanthic folds, Brushfield spots, single palmar crease, high arched palate, protruded tongue, syndactyly, short hands, and atlantoaxial instability. Patients are also prone to develop dementia in their 40s.
All of the following are precursors of monoamines except A. 5-hydroxytryptophan
['B. Dihydroxyphenyl alanine', 'C. 5-hydroxydopamine', 'D. 5-hydroxytryptamine', 'E. L-tryptophan']
Answer: E. Catlike cry is not a feature of fragileX syndrome but, rather, a feature of cri-du-chat syndrome, which is caused by deletion of the short arm of chromosome 5. FragileX syndrome accounts for half of all the X-linked cases of mental retardation. The genetic abnormalities that characterize this syndrome are caused by abnormal repetition of the trinucleotide CGG at a fragile site on the X chromosome. Persons with fragileX syndrome have a shorter than average height, macro-orchidism, large head, a high, arched palate, hyperextensible joints, flat feet, inguinal and hiatus hernia, enlarged aortic root, and mitral valve prolapse. Epilepsy may be seen in 25% of individuals.
Which of the following is not a function mediated by serotonin?
['A. Aggressive behavior', 'B. Sleep', 'C. Problem-solving behavior', 'D. Weight gain', 'E. Sexual behavior']
Answer: B. The main features of Prader-Willi syndrome are hypotonia, hy-pogonadism, hypomentia, and obesity. The majority of children have mild to moderate mental retardation. They develop hyperphagia between the ages of 1 and 4. They also manifest developmental delay and hypogenital-ism. Other features are small hands and feet, cleft palate, incurved foot, congenital dislocation of the hip, scoliosis, heart disease, and deafness.
Which of the following is a precursor of norepinephrine?
['A. Serotonin', 'B. Epinephrine', 'C. Acetylcholine', 'D. Dopamine']
Answer: D. Rett syndrome is seen in females exclusively. A normally developing child begins to slow or regress in her development within the first year or two of life and develops unusual characteristic or stereotyped hand movements. Loss of developmental skill occurs, and head growth decelerates. As individuals with Rett syndrome approach adolescence, they have increased spasticity, scoliosis, bruxism, hyperventilation, apnea, and seizures.
With which of the following is cholestatic jaundice most commonly seen?
['A. Lithium', 'B. Chlordiazepoxide', 'C. Chlorpromazine', 'D. Fluoxetine', 'E. Amitryptiline']
Answer: C. Eighty-five percent of persons with Lesch-Nyhan syndrome exhibit self-injurious behavior. Lesch-Nyhan syndrome is an X-linked recessive condition. Infants with Lesch-Nyhan syndrome develop hypertonia, spasticity, ataxia, and choreoathetosis. Most children who are affected have severe mental retardation, and half of them develop seizures. Microcephaly and macrognathia may be present. They also show physical and verbal aggression.
Which of the following mediates hypotension following chlorpromazine use?
['A. Depression of the respiratory center B. Ionotropic effect on heart', 'C. Alpha-adrenergic blocking effect', 'D. H1 (histamine) blocking effect', 'E. Alpha-adrenergic agonist effect']
Answer: B. Some children with Prader-Willi syndrome have severe mental retardation, although the majority of children affected have mild to moderate mental retardation. The other conditions mentioned are not typically associated with severe mental retardation.
Which of the following drugs is useful as an antiemetic?
['A. Naloxone', 'B. Tetracycline', 'C. Caffeine', 'D. Epinephrine', 'E. Chlorpromazine']
Answer: C. The essential features of Asperger syndrome are severe and sustained impairment of social interaction and the development of restricted, repetitive patterns of behavior, interests, and activities. In the early development of a child with Asperger syndrome there is no significant delay in acquisition of spoken or receptive language or in cognitive development or self-help skills. Children with Asperger syndrome often exhibit an eccentric social lifestyle, as opposed to the passive, aloof style in autism. Certain aspects of communication may become deviant over time; for example, poor prosody, unusual rate of speech, and other deviances may be shown. Cognitive functions may be characterized by areas of relative strength (auditory and verbal skills and rote learning) and areas of weakness (visuo-motor and visuoperceptual skills).
The elimination of which of the following benzodiazepines is not influenced by liver disease?
['A. Midazolam', 'B. Alprazolam', 'C. Chlordiazepoxide', 'D. Lorazepam', 'E. Diazepam']
Answer: D. Anorexia nervosa is not commonly seen in persons with mental retardation.
At which of the following receptors do benzodiazepines act?
['A. GABA-B receptor', 'B. 5-HT1A receptor', 'C. GABA-A receptor', 'D. D2 (Dopamine)', 'E. Chloride channels']
Answer: B. Seizure disorder with mental retardation does not frequently cause schizophreniform psychosis. Seizure disorder is common in persons with mental retardation. It is difficult to control and may require treatment with more than one medication. Over time, the seizures can accelerate the person’s intellectual deterioration. The seizures per se rarely result in violence.
What was the first benzodiazepine to be used in treatment of patients?
['A. Diazepam', 'B. Lorazepam', 'C. Temazepam', 'D. Chlordiazepoxide', 'E. Nitrazepam']
Answer: E. Various conditions can present as loss of skills in persons with mental retardation, including depression, psychosis, anxiety, dementia, and physical conditions, including hypothyroidism, pain, and hearing and visual loss.
Which of the following is true about diazepam?
['A. Peak plasma concentrations are reached in 2 to 3 hours.', 'B. Intramuscular absorption is faster than oral.', 'C. It is highly lipid-soluble.', 'D. It is about 50–60% protein bound in the body.', 'E. It does not cross the placenta.']
Answer: D. Children with mental retardation may not disclose sexual abuse because of the inability to verbalize, lack of understanding, or fear. They are at high risk of sexual abuse. People with mental retardation do benefit from psychotherapy and should not be discouraged from relating their abusive experiences.
What is the primary site of metabolism of diazepam?
['A. Kidneys', 'B. Liver', 'C. Small intestine', 'D. Spleen', 'E. Body fat']
Answer: C. Sexual abuse of children with mental retardation can present as increase in disruptive behavior, stereotyped movements, depression, or anxiety. It can also result in regression of abilities or sophisticated or new sexualized behaviors.
Which of the following is not a side effect of benzodiazepines?
['A. Ataxia', 'B. Nightmares', 'C. Drowsiness', 'D. Amnesia', 'E. Restlessness']
Answer: C. Depression in people with mental retardation may present with increase in self-injury, diurnal behavioral changes, crying, increased tearfulness, psychomotor retardation, self-absorption, loss of interest in usual activities, and disturbance of sleep and appetite. Depressive moods may not be verbalized. Talking to self and laughing is more likely to suggest psychosis.
Which of the following is not seen with benzodiazepine use?
['A. Induction of hepatic microsomal enzymes B. Leucopenia', 'C. Esinophilia', 'D. Change in plasma cortisol', 'E. Respiratory depression']
Answer: D. Special interviewing techniques may need to be used for persons with mental retardation. The interview should begin with open questions. Questions of either/or variety are particularly helpful. The use of pen and paper by the patient to write or draw is helpful. Interviewees should be given a longer than usual time because of their mental retardation and should not be hurried through the interview.
Which of the following is true regarding benzodiazepines?
['A. Chlordiazepoxide has a longer half-life than diazepam.', 'B. Diazepam is more lipid-soluble than lorazepam.', 'C. Lorazepam is more extensively distributed in the body than diazepam.', 'D. Temazepam produces active metabolites.']
Answer: C. Pharmacotherapy does have a very useful role in the treatment of aggressive behavior. A multidisciplinary approach is best. A combination of pharmacotherapy and behavioral intervention is often the most helpful. Treatment should be based on a search for underlying causes. It can be done with the patient as an inpatient or an outpatient basis.
Which of the following has the shortest half-life?
['A. Alprazolam', 'B. Oxazepam', 'C. Temazepam', 'D. Flurazepam', 'E. Lorazepam']
Answer: D. Some patients with Asperger syndrome are clumsy and have problems with motor coordination. Verbal deficits are more common than nonverbal deficits. Relatives are not at increased risk of schizophrenia.
Which of the following has active metabolites?
['A. Oxazepam', 'B. Chlordiazepoxide', 'C. Temazepam', 'D. Triazolam', 'E. Lorazepam']
Answer: C. Asperger syndrome has a major genetic component. It is difficult to distinguish from autism and is more prevalent than classic autism. It continues into adulthood and is not associated with cognitive impairment.
Which of the following is not a symptom of benzodiazepine withdrawal?
['A. Hallucinations', 'B. Tremor', 'C. Depression', 'D. Tinnitus', 'E. Depersonalization']
Answer: E. Almost everyone with Down syndrome has neurofibrillary tangles by the age of 50.
Which of the following may raise plasma concentrations of benzodiazepines?
['A. Barbiturates', 'B. Cimetidine', 'C. Phenytoin', 'D. Carbamazepine', 'E. Rifampicin']
Answer: B. Aggression is the most common reason that psychiatric consultation is sought for individuals among the mentally retarded population. The other conditions mentioned are also more common in the mentally retarded population than in the general population.
Which of the following features is not seen in children born to mothers taking benzodiazepines?
['A. Cleft lip', 'B. Cleft palate', 'C. Respiratory depression', 'D. Absent arms and legs', 'E. Withdrawal symptoms']
Answer: A. Night terrors occur in stage 4 sleep (deep sleep). Peak incidence is between 4 and 7 years of age. The child wakes up from sleep in a terrified state, does not respond when spoken to, and does not appear to see objects or people. Instead the child appears to be hallucinating and may be talking to and looking at people or things that are not actually present. This behavior may continue for up to 15 minutes, during which time the child does not respond to comforting. Eventually, the child goes back to sleep, and upon awaking, has no recollection of the events.
Which of the following is a feature of the sleep pattern upon benzodiazepine withdrawal?
['A. Decrease in REM sleep', 'B. Decreased sleep latency', 'C. REM sleep rebound', 'D. Increased stage 4 sleep', 'E. Suppression of NREM sleep']
Answer: C. Somnambulism, or sleepwalking, typically occurs between the ages of 8 and 14 years. It occurs in stage 3 or 4 of sleep. The child arises calmly from bed with a blank facial expression and cannot be awakened without difficulty. Criminal activity is uncommon. The condition may be familial.
How long does it take for tolerance to benzodiazepines to develop?
['A. 2 days', 'B. 2–3 weeks', 'C. 1–2 months', 'D. 4–6 months', 'E. At least 6 months']
Answer: B. Nightmares occur during REM sleep. They are unlike night terrors in that the child can be awakened and has a clear recollection of the events. Daytime anxieties and frightening television programs may be contributory.
To which of the following can a person taking benzodiazepines have cross-tolerance?
['A. Antipsychotics', 'B. SSRIs', 'C. MAOIs', 'D. Alcohol', 'E. Noradrenergic reuptake inhibitors']
Answer: D. Narcolepsy is associated with HLA DR2 in up to 99% of cases. Onset is typically in the early 20s, and it affects men and women equally. Very rarely is there a family history of narcolepsy in a narcoleptic patient. Cataplexy is seen in up to 90% of patients with narcolepsy.
Which of the following is true regarding drug dependence in patients on benzodiazepines?
['A. It is associated with drugs with long half-life.', 'B. It is associated with the short duration of treatment.', 'C. It is more likely in patients with passive and dependent personality traits.', 'D. Symptoms begin 1 to 2 weeks after stopping the drug.', 'E. Symptoms usually resolve within a week.']
Answer: A. Diagnosis can be confirmed by means of the Multiple Sleep Latency Test. Narcolepsy is a tetrad of features: hypersomnolence is found in 100% of cases, cataplexy in 90%, sleep paralysis in 40%, and hypnogogic hallucinations in 30%. At least 50% of persons with narcolepsy also have a major affective disorder or personality problems. Honda et al. (1983) described the association between narcolepsy and HLA DR2, which they found to be positive in 99% of patients. First-degree relatives have a 40-fold higher chance of having the illness than the general population. Sleep attacks are irresistible and usually occur in boring situations. Diagnosis is usually delayed, and the quality of life in these patients is very poor. Treatment includes psychostimulants (methylphenidate and amphetamine) and sedatives (if paradoxically disrupted nocturnal sleep occurs). Cataplexy is treated with tricyclic antidepressants.
With which of the following is lithium administration during pregnancy associated?
['A. Ebstein’s anomaly', 'B. Depression in the infant', 'C. Neural tube defects', 'D. Hyperglycemia in the newborn']
Answer: C. Almost all the antidepressants suppress REM sleep to some extent. Most of the antidepressants help sleep disturbances secondary to depression. Trazodone has been found to be particularly effective in treatment of sleep disturbances associated with depression.
Which of the following drugs can produce ataxia at therapeutic doses?
['A. Imipramine', 'B. Carbamazepine', 'C. Pimozide', 'D. Chlorpromazine', 'E. Fluoxetine']
Answer: A. Loss of muscle tone is a characteristic feature of REM (rapid eye movement) sleep, also known as paradoxical sleep, which typically starts 90 to 120 minutes after the onset of sleep and then alternates with periods of non-REM sleep in the sleep cycle. It is during REM sleep that most dreaming occurs. K complexes and sleep spindles are characteristic of stage 2 sleep. Early REM onset is seen in depression. REM sleep within a few minutes of sleep onset is suggestive of narcolepsy. Alpha activity is not seen in REM sleep.
The presence of benzodiazepine withdrawal as opposed to anxiety is suggested by all of the following except
['A. Hyperawareness of senses', 'B. Abnormal sense of body movement', 'C. Dysphoria', 'D. Poor sleep with excess worry', 'E. Metallic taste in the mouth']
Answer: A. In depression, patients complain of lack of sleep, early morning awakening, and not feeling refreshed by sleep. Sleep studies show shortened REM latency, increase in REM sleep, and decreased slow-wave deep sleep. Most of the antidepressants suppress REM sleep.
Which of the following is an effect of benzodiazepines in therapeutic dosage?
['A. They block the reuptake of amines.', 'B. They prevent stress-induced increase in brain metabolism.', 'C. They depress the cardiovascular system.', 'D. They inhibit monoamine oxidase.', 'E. They affect the reticular activating system.']
Answer: A. Stage 2 is a physiologic stage of sleep that typically accounts for 40% to 50% of the total sleep time. Benzodiazepines promote stage 2 at the expense of stages 3 and 4. Stage 2 is characterized by sleep spindles and K complexes.
Which of the following is not a side effect of benzodiazepines?
['A. Ataxia', 'B. Confusional state', 'C. Acute dystonia', 'D. Aggression', 'E. Drowsiness']
Answer: D. Psychophysiologic insomnia accounts for about 15% of the cases seen at any sleep center. It typically starts in the early 20s and may persist for decades. Stress seems to precipitate it and the insomnia persists long after the stressor is overcome. Persons with psychophysiologic insomnia do not have any obvious psychiatric disorders. Their anxiety is mainly associated with their preoccupation about the insomnia and not about other areas of life. First-degree relatives of persons with this sleep disturbance also have sleep problems, which suggests a possible genetic contribution.
Which of the following is false regarding benzodiazepines?
['A. They potentiate GABA.', 'B. They may have hangover effects.', 'C. They modulate chloride channel flow.', 'D. They are used to abort seizures.', 'E. Their effects are antagonized by naloxone.']
Answer: B. Schizotypal personality disorder is characterized by discomfort in close relationships, cognitive and perceptual distortions, and eccentric behavior. This pattern begins in early adulthood and is present in a variety of contexts. Persons with schizotypal personality disorder usually have ideas of reference. They may also be superstitious or preoccupied with para-normal phenomena outside the norms of the subculture.
All of the following drugs can cause tremors except A. Amitriptyline
['B. Diazepam', 'C. Lithium', 'D. Haloperidol', 'E. Phenelzine']
Answer: B. Personality disorders are characterized by deeply ingrained, in-flexible patterns of behavior. They cause conflict in relationships and impaired adaptive functioning. They usually cause subjective distress. The pervasive personality traits are evident by adolescence and persist throughout adult life, though the features tend to mellow or ameliorate with age.
Which of the following is true about tricyclic antidepressants?
['A. They are safer than ECT in patients with a history of myocardial infarction.', 'B. They should be avoided in patients with early cataract.', 'C. They cause weight loss.', 'D. They potentiate the pressor effect of norepinephrine.', 'E. Concurrent antipsychotic administration can attenuate their actions.']
Answer: B. Borderline personality disorder is diagnosed more often in women. It is more common than antisocial personality disorder. Up to 2% of the general population may have borderline personality disorder. Persons with this disorder typically have a history of pervasive instability of mood, relationships, and self-image beginning by early adulthood. Their behavior is impulsive and chaotic, and recurrent suicidal gestures are common.
All of the following are side effects of tricyclic antidepressants except A. Blurred vision
['B. Tachycardia', 'C. Tremors', 'D. Impotence', 'E. Diarrhea']
Answer: D. There is a high frequency of neglect, abandonment, and physical and sexual abuse in the history of individuals with borderline personality disorder.