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Which of the following is true about obsessional thoughts?

['A. They are rarely of a sexual nature.', 'B. They are best treated by thought stopping.', 'C. Desipramine is the drug of choice.', 'D. They always give rise to compulsions.', 'E. They are ego-dystonic.']

Answer: D. Thought block is not a first-rank symptom though thought withdrawal is.

Which of the following is true regarding passivity experiences?

['A. They include echo de la pense.', 'B. They exclude thought broadcasting.', 'C. They are common in bipolar disorder.', 'D. They are also called made experiences.', 'E. They occur in obsessional states.']

Answer: E. Obsessional thoughts are recurrent, intrusive, and distressing. Patients realize these are their own thoughts and find them distressing. The obsessional thoughts are commonly of a sexual nature. Thought stopping can be used as an intervention but may not be very effective. Patients respond to medications with an affinity for serotonin receptors, such as clomipramine and SSRIs. The thoughts do not always give rise to compulsions, though they commonly do.

Frequent wrist cutting is seen in all of the following except A. Borderline personality disorder

['B. Schizophrenia', 'C. Depression', 'D. Obsessive-compulsive personality disorder E. High states of tension']

Answer: D. Passivity experiences are also called made experiences, as the patient perceives them to be under the control of an external force. Echo de la pense (thought echo) is the phenomenon in which the patient hears his thoughts aloud. Thought broadcasting is a passivity phenomenon. Psychotic symptoms are not seen in obsessional states. Passivity phenomena may be seen in bipolar disorder but are not common.

Which of the following is not a disorder of thought process?

['A. Omission', 'B. Substitution', 'C. Blurring of conceptual boundaries', 'D. Knight’s move thinking', 'E. Paranoid delusions']

Answer: E. Frequent wrist cutting is seen in a wide range of psychiatric conditions, including schizophrenia, depression, and bipolar disorder. Patients typically report a relief of tension following the act. It is not associated with obsessive-compulsive disorder.

The experience of seeing one’s own body projected into external space is called

['A. Reflex hallucination', 'B. Autoscopic hallucination', 'C. Hypnagogic hallucination', 'D. Pseudohallucination']

Answer: E. Paranoid delusion is a disorder of thought content. The others are examples of disorder of thought process or form.

Which of the following is true about depersonalization?

['A. It is a psychotic experience.', 'B. It is treated with phenobarbitone.', 'C. It is usually pleasant.', 'D. It is associated with depression.', 'E. It is recognized as odd.']

Answer: B. This phenomenon is rare and is encountered in a small minor-ity of patients with temporal lobe epilepsy or other organic brain disorders. In reflex hallucination, a stimulus in one sensory modality results in a hallucination in another.

Which of the following is true about the reliability of psychiatric diagnosis?

['A. It is not increased by training psychiatrists.', 'B. It is not important if validity is guaranteed.', 'C. It is increased by semistructured interviews.', 'D. It is not increased by operational definitions.', 'E. It has not been tested internationally.']

Answer: E. In depersonalization, one’s own feelings are experienced as being detached, distant, not being one’s own, lost, or altered. The person recognizes that this is a subjective change and not a change imposed by outside forces. It is experienced as unpleasant and odd. It is associated with depression, anxiety, and use of various substances, especially hallucinogens.

Which of the following is true regarding delusions?

['A. They are usually of a bizarre nature.', 'B. They are reality for the patient.', 'C. They are held with a conviction that is shakable.', 'D. They are usually self-referent.', 'E. They may present as obsessive-compulsive disorder.']

Answer: C. The reliability of psychiatric diagnosis is increased by the use of semistructured interviews. It is increased by training. Reliability and validity are both important while making a diagnosis. The use of operational criteria like the DSM increases reliability. Most diagnoses have been tested internationally across various cultures.

Which of the following is not an experience seen in normal people?

['A. Depersonalization', 'B. Déjà vu', 'C. Jamais vu', 'D. Encapsulated delusions', 'E. Ideas of reference']

Answer: B. There are various definitions of delusions. A delusion is often defined as “a false, unshakable belief that is out of keeping with the patient’s social and cultural background.” Sometimes, the contents of delusions do not go beyond the impossible and may be true. Thus, delusions may also be defined as “overriding rigid convictions that create a self-evident, private, and isolating reality requiring no proof.” Most delusions are not of a bizarre nature, and all delusions are self-referent.

Which of the following is not a feature of Gilles de la Tourette syndrome?

['A. Coprolalia', 'B. Echopraxia', 'C. Echolalia', 'D. Coprophagia', 'E. Tics']

Answer: D. Encapsulated, overvalued ideas may be seen in normal people. However, delusions are not. Depersonalization, déjà vu, jamais vu, ideas of reference, and hallucinations are all part of normal experience.

Pseudohallucinations occur in all of the following except A. Long-distance truck drivers

['B. Sensory deprivation', 'C. Dreams while asleep', 'D. Prisoners in solitary confinement', 'E. Dreams while awake']

Answer: D. Tourette syndrome begins before age 21 and is characterized by motor tics, vocal tics, coprolalia (utterance of obscenities), copropraxia (obscene gestures), echolalia, echopraxia, and self-injurious behavior. It is not associated with coprophagia. Associated psychiatric conditions include depression, anxiety, personality disorder, ADHD, and obsessive-compulsive disorder.

Which of the following does not favor a diagnosis of delirium?

['A. Symptoms worsening in the evenings', 'B. Visual hallucinations', 'C. Misidentification', 'D. Delusions of persecution', 'E. Improvement at night']

Answer: C. The term “pseudohallucination” is used when the hallucinations are recognized as unreal. This term was introduced by Jaspers. Daydreaming can at times have the quality of a pseudohallucination. It is also seen in sensory deprivation states like long-distance truck drivers and prisoners in solitary confinement.

Verbigeration is seen in

['A. Ganser syndrome', 'B. Catatonic schizophrenia', 'C. Malingering', 'D. Bereavement', 'E. Depression']

Answer: E. “Delirium” is a term used to cover all types of acute disturbance of consciousness with general impairment of cognition whether or not the patient was overactive and disturbed. The clinical features are impairment of consciousness with symptoms worse at night; agitation or hypoactivity; labile mood; incoherent speech; abnormalities of perception with visual hallucinations, illusions, and misinterpretation; cognitive dysfunction with impairment of orientation, concentration, and memory with impaired insight. Delusions may be seen, but they are fragmented and unsystematized.

The characteristic hallucinations seen in alcoholic hallucinosis are A. Tactile

['B. Auditory', 'C. Gustatory', 'D. Olfactory', 'E. Synesthesic']

Answer: B. Verbigeration is a constant repetition of syllables and sound. It is seen in schizophrenia and organic language disorders.

Which of the following is false about ideas of reference?

['A. They are always pathological.', 'B. They occur in alcoholics.', 'C. They are not delusions.', 'D. They may improve spontaneously.', 'E. They can lead to social isolation.']

Answer: B. Auditory hallucinations are the characteristic hallucinations in alcoholic hallucinosis. Auditory hallucinations are present in a clear consciousness without autonomic overactivity. They often begin as simple noises but are gradually replaced by voices that may threaten or abuse the person. Usually the remarks are addressed in the second person. Classified as a substance-induced psychotic disorder, the hallucinations usually respond rapidly to medication and abstinence, and the prognosis is good.

Which of the following is not a type of catatonia?

['A. Echopraxia', 'B. Cataplexy', 'C. Catalepsy', 'D. Psychological pillow', 'E. Stupor']

Answer: A. Ideas of reference can occur in normal people in the absence of any illness. They are not delusions and may resolve spontaneously. They may result in social isolation due to suspiciousness. They are common in alcoholics.

Schneider first-rank symptoms are

['A. Primary psychological symptoms from which all others are derived B. Common in autistic children', 'C. Predictive of decline in social functioning D. Diagnostic of schizophrenia', 'E. Seen in mania']

Answer: B. Cataplexy is the loss of muscle tone seen with sleep and narcolepsy. Echopraxia is the imitation of action of others. In catalepsy, uncomfortable and bizarre postures are maintained against gravity or efforts to rectify them. In psychological pillow, the patient holds his head above the level of the bed while lying down. This is a form of catalepsy. In stupor, the patient does not communicate or move though he or she is alert.

In history taking and mental status examination, all of the following are true except

['A. Occupational history may give an indication of severity of condition.', 'B. Cognitive testing is not indicated if a full history is obtained.', 'C. Family history may give a clue about family dynamics.', 'D. Mental status examination need not be done in the recommended sequence.', 'E. Proverb interpretation demonstrates concrete thinking.']

Answer: E. Schneider first-rank symptoms are phenomena that strongly indicate schizophrenia in the absence of overt brain disease. They have no prognostic value. The presence of more than one first-rank symptom does not increase the probability of schizophrenia. They may be seen in conditions other than schizophrenia; up to one-quarter of patients with mania may have first-rank symptoms.

Loosening of association is pathognomonic of A. Schizophrenia

['B. Mania', 'C. Depression', 'D. All of the above', 'E. None of the above']

Answer: B. The ability to obtain a good history does not preclude the need for cognitive testing. Occupational history may give an indication of the severity of the condition. Proverb interpretation demonstrates concrete thinking, and mental status exam can be done and recorded in any form.

Obsessions in obsessive-compulsive disorder may present as A. Hallucinations

['B. Delusions', 'C. Mental images', 'D. Panic attacks', 'E. Thought echo']

Answer: E. Loosening of association is most commonly seen in schizophrenia; however, it is not pathognomonic of any particular condition.

Which of the following conditions does not classically cause emotional lability?

['A. Mania', 'B. Severe depression', 'C. Pseudobulbar palsy', 'D. Hysteria', 'E. Delirium']

Answer: C. Obsessions, by definition, cannot be psychotic phenomena. They may present as mental imagery.

Which of the following is not seen in alexithymia?

['A. Lack of empathy', 'B. Reduced fantasy thinking', 'C. Reduced symbolic thinking', 'D. Inability to experience feelings', 'E. Difficulty reading']

Answer: B. Emotional lability may be seen in mania, pseudobulbar palsy, hysteria, delirium, and mild to moderate depression. However, in severe depression, the patient usually has sustained low moods.

Visual hallucinations are most commonly seen in A. Late-onset schizophrenia

['B. Temporal lobe dementia', 'C. Antihypertensive treatment', 'D. Acute organic psychosis', 'E. Untreated depression']

Answer: E. Alexithymia is an inability to describe or recognize one’s emotions. Patients also have a limited fantasy life, constriction of affective life, reduced symbolic thinking, and an inability to empathize with others. Difficulty reading is not a feature of alexithymia.

Repetitive, voluntary, purposeful movements are called A. Stereotypy

['B. Mannerism', 'C. Obsession', 'D. Ritual', 'E. Automatism']

Answer: D. Visual hallucinations are common in delirium. In fact, they are extremely uncommon in functional psychiatric illnesses. They are not a common feature of late-onset schizophrenia, which is more likely to be characterized by delusions and auditory hallucinations, though visual hallucinations may be present. Frontotemporal dementia presents with disorganized behavior, change in personality, poor insight, emotional blunting, and stereotyped and perseverative behavior. Untreated depression can result in hallucinations, but they are more often auditory.

The diminution of emotional response is called A. Blunting of affect

['B. Flattening of affect', 'C. Alexithymia', 'D. Depression', 'E. Perseveration']

Answer: B. This is the definition of mannerism. Stereotypy is the constant repetition of meaningless and purposeless gestures or movements. In automatism, the individual is consciously or unconsciously, but involuntarily, compelled to perform certain motor or verbal acts.

The most commonly seen symptom in schizophrenia is A. Delusion

['B. Visual hallucinations', 'C. Auditory hallucinations', 'D. Thought withdrawal', 'E. Thought echo']

Answer: A. Diminution of emotional response is called blunting of affect. Flattening of affect is strictly speaking the absence of an emotional response.

Perseveration is most commonly seen in A. Schizophrenia

['B. Organic brain disorders', 'C. Depression', 'D. Anxiety', 'E. Obsessive-compulsive disorder']

Answer: C. Auditory hallucinations are the most commonly seen symptom in schizophrenia from among the five listed answers.

The experience of seeing one’s own body in external space is called A. Autoscopic hallucination

['B. Extracampine hallucination', 'C. Reflex hallucination', 'D. Visual hallucination', 'E. Gedankenlautwerden']

Answer: B. Perseveration is the inability to shift from one theme to another. A thought is retained long after it has become inappropriate in the given context. It is seen in organic brain disorders.

When a person believes that someone known to him has been replaced by a double, the condition is known as

['A. Fregoli syndrome', 'B. de Clerambault syndrome', 'C. Capgras syndrome', 'D. Othello syndrome', 'E. Diogenes syndrome']

Answer: A. Autoscopy is the experience of seeing one’s own body in external space. Extracampine hallucination is the experience of a hallucination outside the field of that particular sense. Reflex hallucination is the presence of hallucinations in one modality when the stimulus is in another modality. Gedankenlautwerden is also called echo de la pense or thought echo.

Which of the following is a feature of obsessions?

['A. Patient believes they come from an external source.', 'B. Patient believes they are logical.', 'C. Patient finds them pleasurable.', 'D. Patient finds them distressing and unpleasant.', 'E. There is no resistance to them.']

Answer: C. In Capgras syndrome, a person believes that someone known to him has been replaced by an exact double. In Fregoli syndrome, the patient believes that one or more individuals have altered their appearance to resemble familiar people, usually to persecute the patient. In de Clerambault syndrome, the patient believes that another person, usually of higher social standing, is in love with him. Othello syndrome is also called pathological or morbid jealousy. Diogenes syndrome is also called senile squalor, characterized by hoarding and self-neglect.

A patient’s imitating of the examiner’s movements even when asked not to do so is called

['A. Echolalia', 'B. Echopraxia', 'C. Ambitendence', 'D. Waxy flexibility', 'E. Mannerism']

Answer: D. In obsession, patients realize that the obsessive thoughts are their own and illogical, perceive the thoughts as distressing and unpleasant, and usually try to resist them, though with long-standing illness resistance may be absent.

The patient’s lack of awareness of his or her illness or condition is called A. Anosognosia

['B. Hemisomatognosis', 'C. Prosopagnosia', 'D. Autotopagnosia', 'E. Anton syndrome']

Answer: B. Echopraxia is the imitation of movements or actions. Echolalia is the repetition of words. Ambivalence or ambitendence is an inability to make decisions. In waxy flexibility, an awkward posture is held by the patient without distress for longer than would be possible for a normal individual.

Presence of insight is suggested by all of the following except A. Patient recognizes that he is ill.

['B. Patient recognizes that the illness is of a psychological nature.', 'C. Patient recognizes that he needs treatment.', 'D. Patient is willing to accept help.', 'E. Patient agrees with all that the doctor says.']

Answer: A. In anosognosia, patients are unaware of their illness or condition. Anton syndrome is a form of cortical blindness in which the patient denies the visual impairment. It is caused by occipital lobe damage that extends from the primary visual cortex into the visual association cortex.

Which of the following is a self-rating scale?

['A. Hamilton Depression Rating Scale', 'B. Beck Depression Inventory (BDI)', 'C. Montgomery-Asberg Depression Rating Scale D. Yale-Brown Obsessive-Compulsive Scale E. Positive and Negative Syndrome Scale (PANSS) 48. Which of the following is a psychological test to detect organic brain damage?', 'A. Cattell P-16', 'B. Rorschach test', 'C. Stanford-Binet test', 'D. New Word Learning Test', 'E. Minnesota Multiphasic Personality Inventory (MMPI) 49. Tactile hallucinations are seen in A. Dermatitis artefacta', 'B. Alcoholic polyneuropathy', 'C. Cocaine abuse', 'D. Obsessive-compulsive disorder', 'E. Panic disorder']

Answer: E. Agreement with all that the doctor says does not necessarily demonstrate good insight. The criteria that may be used to judge insight are (a) the patient realizes that he has an illness; (b) the patient recognizes the illness to be of a psychological nature; (c) the patient thinks he needs help with the illness; or (d) the patient is willing to accept help.

Nihilistic delusions are most likely to be seen in A. Cotard syndrome

['B. Schizophrenia', 'C. Capgras syndrome', 'D. Fregoli syndrome']

Answer: B. Beck Depression Inventory (BDI) is a self-rating scale. All the others are clinician-rated or observer-rated scales.

A 37-year-old Caucasian male with a history of chronic paranoid schizophrenia is hospitalized for a relapse of symptoms. He is given parenteral haloperidol because he is very agitated and threatening. The patient continues to be belligerent and has to be put in physical restraints. The next day the patient is less agitated and belligerent, but he reports feeling nauseated and tired and toward evening is found to be disoriented to time and place.

['A. Intramuscular injection', 'B. Myoglobinuria due to muscle breakdown secondary to struggling when restrained', 'C. Dystonia secondary to multiple doses of pareneteral antipsychotic D. All of the above']

Answer: D. The New Word Learning test is a test to detect organic brain damage. Cattell P-16 and MMPI are personality inventories. Rorschach test is a projective test and Stanford-Binet is a test for intelligence.

A 32-year-old patient has been under treatment for chronic paranoid schizophrenia. He presents to the ER with a relapse of symptoms and is admitted to the hospital because he is very agitated. He had missed an appointment with his psychiatrist a few days before, although he had his WBC count done the day before that. He is started back on clozapine at the same dosage he was receiving before admission: 450 mg. The next morning he is found unconscious near his bed with a bump on the head. Which of the following could have led to this clinical situation?

['A. Starting the patient on clozapine', 'B. Starting the patient on the same dosage of clozapine as previously C. Not starting the patient on benztropine D. None of the above']

Answer: C. Tactile hallucination is classically seen in cocaine use. Alcoholic polyneuropathy does not cause hallucinations. Obsessive-compulsive disorder or panic disorder is not associated with hallucinations. Dermatitis artefacta is a self-inflicted dermatological injury produced for secondary gain. It is not associated with hallucinations.

A 58-year-old African American male with a long history of NIDDM develops blindness. Approximately 6 months later, he is brought to the ER by his girlfriend. According to the girlfriend, the patient has been reporting seeing burglars breaking into their house. The patient is well oriented to time and place, and he reports that although he realizes what he is seeing is untrue, the experience is very unsettling for him. What is this phenomenon called?

['A. Doppelganger', 'B. Reflex hallucinations', 'C. Charles Bonnet syndrome', 'D. Functional hallucinations']

Answer: A. In Cotard syndrome, the patient has nihilistic delusions, that is, beliefs about the nonexistence of some person or thing. The thoughts are associated with extreme degrees of depressed mood. Comparable ideas concerning failures of bodily function often accompany nihilistic delusions.

Which of the following is one of the four A s identified by Eugene Bleuler as the primary symptoms of schizophrenia?

['A. Abnormal association', 'B. Autistic behavior', 'C. Ambivalence', 'D. All the above']

Answer: D. Intramuscular injections can lead to muscle injury and an increase in CPK values. When an agitated patient is put in restraints and struggles against the restraints, the patient may develop physical injuries, which can lead to muscle breakdown. Parenteral injections can lead to acute dystonic reactions, which can also lead to muscle breakdown. Muscle breakdown can lead to myoglobinuria, which in turn can lead to acute renal failure.

What is the total direct and indirect cost of schizophrenia to the U.S. economy annually?

['A. $100 billion', 'B. $50 billion', 'C. $65 billion', 'D. $40 billion']

Answer: B. A patient who has been off clozapine for more than 36 hours needs to be put back on the starting dosage and the dose slowly increased. Starting at a higher dosage can lead to orthostatic hypotension and other side effects associated with clozapine.

What is the concordance rate for schizophrenia in monozygotic twins?

['A. 90–100%', 'B. 10–20%', 'C. 30–40%', 'D. 40–50%']

Answer: C. Charles Bonnet syndrome is seen in people with recently developed blindness. The person knows that the visual hallucination is not real. A hallucination of one’s own body, which leads to the belief that one has a double, is called doppelganger.

Which of the following cognitive impairments is found in persons with schizophrenia?

['A. Deficits in information processing', 'B. Deficits in executive function', 'C. Deficits in language ability', 'D. None of the above', 'E. All of the above']

Answer: D. According to Bleuler, the four primary symptoms of schizophrenia are abnormal associations, autistic behavior, abnormal affect, and ambivalence.

Which season of birth is associated with a higher incidence of schizophrenia?

['A. Spring', 'B. Summer', 'C. Autumn', 'D. Winter']

Answer: C. The direct and indirect costs of schizophrenia are estimated to cost the U.S. economy around $65 billion annually. Direct cost to the United States is approximately $20 billion.

Which of the following brain regions has consistently been shown to have abnormal volume measurements?

['A. Occipital and parietal regions', 'B. Parietal region', 'C. Temporal region', 'D. Frontal and temporal regions']

Answer: D. Monozygotic twins have a concordance rate of 40–50% for schizophrenia. The lifetime prevalence of schizophrenia for relatives of schizophrenic patients is 4–5% for parents, around 10% for siblings, 13–15% for children with one parent who has schizophrenia, and around 35% for children of parents who are both schizophrenic.

Which of the following antipsychotics has been used in receptor-binding PET studies of schizophrenia?

['A. Droperidol', 'B. Amisulpride', 'C. Clozapine', 'D. Raclopride']

Answer: E. Patients with schizophrenia show impaired attention and concentration, information processing, executive functions, and memory and language functions.

Which of the following psychoanalysts introduced the concept of the schizophrenogenic mother?

['A. Bateson', 'B. Fromm-Reichmann', 'C. Vaughn and Leff', 'D. Brown']

Answer: D. It has been shown that a disproportionate number of children born during winter develop schizophrenia.

A 28-year-old Southeast Asian man presents to the ER accompanied by his parents. According to family members, the patient has been extremely anxious, not sleeping at night and not going to work regularly. During the interview, the patient reports that he is afraid his penis is becoming small and receding into his body. What is the clinical situation described by this man?

['A. Dhat', 'B. Piblokto', 'C. Latah', 'D. Koro']

Answer: D. It has consistently been shown persons with schizophrenia have decreased volume of the frontal and temporal regions. Schizophrenia has also been implicated in reduced volume of the superior temporal gyrus, hippocampus, and thalamus.

Which French psychiatrist introduced the concept of “folie circulaire” (circular insanity)?

['A. Jean-Pierre Falret', 'B. Jules Baillarger', 'C. Benjamin Rush', 'D. Gabriel Langfeldt']

Answer: D. Raclopride has been used in quantitative PET studies of occupancy of dopamine receptors in patients with schizophrenia.

A patient with chronic schizophrenia walks the floors of the state hospital where he is an inmate swearing aloud at other inmates. The resident in charge of this patient tells him that he has to earn the right to watch TV

['A. Extinction', 'B. Token economy', 'C. Counterconditioning', 'D. None of the above']

Answer: B. Frieda Fromm-Reichmann propounded the concept of the schizophrenogenic mother, described as being cold, overprotective, moralistic, rejecting, and dominant.

What is the peak onset of schizophrenia in men?

['A. 22–27 years', 'B. 24–31 years', 'C. 17–25 years', 'D. 26–45 years']

Answer: D. Koro is a culture-bound syndrome seen in Southeast Asia that involves the fear that the penis is shrinking and receding into the abdomen. Dhat is found among Indian men and involves fears about discharge of semen in urine. Piblokto is seen among Eskimo women and involves the person tearing off her clothing, screaming, and crying and running about wildly in the snow. Latah, which is found in women on the Malay Peninsula, is characterized by echolalia, echopraxia, and other extremely compliant behavior.

Which of the following did Bleuler consider a primary symptom of schizophrenia?

['A. Abnormal associations', 'B. Autistic behavior', 'C. Abnormal affect', 'D. Ambivalence', 'E. All of the above']

Answer: A. Jules Baillarger described “folie à double forme.” Gabriel Langfeldt described schizophreniform psychosis. Benjamin Rush, a signer of the American Declaration of Independence, is considered the father of psychiatry in the United States.

Which of the following is considered a bad consequence of deinstitutionalization of schizophrenic patients?

['A. Some of the patients were transferred to alternative forms of unregulated custodial care like nursing homes and poorly managed shelter systems.', 'B. Some patients were let free into nearby communities, which were unable or unwilling to take care of the released patients.', 'C. Responsibility for care was transferred to patients’ families, for whom it has become a burden.', 'D. Some of the released patients ended up in the prison system.', 'E. All of the above']

Answer: B. Token economy involves using contingency management for a group of patients living together in a ward or halfway house. Token economy uses positive reinforcement to encourage desirable behaviors.

For which of the following gene locations is there the strongest research evidence of linkage with schizophrenia in genetic studies of the disorder?

['A. Chromosome 4', 'B. Chromosome 8', 'C. Chromosome 15', 'D. Chromosome 6']

Answer: C. The peak onset of schizophrenia in males is between the ages of 17 and 25 years. Peak onset in females is later, 24 to 35 years.

Which of the following is considered a possible marker distinguishing schizophrenic probands and their biological relatives from controls?

['A. Smooth-pursuit eye movements', 'B. Continuous performance tasks', 'C. Sensory gating', 'D. All of the above']

Answer: E. Eugene Bleuler divided the symptoms of schizophrenia into primary symptoms and secondary symptoms. His four primary symptoms, also known as the four As of schizophrenia, are abnormal associations, abnormal affect, autistic behavior, and ambivalence. Of these four, Bleuler considered the disconnection between thought process and perception and among thought, emotion, and behavior to be the most important.

Which of the following abnormalities is shown by magnetic resonance imaging (MRI) studies of the brains of schizophrenic patients?

['A. Decreased cortical gray matter in the temporal cortex B. Decreased volume of limbic structures C. Increased volume of basal ganglia nuclei D. All of the above']

Answer: E. Deinstitutionalization involved transferring the patients from a hospital setting to a community care setting. This movement gained mo-mentum during the 1960s, but it had severe repercussions for the patients and for society. Some of the patients were transferred from hospitals to nursing homes and poorly managed shelter systems. Others were just released into the community. In some situations the responsibility for care was transferred to the patients’ families, many of which felt burdened and unable to cope with it. Many patients finally wound up in the prison system.

Which of the following areas in the brain shows decreased blood flow during the Wisconsin Card Sorting Test in schizophrenic patients?

['A. Dorsolateral temporal cortex', 'B. Parietal cortex', 'C. Prefrontal cortex', 'D. None of the above']

Answer: D. Some analyses of genetic linkage strongly indicate that chromosome 6 contributes to the development of schizophrenia.

A 23-year-old college student is brought to the ER in the early morning by friends who found him behaving strangely. He was very irritable, abusive, and assaultive toward them. He also reported getting special messages from the TV instructing him to perform special missions. What should the psychiatry resident who sees him in the ER do first?

['A. Contact the patient’s family to obtain a history regarding mental illness in the family.', 'B. Give the patient an injection of long-acting risperidone.', 'C. Do a urine drug screen and other laboratory tests.', 'D. Place the patient on one-to-one observation.']

Answer: D. Biological markers of schizophrenia are neurophysiological features that reveal underlying pathophysiology and also serve as diagnostic tests. They help in predicting which persons may develop the disease and also help in predicting prognoses. Among the biological tests for schizophrenia are the following: CAT scan, regional cerebral blood flow, structural MRI, functional MRI, magnetic resonance spectroscopy, evoked potentials, smooth-pursuit eye movement test, tests of continuous performance tasks, and tests of sensory gating.

Which of the following neurotransmitters has been implicated in the pathophysiology of schizophrenia?

['A. Glutamate', 'B. Serotonin', 'C. Dopamine', 'D. All of the above']

Answer: D. Studies show decreased cortical gray matter in the temporal cortex and limbic structures in persons with schizophrenia. Some studies show that individuals with schizophrenia also have increased numbers of basal ganglia nuclei.

The study of which of the following substances of abuse has substantiated the argument that serotonin plays a role in the development of schizophrenia?

['A. PCP', 'B. LSD', 'C. Marijuana', 'D. None of the above']

Answer: C. Persons with schizophrenia who are doing the Wisconsin Card Sorting Test have been shown to have decreased blood flow in the frontal cortex.

Which of the following anesthetic agents has been shown to have a mechanism of action similar to PCP and can lead to the development of schizophrenia-like symptoms?

['A. Midazolam', 'B. Fentanyl', 'C. Ketamine', 'D. None of the above']

Answer: D. The symptoms presented by the patient can be a feature of either acute schizophrenia or substance-induced acute psychosis, so testing the urine for any drugs and getting laboratory tests to rule out other causes of acute psychosis is an absolute necessity. An acutely psychotic patient is very unpredictable and the patient’s actions may lead to harm to the patient or others. The first thing to do in this situation is to maintain one-to-one observation of the patient to prevent any harm.

Clonidine has been found by some studies to reduce psychotic symptoms in schizophrenic patients. Which of the neurotransmitters do these studies implicate as playing a role in the development of schizophrenia?

['A. Serotonin', 'B. Aspartate', 'C. Norepinephrine', 'D. Dopamine']

Answer: D. According to the dopaminergic theory of schizophrenia, the symptoms of schizophrenia are mainly due to an excess of dopamine. This is also shown by the fact that antipsychotics are mostly dopamine antagonists. Phencyclidine, which exerts its effects through its action on the glutamate receptors, can lead to schizophrenia-like symptoms. The atypical antipsychotics exert their therapeutic effect through serotonin-dopamine antagonism.

A 52-year-old woman who is a resident of a state psychiatric hospital is admitted to a private hospital for treatment of her medical problems. When speaking with the resident physician, she claims she is the president of the company that owns the private hospital. However, she willingly takes all the medicines given to her and willingly stays in the room she shares with another patient. What term denotes this phenomenon?

['A. Double depression', 'B. Double bookkeeping', 'C. Both of the above', 'D. None of the above']

Answer: B. Lysergic acid diethylamide (LSD) is a hallucinogen that blocks serotonin receptors in the brain. The atypical antipsychotics have been shown to have antagonist properties at both dopamine and serotonin receptors.

A parent of a schizophrenic patient criticizes the patient, saying that he is not showing any affection toward his parents. The same parent shies away when the patient wants to show affection in public. How did Gregory Bateson describe this kind of family interaction?

['A. Expressed emotions', 'B. Double-bind communications', 'C. Discursive speech', 'D. None of the above']

Answer: C. PCP (phenycyclidine) acts as an antagonist at the NMDA receptor. It is also known by the street names angel dust, dust, wet, killer weed, and purple rain. It was developed in the 1950s as a general anesthetic. PCP use can lead to severe agitation and hallucinations. The anesthetic ketamine acts as an antagonist at the NMDA receptors and can lead to postanesthetic agitation and hallucinatory behavior.

Emil Kraepelin described persons with dementia praecox as having a prolonged deteriorating course. What percentage of Kraepelin’s sample of patients recovered completely?

['A. None', 'B. 10%', 'C. 22%', 'D. 4%']

Answer: C. Clonidine, a presynaptic alpha-2 agonist, leads to a decrease in the release of norepinephrine. Clonidine’s effect of reducing schizophrenic symptoms in some individuals implicates norepinephrine as playing a role in the development of schizophrenia.

Which of the following described the first-rank symptoms of schizophrenia?

['A. Manfred Bleuler', 'B. Kurt Schneider', 'C. Ernst Kretschmer', 'D. None of the above']

Answer: B. Some individuals with schizophrenia are totally convinced of the reality of their delusions, but this does not influence their actions and beliefs. This paradox is called double orientation or double bookkeeping.

Which of the following is the most common symptom of acute schizophrenia?

['A. Auditory hallucinations', 'B. Delusions of reference', 'C. Suspiciousness', 'D. Lack of insight']

Answer: B. The double-bind communication pattern was described by Bateson and Jackson. In this type of communication pattern, the family members or caretakers of the patient give mutually incompatible messages like the example shown in the question.

Which of the following statements is true regarding periodic catatonia?

['A. It was described by R. Gjessing.', 'B. The patients have periodic recurrent incidences of both stuporous and excited catatonic states.', 'C. Each episode is associated with a shift in the patient’s metabolic nitrogen balance.', 'D. All of the above']

Answer: D. Kraepelin described dementia praecox as having a chronic deteriorating course, but he also reported that, in his sample of patients, 4% recovered completely and 13% had significant remission.

Which of the following forms of schizophrenia has the best prognosis?

['A. Paranoid schizophrenia', 'B. Catatonic schizophrenia', 'C. Disorganized schizophrenia', 'D. Schizophrenia, undifferentiated type 34. A 34-year-old woman is referred to a psychiatrist by her primary care physician. According to her husband, the patient has been behaving differently in the last few months. She is paying less attention to her appearance. She has become less industrious in keeping the house clean and taking care of her children and seems isolated from the family. She doesn’t get up until late afternoon. Husband reports that these changes appeared gradually over the last two years and that the patient is showing further deterioration. The patient reports fleeting delusional beliefs and hallucinations. Which of the following is the best diagnosis?', 'A. Paranoid schizophrenia', 'B. Undifferentiated schizophrenia', 'C. Stuporous catatonia', 'D. Simple schizophrenia']

Answer: B. The symptoms Schneider called first-rank symptoms are characteristic of schizophrenia and rarely found in other illnesses. These include hearing thoughts as if spoken aloud, third-person auditory hallucinations, hallucinations in the form of commentary, somatic hallucinations, thought withdrawal or thought insertion, thought broadcasting, delusional perception, and feelings or actions experienced as made or influenced by external agencies.

A 42-year-old with schizophrenia keeps repeating certain words in the same fashion. What is this phenomenon called?

['A. Echolalia', 'B. Perseveration', 'C. Echopraxia', 'D. Verbigeration']

Answer: D. Ninety-seven percent of persons with an acute onset of schizophrenia have lack of insight, 74% have auditory hallucinations, less than 70% have delusions of reference, and around 65% report feeling suspicious.

Which of the following stressed the inability of schizophrenics to use their ability of abstraction?

['A. Norman Cameron', 'B. Kurt Goldstein', 'C. Lidz', 'D. None of the above']

Answer: D. Periodic catatonia, first described by Gjessing, is characterized by periodic recurrent incidences of both stuporous and excited catatonic states. Each episode is associated with a shift in the patient’s metabolic nitrogen balance.

Which of the following is not a feature of Type I schizophrenia, according to Crow’s classification?

['A. Acute onset', 'B. Predominantly positive symptoms', 'C. Insidious onset', 'D. Good social functioning']

Answer: A. Persons who develop paranoid schizophrenia have a later onset (usually in their late 20s or in their 30s). By then they have already established an identity. They have completed their education and started working. Their ego resources have been described as better than those of catatonic and disorganized schizophrenics.

Which of the following is a good prognostic indicator for schizophrenia?

['A. Prominent affective symptoms', 'B. Insidious onset', 'C. Ventriculomegaly', 'D. Negative symptoms']

Answer: D. According to DSM-IV research criteria, persons with simple schizophrenia (simple deteriorative disorder) are characterized by a progressive deterioration over a period of at least 1 year. They show a marked decline in occupational or academic functioning. They show a gradual appearance of and worsening of negative symptoms. They also show a decline in their relationships. Hallucinations and delusions are rare and, even when present, are fleeting.

According to Vaughn and Leff, what is the optimal duration of contact between patients and their family members?

['A. Less than 48 hours per week', 'B. Less than 72 hours per week', 'C. More than 48 hours per week', 'D. Less than 35 hours per week']

Answer: D. Verbigeration is characterized by use of words in a stereotypical fashion. Echolalia is the repetition of the examiner’s words. Perseveration is the repetition of words even after the significance of the same is past. Verbigeration is found exclusively in chronic and regressed patients with schizophrenia.

A patient who presents to a clinic describes seeing green ghosts when he hears classical music. What is the phenomenon described by the patient?

['A. Haptic hallucination', 'B. Autoscopic hallucination', 'C. Hypnagogic hallucination', 'D. Reflex hallucination']

Answer: B. Kurt Goldstein described the thinking of persons with schizophrenia as being very concrete and talked about the decrease in their ability to use abstraction. According to Norman Cameron, overinclusive thinking is a significant feature of persons with schizophrenia. Overinclusion refers to the tendency of these persons to include many irrelevant items in their beliefs and behavior. Lidz did psychoanalytic studies in families of schizophrenic patients and reported two types of abnormal family pattern: marital schism and marital skew.

A patient reports to his doctor that enemies from Mars have replaced his wife with an impostor that looks and behaves exactly like his real wife.

['A. Fregoli syndrome', 'B. Capgras syndrome', 'C. Cotard syndrome', 'D. Othello syndrome']

Answer: C. Crow et al. described two types of schizophrenia. Type I is characterized by acute onset, mostly positive symptoms, and good social functioning during periods of remission, and it responds well to treatment with antipsychotics. Type II has an insidious onset, poor prognosis, and mostly negative symptoms.

A patient with a long history of schizophrenia is brought to the hospital by the local fire department’s EMTs after his landlord found him standing in bizarre positions for a prolonged period. On examination he is found to be standing in a very uncomfortable position. The ER staff reports that he has maintained this position for the last 40 minutes and has not responded to any attempt to talk to him. What is the most appropriate management?

['A. Haloperidol intramuscularly', 'B. ECT', 'C. Risperidone orally dissolving tablet D. Lorazepam intramuscularly']

Answer: A. Prominent affective symptoms are a good prognostic indicator. Poor prognostic indicators are insidious onset, male gender, venticulomegaly, social isolation, poor occupational history, earlier onset, negative symptoms, single marital status (widowed, separated, never married, or divorced), and prolonged episode. Good prognostic indicators are acute onset, no prior psychiatric history, paranoid subtype, good social and occupational history, married or in a stable relationship.

A 35-year-old woman is referred to a psychiatric outpatient clinic by a plastic surgeon. According to the referral letter, this person has consulted three cosmetic surgeons in the last 6 months about what she perceives to be a deformity in her upper lip. All the physicians have told her that there is no deformity and that there is no need for any surgery. But the woman firmly believes that there is a deformity, and this belief has hampered her socially and occupationally. What is the diagnosis?

['A. Hypochondriasis', 'B. Somatization', 'C. Body dysmorphic disorder', 'D. Delusional disorder, somatic type']

Answer: D. Vaughn and Leff described the effect of expressed emotion in relatives and patient’s response to medications. Spending less than 35 hours per week with relatives was optimal for patients taking antipsychotic medications. According to Vaughn and Leff spending less than 35 hours leads to a relapse rate of 15%. The more time spent with relatives with high expressed emotion, the higher the relapse rate.

Among the following, which is not a predictor of good response to ECT in patients with schizophrenia?

['A. Recent onset', 'B. Shorter duration of illness', 'C. Mood incongruent delusions', 'D. Presence of affective symptoms']

Answer: D. In reflex hallucination a stimulus in one modality results in hallucinations in another sensory modality. Hypnagogic hallucinations are described in narcolepsy and in normal persons as hallucinations when a person is drifting off to sleep. Autoscopic hallucination is the experience of seeing one’s own body projected into external space. If the person is convinced that that he or she has a double, the hallucination is known as “doppelganger.” Haptic hallucinations are tactile hallucinations.

Which of the following countries was not part of the International Pilot Study of Schizophrenia conducted by the World Health Organization?

['A. Nigeria', 'B. United Kingdom', 'C. Taiwan', 'D. India', 'E. United States']

Answer: B. In Capgras syndrome, the patient insists that a friend or family member has been replaced by a double. In Fregoli syndrome, the patient identifies a familiar person in many different strangers. Extremely nihilistic delusion in depressed individuals is known as Cotard syndrome. Delusions of jealousy on the part of husbands about their wives are known as Othello syndrome.

Which of the following abnormalities is not seen in schizophrenic patients?

['A. Reduction in the amplitude of P300 wave.', 'B. Deficits in smooth-pursuit eye movements (SPEM) C. Reduction in blood flow in the prefrontal cortex while taking Wisconsin Card Sorting Test', 'D. All of the above']

Answer: D. The patient has catatonic schizophrenia. Intramuscular lorazepam is the treatment of choice for catatonic posturing in schizophrenia.

Which of the following atypical antipsychotics used in the treatment of schizophrenia is also a norepinephrine reuptake inhibitor?

['A. Aripiprazole', 'B. Ziprasidone', 'C. Risperidone', 'D. None of the above']

Answer: D. This patient firmly believes that there is a deformity in her upper lip even when presented evidence to the contrary. The belief is delusional. In body dysmorphic disorder the belief does not have the delusional intensity.

According to Ernst Kretschmer’s classification of men into different constitutional groups, which of the following body types has more propensity to develop schizophrenia?

['A. Asthenic', 'B. Pyknic', 'C. Athletic', 'D. None of the above']

Answer: C. Electroconvulsive therapy has been found to be most beneficial in persons with acute onset schizophrenia, persons with shorter episodes, and those with comorbid affective symptoms. Patients should first be treated with antipsychotics. Patients who do not show any response to antipsychotics or who are not able to take antipsychotics would benefit from being treated with ECT.

Which of the following did Vaughn and Leff consider to be a component of

['A. Critical comments', 'B. Hostility', 'C. Overinvolvement', 'D. Lack of warmth', 'E. All of the above']

Answer: E. The International Pilot Study of Schizophrenia was conducted by the World Health Organization in 1973 to study the diagnosis of schizophrenia in seven countries: Colombia, Czechoslovakia, Denmark, India, Nigeria, Taiwan, and United Kingdom. This study showed that schizophrenic patients in countries like India and Nigeria had better prognoses. This was ascribed to the better family support and less incidence of expressed emotions in these countries.

Which of the following is not a poor prognostic indicator for schizophrenia?

['A. Insidious onset', 'B. Male sex', 'C. Negative symptoms', 'D. Short episode', 'E. Younger age of onset']

Answer: D. P300 is an evoked potential developed after a subject hears a stimulus enmeshed in a series of irrelevant stimuli. This measure is indicative of the auditory information processing. In schizophrenic patients the amplitude of P300 wave is reduced. Smooth-pursuit eye movement (SPEM) abnormalities are found in schizophrenia. These deficits often are explained in the context of the attentional and inhibitory deficits central to schizophrenia psychopathology. Patients with schizophrenia have a decrease in the blood flow in the prefrontal cortex while doing the neuropsychological test called the Wisconsin Card Sorting Test.

The term “dementia praecox” was coined by A. Emil Kraepelin

['B. Eugene Bleuler', 'C. Karl Jaspers', 'D. Adolf Meyer', 'E. Kurt Schneider']

Answer: D. Ziprasidone, besides being a serotonin-dopamine antagonist, also inhibits the reuptake of norepinephrine and serotonin.

For a diagnosis of schizophrenia according to the DSM-IV, how long should the disturbance be present?

['A. 1 month', 'B. 3 months', 'C. 6 months', 'D. 9 months', 'E. 1 year']

Answer: A. Kretschmer posited three chief constitutional groups: the tall, thin asthenic type; the more muscular, athletic type; and the rotund, pyknic type. He suggested that the lanky asthenics and to a lesser degree the athletic types, were more prone to schizophrenia, while the pyknic types were more likely to develop manic-depressive disorders. His work was criticized because his thinner, schizophrenic patients were younger than his pyknic, manic-depressive subjects, so the differences in body type could be explained by differences in age.

For a diagnosis of schizophreniform psychosis according to DSM-IV, how long should the disturbance be present?

['A. 6 months', 'B. At least 1 month but less than 6 months C. Less than 1 month', 'D. 3 months', 'E. None of the above']

Answer: E. Expressed emotion is a concept well described by Vaughn and Leff in the 1970s. This concept is characterized by a critical, overinvolved environment experienced by schizophrenic patients either at home or at the caretakers’ place, which leads to increased relapse rates. The four components of expressed emotion are the parent’s or caretaker’s critical comments, hostility, overinvolvement, and lack of warmth.

The lifetime prevalence of schizophrenia is A. 0.2–0.6%

['B. 1%', 'C. 0.1–0.5%', 'D. 1–2%', 'E. 2–3%']

Answer: D. Longer episode is considered a poor prognostic indicator. Shorter episodes are associated with a better outcome. The following are considered as poor prognostic indicators for schizophrenia: insidious onset, longer episode, presence of negative symptoms, younger age at onset, enlarged lateral ventricles, single status (widowed, divorced, separated, or never married), poor social skills, poor occupational history, and poor psy-chosexual development.

Which of the following is true regarding schizophrenia?

['A. Prevalence is greater in men than women.', 'B. The age of onset is earlier in women.', 'C. Women have a poorer prognosis than men.', 'D. The age of onset is 5 years earlier in men than in woman.', 'E. Men are more likely to have negative symptoms.']

Answer: A. Emil Kraepelin divided mental disorders into dementia praecox and manic-depressive psychosis. He first described dementia praecox in 1893. He elucidated four subtypes: catatonic, hebephrenic, paranoid, and simple.

Which of the following is a positive symptom of schizophrenia?

['A. Avolition', 'B. Alogia', 'C. Auditory hallucinations', 'D. Affective flattening']

Answer: C. For a diagnosis of schizophrenia, the disturbance should be present for at least 6 months. At least two of the following five symptoms must be present for a significant portion of a one-month period: delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms (affective flattening, alogia, avolition).

Which of the following suggests schizophrenia?

['A. Perseveration', 'B. Autoscopy', 'C. Olfactory hallucinations', 'D. Asyndetic thinking', 'E. Visual hallucinations']

Answer: B. For a diagnosis of schizophreniform disorder, the episode should last at least 1 month and less than 6 months. If the symptoms last less than 1 month, the episode is classified as “brief psychotic disorder.”

The most common feature of chronic schizophrenia is A. Social withdrawal

['B. Underactivity', 'C. Lack of conversation', 'D. Few leisure interests', 'E. Slowness']

Answer: B. The prevalence of schizophrenia is around 1%.

What percentage of persons with acute schizophrenia experience significant depressive symptoms?

['A. 5%', 'B. 10%', 'C. 25%', 'D. 50%', 'E. 75%']

Answer: D. Prevalence of schizophrenia is equal in men and women. It has an earlier onset in men. Women have a better prognosis. Men are more likely to have negative symptoms.

In persons with schizophrenia, paranoid symptoms are more common in A. Children

['B. Young adults', 'C. The middle-aged', 'D. The elderly', 'E. Women']

Answer: C. Alogia, avolition, and affective flattening are considered negative symptoms. Delusions and hallucinations are positive symptoms.

The risk of siblings of affected individuals developing schizophrenia is A. 5%

['B. 10%', 'C. 20%', 'D. 40%', 'E. 50%']

Answer: D. Asyndesis describes the lack of connection between two consecutive thoughts and is a characteristic of schizophrenia. Schizophrenic patients have an inability to preserve conceptual boundaries.

The risk of schizophrenia is increased in first-degree relatives of patients with

['A. Depressive disorder', 'B. Bipolar disorder', 'C. Obsessive-compulsive disorder', 'D. Panic disorder', 'E. Schizoaffective disorder']

Answer: A. Social withdrawal is the most common feature of chronic schizophrenia. It is seen in 74% of patients with chronic schizophrenia.

Fertility rates among schizophrenic patients are A. Increased

['B. Decreased', 'C. The same as for the general population D. Subject to improvement with treatment 64. In persons with schizophrenia, brain changes are more evident on A. The left side of the brain B. The right side of the brain', 'C. There is no predisposition to either side of the brain.', 'D. The cerebellum']

Answer: D. Around 50% of patients with acute schizophrenia show significant depressive symptoms. This supports the view that depression is an integral part of schizophrenia. The depressive symptoms remit with the treatment of psychosis.

Psychomotor retardation is associated with increased blood flow in the A. Left parahippocampal gyrus

['B. Caudate nuclei', 'C. Right anterior cingulate nuclei', 'D. Right prefrontal cortex', 'E. Frontal lobes']

Answer: C. Paranoid symptoms are most common in middle-aged patients with schizophrenia.

The risk of children developing schizophrenia if both parents have schizophrenia is

['A. 5%', 'B. 17%', 'C. 46%', 'D. 72%', 'E. 100%']

Answer: B. The prevalence of schizophrenia among siblings of patients with schizophrenia is around 10%. If one parent is schizophrenic, prevalence in a child is around 17%. If both parents have schizophrenia, prevalence in children rises to 46%.

Enlarged lateral ventricles in schizophrenia are associated with A. Being female

['B. Being male', 'C. Later age of onset of illness', 'D. Lack of impairment on neuropsychological testing E. Good response to treatment']

Answer: E. The risk of schizophrenia is increased in the first-degree relatives of patients with schizoaffective disorder.