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All of the following are true about the epidemiology of bipolar disorder except | ['A. High incidence of comorbidity', 'B. Lifetime prevalence of about 1% in classic cases C. Greater prevalence in women', 'D. Average age of onset around 19 to 20 years E. Equal incidence in all socioeconomic strata 82. The key difference between mania and hypomania, according to DSM-IV, is A. Degree of elevation of mood B. Presence of psychosis', 'C. Number of episodes', 'D. Extent of social and occupational dysfunction E. Number of symptoms'] | Answer: A. The interepisode duration in bipolar I disorder decreases as the illness progresses. |
For a diagnosis of bipolar I disorder according to DSM-IV, which of the following criteria is a must? | ['A. At least one hypomanic episode', 'B. At least one major depressive disorder episode C. Depressed mood for more than 2 years D. Numerous periods of hypomania', 'E. At least one manic or mixed episode'] | Answer: A. DSM-IV specifies that mood-incongruent delusions or hallucinations should not be included to support a diagnosis of major depressive disorder. All the other features listed above support a diagnosis of major depressive disorder. |
What is the approximate duration of untreated depressive episodes in patients with bipolar disorder? | ['A. 3 months', 'B. 3 to 6 months', 'C. 6 to 12 months', 'D. 2 to 4 weeks', 'E. 2 months'] | Answer: C. Features of atypical depression include reactive mood, increase in appetite or gain in weight, hypersomnia, leaden paralysis, and sensitivity to interpersonal rejection. In the vignette, there is nothing to suggest that this patient has borderline personality disorder or generalized anxiety disorder or is malingering. |
A 29-year-old man is admitted for further evaluation. He was brought to the hospital by his wife, who states that her husband has been demanding more sex, repeating the demand sometimes up to 10 to 15 times per day for the past 8 to 10 days. She also observes that he has been working late into the night, sleeping only 2 to 3 hours, and seems full of energy. He has been talking a lot and has taken on at least four new projects at work during the past 10 days. The woman denies any other physical health problems or drug abuse in her husband. The man himself sees no problem and believes that his wife is “just wasting” his time. As you are assessing the case, his col-league calls you and tells you that the man has been “making a mess” at work for the past few days. What is the most probable diagnosis? | ['A. Bipolar II disorder', 'B. Bipolar I disorder', 'C. Bipolar disorder, mixed type', 'D. Cyclothymia', 'E. Rapid-cycling bipolar disorder'] | Answer: E. The onset of a depressive episode must occur within 4 weeks of delivery for a diagnosis of major depressive disorder with postpartum onset. |
All of the following are known causes of secondary mania except A. Cocaine | ['B. Propranolol', 'C. Steroids', 'D. Antidepressants', 'E. L-dopa'] | Answer: B. For a diagnosis of mixed manic episode, a patient should meet the criteria for both mania and major depressive disorder every day for 1 week. |
In a manic patient, the affect could be A. Euphoric | ['B. Irritable', 'C. Labile', 'D. Depressed, in mixed state', 'E. All of the above'] | Answer: C. In the prepubertal age groups, it is the boys who are more prone to depression than girls. However, the lifetime prevalence of depression is almost twice as high in women as in men, and this is thought to be secondary to high estrogen levels in women. |
A 29-year-old man comes along with his wife of 4 years to the psychiatric clinic. The patient’s wife reports that he has had repeated episodes of “highs and downs” for the last 3 years. The episodes are short, lasting only a few days. These episodes disrupt the patient’s work schedule and sometimes the young couple’s social life. What is the most appropriate diagnosis? | ['A. Bipolar I disorder', 'B. Bipolar II disorder', 'C. Cyclothymia', 'D. Dysthymia'] | Answer: B. Up to 50% of patients recover from a depressive episode within 6 months with or without treatment. Recurrence of depression is as high as 80% after three episodes. In up to 80% of sudden-onset depression, a significant psychosocial stressor can be identified in the past 6 months. |
Which of the following over-the-counter (OTC) medications is not advisable in a 22-year-old sexually active female college student? | ['A. Acetaminophen', 'B. Motrin', 'C. Loratidine', 'D. St. John’s wort'] | Answer: A. Mirtazapine blocks presynaptic alpha-2 receptors and thereby increases the release of norepinephrine. The released norepinephrine also stimulates central alpha-1 adrenoreceptors located on central serotonergic neurons, leading to release of serotonin. All of the other antidepressants mentioned increase serotonin transmission by reuptake inhibition. |
Following childbirth, a 32-year-old woman has developed severe depression. The woman refuses to eat, is found to be very agitated, and is expressing fears that her baby has an incurable illness. What is the most appropriate treatment at this point? | ['A. Tricyclic antidepressants', 'B. Wellbutrin', 'C. SSRIs and antipsychotics', 'D. ECT'] | Answer: A. The dexamethasone suppression test is positive in about 50% of patients with major depression and 80% of patients with major depression and psychotic features. |
Which psychologist from the University of Pennsylvania proposed the principle of “low rate of reinforcement” as the cause of depression? | ['A. Beck', 'B. Seligman', 'C. Lewinsohn', 'D. Bowlby'] | Answer: D. Several studies have shown low levels of cholesterol in persons with major depressive disorder and an association between low cholesterol and an increased risk of suicide. Some studies have shown a positive correlation between severity of depression and the ratio of omega 6 fatty acids to omega 3 fatty acids in plasma and red blood cell phospholipids. |
Some studies of the genetics of bipolar disorder have found that the illness has a higher probability of being transmitted through mothers than through fathers. What is this phenomenon called? | ['A. Penetrance', 'B. Imprinting', 'C. Heterogeneity', 'D. None of the above'] | Answer: D. Of all the tricyclic antidepressants, nortriptyline, desipramine, and clomipramine are relatively less sedating. Maprotiline (Ludiomil), a tetracyclic antidepressant, is very sedating. |
Which of the following sleep abnormalities is found in depressed persons? | ['A. Decreased REM sleep latency', 'B. Increased REM density', 'C. Early morning awakening', 'D. All of the above'] | Answer: A. Moclobomide is a reversible and selective inhibitor of MAO-B; phenelzine and tranylcypromine inhibit both MAO-A and MAO-B and are irreversible. Selegiline (L-deprenyl) is an irreversible inhibitor of MAO-B, but at higher doses it inhibits MAO-A too. Maprotiline is a tetracyclic antidepressant. |
Who coined the term “neurasthenia”? | ['A. James Braid', 'B. William Cullen', 'C. George Beard', 'D. Robert Post'] | Answer: A. Orthostatic hypotension results from alpha-1 adrenergic blockade and not from muscarinic receptor blockade. All of the other side effects mentioned are from muscarinic receptor blockade. |
A 42-year-old presents to the clinic 1 month after his spouse’s death. He reports feeling extremely depressed and has a total lack of interest in all activities, decreased ability to go to sleep, and an inability to resume his work. | ['A. Normal sadness', 'B. Bereavement', 'C. Major depression', 'D. Mental fatigue', 'E. None of the above'] | Answer: E. Unilateral electrode placement is associated with less confusion and fewer memory problems. Other factors that can reduce confusion and memory problems include brief pulse stimulation and hyperventilation with 100% oxygenation prior to applying the stimulus. |
What is the lifetime prevalence of dysthymic disorder? | ['A. 1%', 'B. 10%', 'C. 3%', 'D. 6%', 'E. 15%'] | Answer: C. All the evidence to date suggests that any form of therapy is as effective as antidepressants in the treatment of mild to moderate depression. Antidepressants are the treatment of choice in severe depression. Combined treatment with cognitive-behavorial therapy and antidepressants has shown to be better than either individually. It is also used if one modality fails to produce a complete response, if depression is chronic, or if multiple symptoms are present. |
What percentage of persons with bipolar disorder commit suicide? | ['A. Less than 5%', 'B. 5–10%', 'C. 10–15%', 'D. Greater than 20%', 'E. None of the above'] | Answer: B. A person who is symptom-free for more than 2 months does not meet the criteria for dysthymia. Also, there should be no evidence for major depressive disorder for the first 2 years of the disturbance. |
In some depressed persons, the main fold in the upper eyelid is angulated upward and backward at the junction of the inner third with the middle third of the fold. What is this sign called? | ['A. Omega sign', 'B. Veraguth’s fold', 'C. Snout spasm', 'D. Temple sign', 'E. None of the above'] | Answer: B. The category “depressive disorder not otherwise specified (NOS)” is used if the symptoms do not meet criteria for major depressive disorder, dysthymia, adjustment disorder with depressed mood, or adjustment disorder with mixed anxiety and depressed mood. |
The loss of a parent before what age is considered as a risk factor for the development of depression in adulthood? | ['A. Before 3 years', 'B. Before 7 years', 'C. Before 11 years', 'D. Before 15 years', 'E. Before 5 years'] | Answer: D. Clinical evaluation of TRH stimulation tests revealed blunting of TSH response in approximately 25% of euthyroid patients with major depression. |
Which of the following has an equal prevalence in both sexes? | ['A. Bipolar I disorder', 'B. Dysthymia', 'C. Major depressive disorder', 'D. All of the above', 'E. None of the above'] | Answer: C. Bipolar disorder is equally prevalent in both men and women. Up to 60% of individuals with bipolar disorder develop substance abuse at some point, and up to 50% of individuals have anxiety disorder. Although the prevalence of classic bipolar disorder is 1%, the prevalence of all other variants of bipolar disorder is 2% to 5%. |
Cessation of diazepam after chronic use may cause all of the following except | ['A. Depersonalization and derealization B. Perceptual disturbances', 'C. Anxiety', 'D. Constipation', 'E. Rhinorrhea'] | Answer: D. In mania, the person affected experiences significant social and occupational dysfunction, which usually results in hospitalization. This is not always the case with hypomania. The number of symptoms, number of episodes, and degree of elevation or psychosis have no bearing on the diagnosis. |
A 54-year-old man is prescribed buspirone for generalized anxiety disorder. | ['A. Does not cause dependence', 'B. Acts rapidly to give symptomatic relief C. Causes sedation', 'D. Can cause agitation', 'E. Is effective in low dosages'] | Answer: E. For the diagnosis of bipolar I disorder, there should be at least one manic or mixed episode; there is no need for depressive or hypomanic episodes. However, for a diagnosis of bipolar II, the patient should never have a manic or mixed episode but should have at least one episode of hypomania and one or more episodes of major depression. |
A 26-year-old woman presents who appears to have generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying: “I need something to control them immediately.” She is otherwise fit and healthy and has no history of any substance abuse or dependence. A reasonable approach would be to A. Start the patient on intensive psychotherapy B. Start the patient on a combination of bupropion and clonazepam C. Start the patient on any SSRI D. Start the patient on an SSRI and refer the patient to cognitive-behavorial therapy | ['E. Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for a short duration'] | Answer: C. In bipolar disorder, depressive episodes tend to last longer than manic episodes. The mean duration of an untreated depressive episode is 6 to 12 months, whereas the mean duration of an untreated manic episode is 3 to 6 months. |
A 28-year-old female patient is diagnosed with generalized anxiety disorder and substance abuse. A trial of SSRIs fails, and the physician is reluctant to prescribe any benzodiazepines for symptomatic relief in view of the patient’s history of substance abuse. He prescribes buspirone. Buspirone acts as a A. 5HT2C agonist B. 5HT1A agonist | ['C. 5HT1A antagonist', 'D. GABA agonist', 'E. Serotonin reuptake inhibitor'] | Answer: B. This patient meets the criteria for mania because he has more than three manic symptoms that have been present for more than 7 days and that are also causing significant problems in his social and occupational functioning. |
Which of the following is true about specific phobias? | ['A. More common in men', 'B. More common in women', 'C. Phobic avoidance uncommon', 'D. Onset in adult life', 'E. Treatment usually not effective'] | Answer: B. Propranolol, a β-blocker, is a known cause of depression and not mania. Other medications or substances known to cause secondary mania are alcohol, amphetamines, barbiturates, and ACTH. |
People with anxiety disorders have all of the following cardiac abnormalities except | ['A. Decreased deceleration after stress B. High beat-to-beat fluctuation', 'C. Higher baseline heart rate', 'D. Higher subjective awareness of heartbeats E. Increased deceleration after stress 7. All of the following neurotransmitter abnormalities are detected in anxiety disorders except', 'A. Increased platelet MAO activity', 'B. Increased activity of central noradrenaline C. Increased central GABA activity', 'D. Increased circulating adrenaline', 'E. Increased circulating noradrenaline 8. In patients with anxiety spectrum disorders, all of the following are observed except', 'A. Decreased skin conductance', 'B. Panic in response to sodium lactate infusion C. Increased cutaneous blood flow', 'D. Decreased splanchnic blood flow', 'E. Decreased habituation following electrodermal stimulation'] | Answer: E. The patient’s affect need not be euphoric all the time for a diagnosis of mania. In fact, mixed manic episodes are as common as pure manic episodes. |
All of the following statements are true about mitral valve prolapse (MVP) and panic attacks except | ['A. The incidence of MVP in the general population is 5–20%.', 'B. The incidence of MVP in panic-disorder patients is up to 40–50%.', 'C. MVP causes panic attacks.', 'D. No evidence suggests MVP causes panic attacks.', 'E. MVP and panic may represent part of primary autonomic syndrome.'] | Answer: C. Cyclothymia is characterized by numerous periods with hypomanic symptoms alternating over the course of 2 years with numerous periods of depressive symptoms that do not meet the diagnostic criteria for a major depressive episode. For a diagnosis of cyclothymia, the person must not be symptom-free for more than 2 consecutive months and should not have had any major depressive, mixed, or manic episodes during the 2 years. |
A 34-year-old female patient is referred by her psychiatrist for systematic desensitization therapy because of a specific phobia. However, before she starts therapy, the patient wants to know if there are any factors that would result in a less-than-ideal response in her case. All of the following are predictors of good response except A. Good relaxation response | ['B. Free-floating anxiety', 'C. Good motivation', 'D. No secondary gain from the phobia', 'E. No obsessions'] | Answer: D. St. John’s wort induces enzymes that increase the metabolism of oral contraceptive pills. So it is necessary to discuss the issue of over-the-counter antidepressants like St. John’s wort with sexually active women in the reproductive age group. |
A 24-year-old woman is diagnosed with social phobia. All of the following are effective treatments except | ['A. SSRIs', 'B. Flooding', 'C. Modeling', 'D. Systematic desensitization', 'E. ECT'] | Answer: D. Electroconvulsive therapy is the treatment of choice in patients suffering from postpartum depression. ECT is especially effective in people who are refusing to take any medicines orally. Its fast onset of action can be particularly life saving in women refusing to eat and refusing to take care of their newborn infants and for those harboring murderous impulses toward their newborn children. |
Regarding phobias, all of the following are true except A. The phobia is associated with major depressive disorder. | ['B. Patients come from stable families.', 'C. Traits are anxiety and dependency.', 'D. People with phobias are no different from the general population in terms of education and social class.', 'E. Phobias are usually triggered by major life events.'] | Answer: C. Lewinsohn propounded the theory of “low rate of reinforcement, or lack of appropriate rewards” as a cause for depression. Martin Seligman propounded the notion of “learned helplessness” as a theory for origin of depression. Beck propounded a cognitive triad of depression consisting of negative views of self, the world, and the future. Bowlby propounded the theory of “object loss” as a cause for depression. |
All of the following have higher incidence in women than men except A. Needle phobia | ['B. Social phobia', 'C. Animal phobia', 'D. Hospital phobia', 'E. Claustrophobia'] | Answer: B. Imprinting is the phenomenon by which the probability of the disease depends on whether the gene is inherited from the mother or the father. Other examples of imprinting are Prader-Willi syndrome and Angelman syndrome. |
All of the following theories have been put forward to explain phobias except | ['A. The concept of “preparedness”', 'B. Classic conditioning', 'C. Neurodevelopmental theory', 'D. Operant conditioning', 'E. Observational learning'] | Answer: D. Sleep studies of depressed patients show abnormalities such as decreased REM sleep latency, increased REM density, and early morning awakening. |
Pathological anxiety is distinguished from a normal emotional response by all of the following characteristics except A. Autonomy | ['B. Physical health status', 'C. Intensity', 'D. Duration', 'E. Behavior'] | Answer: C. “Neurasthenia” is a term coined by George Beard to describe a chronic condition characterized by anxious-depressive symptomatology. In this condition, people are overly anxious with a chronic predisposition to mental fatigue, lethargy, exhaustion, and irritability. This diagnosis is most used in China. |
Which of the following structures is the main source of the brain’s adrenergic innervations? | ['A. Nucleus raphe', 'B. Locus ceruleus', 'C. Nucleus of Meynert', 'D. Midbrain', 'E. Medial temporal lobe'] | Answer: C. According to DSM-IV-TR, the diagnosis of major depressive disorder (MDD) should not be given unless the symptoms are still present 2 months after the loss of a loved one. But if the depression is so severe that the person has thoughts of ending his own life, recurrent feeling of worthlessness, guilt about things other than actions taken or not taken by the survivor at the time of the loved one’s death, marked psychomotor impairment, hallucinatory experience other than thinking that he hears or sees the deceased person, then a diagnosis of MDD should be made. |
According to Epidemiological Catchment Area studies, which of the following is the most common anxiety disorder in the United States? | ['A. Panic disorder', 'B. Social phobia', 'C. Agoraphobia', 'D. Specific phobia', 'E. Generalized anxiety disorder'] | Answer: D. Dysthymia has a lifetime prevalence of 6%. |
A 65-year-old man experiences a panic attack for the first time. He also has angina and COPD. The physician makes a diagnosis of organic anxiety syndrome. All of the following are features of organic anxiety syndrome except A. Onset of symptoms after 35 years of age B. Family history of anxiety disorders C. No history of childhood anxiety disorders D. Poor response to the usual treatments of panic disorder E. No avoidance behavior | [] | Answer: C. It has been shown that 10% to 15% of persons diagnosed with bipolar disorder eventually commit suicide. An estimated 8% to 10% of patients with schizophrenia eventually commit suicide. |
All of the following are true regarding anxiety seen in primary care settings except | ['A. High rates of anxiety are seen in patients with chest pain, dyspnea, and dizziness.', 'B. Presenting problem in 11% of patients visiting PCPs C. Most common psychiatric disorder in PCP’s office D. More than 90% of patients present with somatic symptoms E. High utilizers of PCPs’ time and resources 20. Patients with generalized anxiety disorder have excessive anxiety and worry on more days than not for at least how long?', 'A. 2 weeks', 'B. 2 months', 'C. 6 weeks', 'D. 6 months', 'E. 4 weeks'] | Answer: B. Veraguth’s fold is seen in some depressed patients; in this sign, the main fold in the upper eyelid is angulated upward and backward at the junction of the inner third with the middle third of the fold. |
All of the following are true about specific phobias except A. If the patient is under 18 years, the phobia should last for longer than 6 months. | ['B. Natural environment phobias (fear of heights, water) have an onset in childhood.', 'C. Situational phobias (fear of elevators, airplanes) have an onset in the mid-thirties.', 'D. Lifetime prevalence is 10%.', 'E. CBT offers good benefits.'] | Answer: C. The loss of a parent before the age of 11 is considered a risk factor for the development of depression in adulthood. |
A 23-year-old male patient believes he has social phobia and would like to know if the information he has about social phobia is true or not. All of the following facts are true about social phobia except A. Most common anxiety disorder B. More common in women in clinical samples C. Onset is usually in adolescence | ['D. Has two specific subtypes: performance anxiety versus generalized anxiety', 'E. Most common comorbidities are depression and substance abuse (alcohol or drug abuse)'] | Answer: A. Bipolar I disorder has an equal prevalence in women and men, whereas both dysthymia and major depressive disorder have a higher prevalence among women. |
Regarding posttraumatic stress disorder (PTSD), all of the following are true except | ['A. Symptoms should last for more than 1 month.', 'B. There are four subtypes: acute, subacute, chronic, and delayed onset.', 'C. Prevalence is about 8% in the general population.', 'D. Prevalence is up to 20% in people exposed to combat.', 'E. Acute stress disorder is a different diagnosis.'] | Answer: E. Benzodiazepine withdrawal causes withdrawal symptoms that can last for many days. Apart from anxiety and delirium, it can also cause depression and seizures. Both constipation and diarrhea are recognized features of benzodiazepine withdrawal. Rhinorrhea is a feature of opiate withdrawal. |
The DSM-IV diagnostic criteria for acute stress disorder include most of the criteria for PTSD, but they add and emphasize one of the following groups of symptoms. Which group? | ['A. Dissociative symptoms', 'B. Psychotic symptoms', 'C. Neurotic symptoms', 'D. Depressive symptoms', 'E. Cognitive symptoms'] | Answer: A. Buspirone, an azaspirodecanedione, is a nonbenzodiazepine anxiolytic and doesn’t cause any sedation or dependence. However, it takes up to 4 to 6 weeks to work, and the dose has to be titrated up to 30 mg per day. |
Which of the following people have the highest prevalence of posttraumatic stress disorder? | ['A. People involved in traffic accidents B. Vietnam veterans', 'C. Victims of a violent assault', 'D. Torture victims'] | Answer: E. Although SSRIs on their own may be effective in anxiety disorders, it takes a while before they can be effective, and therefore clonazepam is often used for symptomatic relief until the SSRIs become effective. Bupropion is activating and can make the anxiety worse. |
Of all the following factors, which is the most important risk factor for the development of posttraumatic stress disorder? | ['A. Individual vulnerability', 'B. Nature of the trauma', 'C. Sex of the victim', 'D. Age of the victim', 'E. All of the above are equally important.'] | Answer: B. Buspirone decreases the symptoms of anxiety by 5HT1A agonistic action. However, it takes a few weeks to act and the dose might have to be titrated up to 30 mg twice a day. |
A 36-year-old woman is diagnosed with posttraumatic stress disorder following a violent assault and rape. Over the next 2 years, although the posttraumatic stress disorder abates, she feels anxious and depressed and starts using alcohol and other illicit drugs. Which of the following is the most common comorbid condition in women with PTSD? | ['A. Substance abuse (alcohol or drugs)', 'B. Eating disorders', 'C. Anxiety disorder', 'D. Psychotic disorders', 'E. Depression'] | Answer: B. Specific phobias are the most common phobias and more common in women than men. By definition, avoidance should be present for the condition to be called a phobia. Systematic desensitization, exposure, and response prevention are found to be effective treatments. |
For a diagnosis of chronic PTSD according to DSM-IV, for at least how long must the patient have symptoms of PTSD? | ['A. 6 months', 'B. 1 year', 'C. 2 years', 'D. 3 months', 'E. 1 month'] | Answer: E. Patients with anxiety disorders have higher baseline heart rates than the norm. The rates continue to be higher after stress; hence, they have decreased deceleration after stress. |
Which of the following SSRIs has been approved by the FDA for the treatment of posttraumatic stress disorder? | ['A. Fluvoxamine', 'B. Fluoxetine', 'C. Sertraline', 'D. Citalopram', 'E. Escitalopram'] | Answer: C. Patients with anxiety disorders have increased levels of activating neurotransmitters like adrenaline and noradrenaline and decreased GABA activity. |
All of the following therapies have been found to be effective in the treatment of PTSD except | ['A. Psychosomatic psychotherapy', 'B. Psychoanalytic psychotherapy', 'C. Cognitive-behavioral psychotherapy', 'D. Group therapy', 'E. Eye movement desensitization and reprocessing (EMDR)'] | Answer: A. Patients with anxiety spectrum disorders have numerous electrodermal abnormalities, including increased skin conductance, decreased habituation, and higher spontaneous fluctuations. |
According to DSM-IV, all of the following are the criteria for somatization disorder except | ['A. Four or more pain symptoms', 'B. Two gastrointestinal symptoms that are not pain related C. One sexual symptom', 'D. One pseudoneurologic symptom', 'E. Age of onset after 30 years'] | Answer: C. Numerous studies have been done to see if there is any causal relationship between MVP and panic but, to date, there is no evidence to prove MVP causes or predisposes patients to have panic attacks. |
Which of the following does not suggest a somatization disorder? | ['A. Family history of bipolar disorder and histrionic personality B. Early onset of symptoms', 'C. Chronic course', 'D. Involvement of multiple organs', 'E. Absence of laboratory, radiologic, and physical abnormalities 33. Which of the following is the most common somatoform disorder?', 'A. Conversion disorder', 'B. Somatization disorder', 'C. Pain disorder', 'D. Hypochondriasis', 'E. Body dysmorphic disorder'] | Answer: B. Presence of free-floating anxiety is a predictor of a poor response, as it does not allow the patient to relax or divert attention from the phobic stimulus. |
All of the following are characteristic features of conversion disorder except A. Patients are usually suggestible. | ['B. Symptoms are initiated or exacerbated following severe stress.', 'C. Patients believe that they are severely ill.', 'D. Symptoms are not feigned.', 'E. Usually occurs between the ages of 10 and 35 years 35. All of the following are true about conversion disorders except A. About one-third of patients with conversion disorder have concurrent neurological illness.', 'B. The symptoms tend to conform to the patient’s own idea of illness.', 'C. Thirty percent of patients’ pseudoseizures are due to a neurological illness.', 'D. Remission is usually observed within 2 weeks of hospitalization.', 'E. Recurrence rate is as high as 20–25% within the first year.'] | Answer: E. ECT is usually indicated for severe depression not responding to medications. Apart from the above-mentioned treatments, MAOIs have also been found to be effective in the treatment of social phobia. |
A 36-year-old male patient is admitted to the chronic pain unit for severe, chronic back pain. After extensive evaluations, pain disorder associated with psychological factors and a general medical condition is diagnosed. All of the following are true about pain disorder except A. A significant psychological stress is often a precipitating factor. | ['B. Peak incidence is during third and fourth decade of life.', 'C. Men mainly complain of back pain.', 'D. Women mainly complain of abdominal pain.', 'E. Multidisciplinary treatment approach is best.'] | Answer: A. Major depressive disorder is no more common in phobia patients than in the general population. There is also an association between phobias and childhood enuresis. |
According to DSM-IV, to diagnose a patient with hypochondriasis, the symptoms should last at least | ['A. 2 weeks', 'B. 2 months', 'C. 6 weeks', 'D. 6 months', 'E. 1 month'] | Answer: B. All anxiety-related problems are more common in women, except social phobia, where the prevalence is equal. |
All of the following are true about hypochondriasis except A. It is more common in women. | ['B. Onset is in early adulthood.', 'C. Course is chronic with waxing and waning of symptoms.', 'D. The belief of having a serious disease is not of delusional intensity.', 'E. The symptoms can involve more than one system.'] | Answer: C. Neurodevelopmental theory is often used to explain the etiology of schizophrenia. |
Factitious disorder with predominant physical signs and symptoms, is also known as | ['A. Hypochondriasis', 'B. Munchausen syndrome', 'C. Munchausen syndrome by proxy', 'D. Somatoform disorder', 'E. None of the above'] | Answer: B. Pathological anxiety is autonomous; that is, it may or may not have a trigger. Intensity and duration are out of proportion to real or imagined stressors, and behavior is impaired. Physical health status is not a criterion used to distinguish normal fear from pathological anxiety. |
All of the following are true about factitious disorder except A. A desire to assume the role of sick patient B. No secondary gain | ['C. Good prognosis once the condition is diagnosed D. Intentional production of signs and symptoms E. Exact prevalence is unknown'] | Answer: B. Locus ceruleus is a small retropontine structure and is the main source of the brain’s adrenergic innervations. Stimulation of the center causes panic attacks; blockade of locus ceruleus decreases panic attacks. |
A 28-year-old woman is admitted to a general medical unit for hypoglycemia. A psychiatry consultation is requested because the patient’s story | ['C. Factitious disorder', 'D. Malingering', 'E. Munchausen syndrome by proxy'] | Answer: D. Specific phobia is the most common anxiety disorder; it has a lifetime prevalence of 11%. Social phobia is the next most common. |
All of the following are true about dissociative amnesia except A. More common in persons who experienced childhood abuse B. Men and women equally affected | ['C. Adults less likely to dissociate than children D. Dissociative identity disorder more common in men E. Dissociation measured clinically by the Dissociative Experience Scale (DES)'] | Answer: B. Patients with organic anxiety syndrome usually do not have a family history of anxiety disorders. Another feature that helps to distinguish organic anxiety syndrome from primary panic disorder is the absence of triggering factors for the anxiety syndrome. |
All of the following are true about dissociative amnesia except A. Defined in DSM-IV | ['B. Equal incidence in men and women', 'C. More common in first and second decades of life D. Can be global or episodic', 'E. Can last up to 5 days'] | Answer: C. Depression is in fact the most common psychiatric disorder seen by primary care physicians. (Source: Sartovius et al. Depression comorbid with anxiety. Results from WHO study on psychological disorders in primary health care. Br J Psychiatry 1996; 168 Suppl 30:538–43.) |
A 34-year-old male is seen in the psychiatric emergency room of a city hospital for bizarre presentation. Social worker tells the psychiatrist that after obtaining extensive collateral information, she learned that the patient lives in a nearby town and was “normal” until a severe earthquake hit the town recently. He is not able to recall his personal information, and neither is he able to explain how he traveled the 65 miles from his town or when he ar-rived in this city. There is no history of any substance abuse and family members are concerned. What is the most likely diagnosis? | ['A. Dissociative amnesia', 'B. Dissociative fugue', 'C. Transient global amnesia', 'D. Malingering', 'E. Dissociative identity disorder'] | Answer: D. Patients with generalized anxiety disorder have symptoms of excessive worry and anxiety on most days for at least 6 months. They find it hard to control worrying and should have three of the following six symptoms: muscle tension, restlessness, easy fatigability, difficulty concentrating, irritability, and insomnia. |
The average number of personality states in dissociative identity disorder is A. 3 | ['B. 13', 'C. 30', 'D. 33', 'E. 10'] | Answer: C. Situational phobia typically has a bimodal onset, with one peak in childhood and the other in midtwenties. |
All of the following are true about dissociative identity disorder except A. More common in men | ['B. High comorbid depression', 'C. Up to 50% have auditory hallucinations D. Very susceptible to hypnosis', 'E. Psychotherapy is the treatment of choice 47. All of the following are true about depersonalization disorder except A. More common in women', 'B. Onset usually in late adolescence or early adulthood C. May last for weeks in adults', 'D. Reality testing impaired', 'E. Up to 50% have transient depersonalization symptoms at some point 48. How many anxiety disorders does the DSM-IV-TR list?', 'A. 10', 'B. 12', 'C. 6', 'D. 4', 'E. 13'] | Answer: B. Although the prevalence of social phobia is higher in women in both epidemiological and community samples, the prevalence is found to be greater in men in clinical samples. This may be because of increased awareness of the condition because of the pressure to perform. |
The only social factor that has been identified as a factor contributing to the development of panic disorder is | ['A. Recent history of death in the family B. Recent history of separation or divorce C. Lack of friends', 'D. Unsupportive family', 'E. Recent history of witnessing a panic attack'] | Answer: B. There are three subtypes of PTSD based on duration: Acute symptoms last for less than 3 months. Chronic symptoms last for more than 3 months. Delayed onset symptoms appear more than 6 months after the trauma. In acute stress disorder, symptoms occur within 4 weeks of the traumatic event and last for at least 2 days and a maximum of 4 weeks. |
Which of the following best describes the relationship between mitral valve prolapse and panic disorder? | ['A. No clinical relevance', 'B. High clinical relevance', 'C. Patients with panic disorder predisposed to develop mitral valve prolapse', 'D. High incidence of panic disorder in patients with mitral valve prolapse', 'E. Panic disorder well controlled if mitral valve prolapse is corrected 51. A 22-year-old woman is seen in the outpatient clinic for anxiety problems.', 'After the assessment, the psychiatrist tells the patient that she has agoraphobia because she has expressed fear associated with public places. She tells the psychiatrist that her father was killed in a motor vehicle accident when she was 6 years old and wonders if that could be responsible for her problems. All of the following could be the defense mechanisms used in this patient except A. Symbolization', 'B. Avoidance', 'C. Undoing', 'D. Repression', 'E. Displacement'] | Answer: A. The diagnostic criteria for acute stress disorder emphasize dissociative symptoms like depersonalization, derealization, and dissociative amnesia. |
The article “Conditioned Emotional Reactions” by John B. Watson explains the behavioral theory of | ['A. Panic disorder', 'B. Depression', 'C. Obsessive-compulsive disorder', 'D. Phobia', 'E. Posttraumatic stress disorder'] | Answer: D. Torture victims have the highest prevalence of PTSD. The prevalence in Vietnam veterans is about 30%. Prevalence in victims of a violent assault is 20%. |
Which of the following phobias shows a strong familial tendency? | ['A. Blood/injection/injury', 'B. Animal', 'C. Heights/elevators', 'D. Spiders/insects', 'E. Social'] | Answer: B. The nature of trauma is the most important risk factor for the development of PTSD. Although individual vulnerability is an important risk factor, it seems to play a role in less severe trauma. |
The blood/injection/injury phobia is different from other phobias in that A. It is twice as common in women. | ['B. It has low familial inheritance.', 'C. It is characterized by severe tachycardia and hypertensive response.', 'D. It is easily treated.', 'E. Bradycardia and hypotension often follow the initial tachycardia.'] | Answer: E. The most common comorbid condition in women with posttraumatic stress disorder is depression (49%), whereas the most common comorbid condition in men is substance abuse (52%). |
Dissociative amnesia, according to DSM-IV, has five subtypes. Which of the following is not one of the subtypes? | ['A. Continuous amnesia', 'B. Discontinuous amnesia', 'C. Localized amnesia', 'D. Generalized amnesia', 'E. Selective amnesia'] | Answer: D. Presence of symptoms for at least 3 months is required to diagnose chronic PTSD. |
All of the following statements about dissociative amnesia are true except A. Amnestic disorders are important differential diagnoses. | ['B. SCID-D-R is the only tool available to assess the degree of dissociative amnesia.', 'C. Patients often present with anxiety, depression, or history of blank spells.', 'D. Implicit-semantic memory is more affected.', 'E. Amnesia usually centers around a traumatic event.'] | Answer: C. Although all SSRIs are found to be effective in the treatment of PTSD, only sertraline and paroxetine are FDA-approved. |
All of the following culture-bound disorders have fugue as a prominent feature except | ['A. Dhat', 'B. Latah', 'C. Amok', 'D. Grisi Siknis', 'E. Piblokto'] | Answer: B. Of all the therapies, cognitive-behavioral therapy has been well studied and is found to be very effective. Psychoanalytic psychotherapy is not indicated in patients with PTSD. |
A 42-year-old male is diagnosed with dissociative fugue after he is found in a nearby town 3 days after his “disappearance.” The patient has a hard time understanding the concept of dissociative fugue and would like to “come to terms” with what has happened. The choice of treatment, in this patient would be A. Antidepressants | ['B. Benzodiazepines', 'C. Hypnosis', 'D. Sodium amobarbital interviews', 'E. Psychodynamic psychotherapy'] | Answer: E. For a diagnosis of somatization disorder, the onset of symptoms should be before 30 years of age; the multiple, recurring, physical symptoms usually start in adolescence and the diagnostic criteria are usually met by the age of 25 years. |
The term “amaxophobia” implies | ['A. Fear of dogs', 'B. Fear of cats', 'C. Fear of strangers', 'D. Fear of riding in cars', 'E. Fear of dirt and germs'] | Answer: A. Patients with somatization disorders often have a family history of somatization disorder, antisocial personality, and substance abuse. In fact, 10% to 20% of first-degree female relatives of female patients with somatization disorder develop somatization disorder. |
Severe debilitating OCD in a 42-year-old patient is found to be resistant to pharmacotherapy, psychotherapy, and ECT. The option of psychosurgery is discussed with the patient. The most common psychosurgical procedure for OCD is A. Cingulotomy | ['B. Subcaudate tractotomy', 'C. Caudate nucleus ablation', 'D. Internal capsule stimulation', 'E. Frontal tractotomy'] | Answer: A. Conversion disorder is the most common somatoform disorder; the annual incidence in general population is up to 11 to 300/100,000. |
Following the September 2001 terrorist attacks, the most common psychiatric problem diagnosed in the Manhattan residents was A. PTSD and depression | ['B. In PTSD, acrophobia and anxiety', 'C. Panic disorder and PTSD', 'D. Depression and anxiety', 'E. Xenophobia'] | Answer: C. Patients with conversion disorder often present with la belle indifference and do not believe they are seriously ill. The reported prevalence rates of conversion disorder vary widely according to different studies. (Source: DSM IV TR, page 496.) |
Apart from SSRIs, which have proven efficacy in PTSD, all of the following medications are considered to be useful in the treatment of PTSD except A. Anticonvulsants | ['B. MAOIs', 'C. Trazodone', 'D. Propranolol', 'E. Antipsychotics'] | Answer: C. More than half of the patients with pseudoseizures have a neurological illness. |
A 32-year-old man is seen in the psychiatry outpatient clinic after “going crazy.” He states that 4 months ago he was involved in an automobile accident and was trapped in his car for several hours. Since then he has not been able to drive and has nightmares about the accident. He also complains of difficulty sleeping and inability to concentrate at work; he says he feels nervous and on edge all the time. The diagnosis is A. Acute PTSD | ['B. Acute stress disorder', 'C. Chronic PTSD', 'D. Major depressive disorder', 'E. Panic disorder'] | Answer: D. Women with pain disorder often complain of headaches. Treatment focuses on enabling the patients to live with pain, and patients who continue to work have a better prognosis. |
A 38-year-old woman with a diagnosis of acute PTSD completes an MMPI as part of a psychological workup; all of the following scales are likely to be elevated except | ['A. F: Infrequency scale', 'B. SC: Schizophrenia', 'C. D: Depression', 'D. ES: Ego strength', 'E. Ps: Psychaesthenia'] | Answer: D. For a diagnosis of hypochondriasis, the symptoms should last for at least 6 months and should not be accounted for by another mental disorder. |
All of the following are true about posttraumatic stress disorder except A. Concept was developed after World War I B. Also called shell shock | ['C. Lifetime prevalence of about 8%', 'D. Women more commonly affected than men E. Severity of trauma is an important risk factor.'] | Answer: A. The incidence of hypochondriasis is equal in men and women; the prevalence of hypochondriasis in the general population varies from 3% to 13%. |
All of the following are true about mixed anxiety-depressive disorder except A. Prevalence is unknown. | ['B. About two-thirds of patients with depressive symptoms have anxiety symptoms.', 'C. Sertraline is FDA-approved for treatment of this condition.', 'D. Prognosis is unknown.', 'E. Criteria include persistent or recurrent dysphoric mood for at least 1 month.'] | Answer: B. Munchausen syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. This is usually a more severe form and accounts for 10% of individuals with factitious disorder. |
All of the following are true about the psychological profile of patients with factitious disorder except | ['A. Poor sense of identity', 'B. Strong dependence needs', 'C. Narcissism', 'D. High frustration tolerance', 'E. Absence of formal thought disorder'] | Answer: C. The prognosis in factitious disorder is poor because patients have little insight and go from one hospital to another. Because of this and also because of reluctance of the physicians to diagnose factitious disorder in the absence of thorough knowledge of a patient’s history; the prevalence of this disorder is unknown. |
All of the following are features of Ganser syndrome except A. Most commonly seen in mentally retarded people B. Approximate answers | ['C. Considered by some to be a variant of malingering D. Classified as a dissociative disorder NOS in DSM-IV', 'E. Existence of this disorder is controversial 69. The most important feature distinguishing malingering from factitious disorder is', 'A. Age of onset', 'B. Secondary gain', 'C. Intentional production of symptoms', 'D. Course of illness', 'E. Response to confrontation'] | Answer: C. This patient has most of the features of factitious disorder, such as intentional production of signs and symptoms, enjoying being in a sick role, and no obvious secondary gain. Also patient has other “typical features” like dependency needs and elopement from the hospital as soon as her deception is uncovered. |
The condition “brainwashing” included in DSM-IV under “dissociative disorder, not otherwise specified” is characterized by all of the following except A. It occurs largely in the setting of political reforms. | ['B. It is seen in people subjected to prolonged and intense coercive persuasion.', 'C. Patients subjected to brainwashing may undergo considerable harm.', 'D. Coercive techniques include isolation, degradation, induction of fear, etc.', 'E. Confrontation of the brainwashed subject is very helpful in treatment.'] | Answer: D. Although men and women are equally affected, dissociative identity disorder is more commonly seen in women, whereas dissociative fugue is more common in men, especially during wartime. It is more common in people with childhood trauma. Dissociation can be measured clinically by the Dissociative Experiences Scale, a 28-item self-report questionnaire. |
A 24-year-old woman is referred for a psychiatric consultation by a plastic surgeon. She is very angry that the surgeon thinks “It’s in my brain” and refused to acknowledge that she has a “crooked nose.” The psychiatrist thinks that there is no obvious defect with the patient’s nose but reassures her and tries to calm her. After obtaining all the collateral information and extensively interviewing the patient, he diagnoses her with body dysmorphic disorder. All of the following about this disorder are true except A. Suicide is rare. | ['B. Preoccupation with imagined or slight physical anomaly is markedly excessive.', 'C. Up to one-third of patients with this disorder may be housebound.', 'D. Hair, nose, and skin complaints are most common.', 'E. Comorbid depression and anxiety are common.'] | Answer: C. Dissociative amnesia is more common in the third and fourth decades of life. It is defined in DSM-IV as “Inability to recall important personal information, usually of traumatic nature, that is too extensive to be explained by normal forgetfulness.” It can last anywhere between 24 hours and 5 days in up to 75% of cases, and it is seen equally in men and women. |
According to the psychodynamic theory, all of the following defense mechanisms can play a role in the manifestation of body dysmorphic disorder except | ['A. Dissociation', 'B. Distortion', 'C. Repression', 'D. Symbolization', 'E. Denial'] | Answer: B. The most likely diagnosis in this patient would be dissociative fugue. It is commonly seen after natural disasters and in men in their second to fourth decades of life. This is associated with inability to recall one’s past. In dissociative amnesia, there is no history of travel away from one’s home. In dissociative identity disorder, there are two or more distinct personalities. Malingering is unlikely given the above history. |
All of the following are true about the epidemiology of chronic fatigue syndrome except | ['A. Women are more commonly affected.', 'B. Incidence is more common in young adults.', 'C. Incidence is 1 per 100.', 'D. Prevalence is 0.29% in men.', 'E. Fatigue is present for more than 6 months.'] | Answer: B. The average number of personality states in dissociative identity disorder is 13; however, they vary from 1 to 50. |
According to psychodynamic theory, all of the following defense mechanisms are possible in factitious disorders except A. Regression | ['B. Identification', 'C. Symbolization', 'D. Sublimation', 'E. Repression'] | Answer: A. Although dissociation is equally common in men and women, dissociative identity disorder is more common in women than in men; it is usually diagnosed in the third or fourth decades of life. High rates of depression and auditory hallucination are reported, but they do not have a formal thought disorder; they are also easily hypnotized. Although antidepressants and anti-anxiety agents are used, psychotherapy is the treatment of choice. |
The brain-imaging studies in panic disorder implicate pathological involvement of the | ['A. Temporal lobe', 'B. Frontal lobe', 'C. Parietal lobe', 'D. Midbrain', 'E. Occipitoparietal junction'] | Answer: D. Reality testing is intact in depersonalization disorders and is an important distinction from other psychotic disorders. Though depersonalization disorder is more common in women, transient depersonalization symptoms are equally common in men and women. |
The percentage of elderly people with depressive symptoms is A. 5% | ['B. 7%', 'C. 15%', 'D. 30%', 'E. 50%'] | Answer: B. DSM-IV-TR lists 12 anxiety disorders: (1) panic disorder with agoraphobia, (2) panic disorder without agoraphobia, (3) agoraphobia without history of panic disorder, (4) specific phobia, (5) social phobia, (6) obsessive-compulsive disorder, (7) posttraumatic stress disorder, (8) acute stress disorder, (9) generalized anxiety disorder, (10) anxiety disorder due to a general medical condition, (11) substance induced anxiety disorder, (12) anxiety disorder NOS. |
The prevalence of delusions in Alzheimer’s and vascular dementia is A. 5–10% | ['B. 10–15%', 'C. 20–50%', 'D. 50–60%', 'E. 60–95%'] | Answer: B. Apart from a recent history of separation or divorce, no other social factor is identified as a contributory factor for the development of panic disorder. It is two or three times more common in women than in men and occurs equally among all races. |
Which of the following is true about depression in the elderly? | ['A. Depressed mood is essential for the diagnosis.', 'B. Depression may present with a physical symptom.', 'C. The condition is usually reactive to social circumstances.', 'D. The condition requires only readjustment of social circumstances.', 'E. Depression is rarely comorbid with physical illness.'] | Answer: A. Historically, there has been a lot of debate and interest concerning a possible association between mitral valve prolapse and panic disorder. However, many studies have found no clinical relevance, and prevalence of panic disorder in patients with mitral valve prolapse is the same as the prevalence of panic disorder in patients without mitral valve prolapse. |
Which of the following is true about depression in the elderly? | ['A. Elderly persons may deny their symptoms.', 'B. The elderly find it easier to express feelings than the young.', 'C. Suicidal plans are rare.', 'D. Anxiety features are common.', 'E. Wishing to die always indicates depression.'] | Answer: C. Repression, displacement, and symbolization could all be the defense mechanisms contributing to agoraphobia in this patient. Undoing is commonly seen in patients with obsessive-compulsive disorder. |
Which of the following is true regarding geriatric depression? | ['A. Minor depression rarely progresses to major depression.', 'B. It always requires antidepressants.', 'C. It should not be treated until DSM-IV criteria are met.', 'D. It may worsen physical illness.', 'E. It is frequently overtreated.'] | Answer: D. Watson in his article “Conditioned Emotional Reactions” tried to explain the behavioral factors involved in generating fear or phobia. He described his experiences with Little Albert, an infant with a fear of rats and rabbits. |
Which of the following is not true regarding the dexamethasone suppression test? | ['A. May be positive in dementia', 'B. May be positive in infection', 'C. May be positive in diabetes', 'D. Is a specific test for depression', 'E. May be affected by medication'] | Answer: A. The blood/injection/injury phobia has a particularly high familial tendency. Studies have shown that at least two-thirds to three-fourths of the affected patients have at least one first-degree relative with specific phobia of the same type. |
All of the following are risk factors for development of depression in the elderly except | ['A. Physical illness', 'B. Female sex', 'C. History of depression', 'D. Recent bereavement', 'E. Living alone'] | Answer: E. Blood/injection/injury phobia is unique in that bradycardia and hypotension follow initial tachycardia. It is almost equally common in men and women and has high familial inheritance. It is also one of the most difficult conditions to treat. |
Patients with late-onset depressive disorder have A. Decreased likelihood of a history of depression B. Decreased risk of developing dementia C. Reduced mortality | ['D. Decreased structural abnormalities', 'E. Good treatment response'] | Answer: B. DSM-IV defines dissociative amnesia as “inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.” It is further classified into five subtypes: (I) continuous amnesia, (II) selective amnesia, (III) localized amnesia, (IV) generalized amnesia, and (V) systematized amnesia. |
Which of the following is not true about depression in the elderly? | ['A. It may present as dementia.', 'B. Treatment improves cognition.', 'C. Dementia is more common in those living in a community.', 'D. Depression in the elderly may be due to cognitive deficits.', 'E. Depression is more common in early than late dementia.'] | Answer: D. Dissociative amnesia is more likely to involve interruption of episodic-autobiographical memory; that is, historical factual information is commonly affected. |
All of the following suggest a diagnosis of dementia except A. Impaired memory | ['B. Fluctuating level of consciousness', 'C. Difficulty dressing', 'D. Impaired digit span', 'E. Difficulty in finding the way home'] | Answer: A. Latah and Amok are seen in Western Pacific countries, Grisi Siknis is seen in Nicaragua and Honduras, and Piblokto is seen in Eskimos. All these phobias are characterized by high agitation, fugue, and amnesia for the episode. Dhat, seen in rural Northern India, is guilt, as well as concern about losing energy, associated with masturbation. |
A 60-year-old male is referred for assessment of his mental state. Which of the following symptoms is most suggestive of pseudodementia? | ['A. Aphasia', 'B. Agnosia', 'C. Rapid onset and progression', 'D. Apraxia', 'E. Loss of short-term memory'] | Answer: E. Psychodynamic psychotherapy is the mainstay of treatment in patients with dissociative fugue; a slow exploratory and expressive therapy combined with a good therapeutic alliance helps. Antidepressants are only useful if there is a comorbid depression. Hypnosis and sodium amobarbital interviews are used if amnesia for identity or autobiographical memory is very dense. |
Which of the following is true regarding suicide in the elderly? | ['A. Suicide is associated with depression in about 40% of patients.', 'B. Substance abuse is as common as in the younger age groups.', 'C. Attempts are associated with a low degree of intent.', 'D. Hypochondriasis and insomnia are rare.', 'E. Attempts are a strong predictor of successful suicide.'] | Answer: D. The term “amaxophobia” denotes an abnormal and persistent fear of riding in a car. Cynophobia is fear of dogs. Ailurophobia is fear of cats. Xenophobia is fear of strangers. Mysophobia is fear of dirt and germs. |
Which of the following is not associated with suicide in the elderly? | ['A. Living alone', 'B. Bereavement', 'C. Frequent suicidal thoughts', 'D. Financial worries', 'E. Previous suicide attempts'] | Answer: A. Cingulotomy is the most common psychosurgical procedure performed for treatment-resistant OCD. It helps in 25–30% of otherwise treatment-resistant OCD. The most common complications of this procedure are seizures. |
All of the following are physical changes in aging women except A. Shrinkage of the labia | ['B. Shorter period of sexual arousal', 'C. Thinning of vaginal walls', 'D. Vaginal dryness', 'E. Dry skin'] | Answer: A. A survey conducted 5 to 8 weeks after the 9/11 attacks found a prevalence of 9.8% of either PTSD or clinical depression in Manhattan residents, and another 3.7% of the population met the criteria for both the diagnoses. |
Which of the following is found with use of tricyclics in treatment of depression in the elderly? | ['A. Decreased plasma half-life', 'B. Increased steady-state levels', 'C. Reduced volume of distribution', 'D. Reduced risk of postural hypotension E. Reduced sensitivity to antimuscuranic side effects 16. Which of the following is a definite risk factor for Alzheimer’s disease?', 'A. Head injury', 'B. Age', 'C. Male sex', 'D. Aluminum', 'E. Cigarette smoking'] | Answer: E. Antipsychotics are not found to be of any value in the treatment of PTSD, and therefore these drugs are used only to control severe aggression or agitation. Apart from MAOIs, anticonvulsants, trazodone, and propranolol, medications like reversible MAOI like moclobomoide and clonidine are also found to be useful. |