MRCPsych Parts I and II: Individual Statements and EMI Practice Exams
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MRCPsych Parts I and II: Individual Statements and EMI Practice Exams
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MRCPsych Parts I and II: Individual Statements and EMI Practice Exams
Justin Sauer
MBBS BSc MRCPsych
Specialist Registrar, Maudsley Hospital, London, UK
Hodder Arnold A MEMBER OF THE HODDER HEADLINE GROUP
First published in Great Britain in 2005 by Hodder Education, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.hoddereducation.co.uk Distributed in the United States of America by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press © 2005 Justin Sauer All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer), every effort has been made to check drug dosages; however, it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies' printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN-10: 0 340 90471 2 ISBN-13: 978 0 340 90471 8 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Clare Christian Project Editor: Clare Patterson Production Controller: Jane Lawrence Cover Design: Nichola Smith Indexer: Laurence Errington Typeset in 9.5 on 12pt Rotis Serif by Phoenix Photosetting, Chatham, Kent. Printed and bound in Great Britain by CPI Bath. What do you think about this book? Or any other Hodder Arnold title? Please visit our website at www.hoddereducation.co.uk
Dedicated to Nina, Jay and Kimby
vi
CONTENTS Foreword Acknowledgements How to use this book SECTION 1 : Part I MRCPsych Paper 1 Paper 1 Answers Paper 2 Paper 2 Answers Paper 3 Paper 3 Answers
vii viii ix
3 21 33 51 63 82
SECTION 2 : Part II MRCPsych Paper 4 Paper 4 Answers Paper 5 Paper 5 Answers Paper 6 Paper 6 Answers
97 114 129 145 159 176
Index
193
vii
FOREWORD The MRCPsych is a very fair examination. I know that there will be times during your personal preparation when you will view the exam as an enormous and impossibly difficult hurdle. ‘What kind of twisted sadist,’ you will ask, ‘would dream up such impossible questions whose answers cannot be found even in the biggest textbooks?’ As comfort, I would ask you to consider my (albeit second-hand) experience of the exam, gained during 9 years as Tutor for a scheme with 83 trainees. As cohort after cohort of SHOs went through both parts of the exam, my constant observation was that the seriousness with which a candidate approached their preparation for the exam was absolutely linked to their chances of success. Indeed, when I saw brilliant candidates fail, the reason was always clear – they simply hadn’t prepared sufficiently. Far less naturally talented folk sailed through every time if they put the effort in during the revision period. So, if ‘preparation, preparation, preparation’ is the secret to success in the MRCPsych, how should you go about it? The most time-efficient way to cover the theoretical material needed for the exam is to work through questions like the ones in this book. You will quickly learn which are the areas where your knowledge base is weakest and can direct your textbook reading appropriately. You will also be able to judge how far your revision still needs to go. If you can, study the questions with a colleague or a group of trainees who are preparing for the exam. You will find that the discussions that result from attempts to answer some of the questions will throw up areas of knowledge that are completely new to you. Further, you are much more likely to remember the answers to these questions in a few weeks’ time if they come up in the real exam situation if you have had a discussion with friends about what the right answer really is. Remember that there are only so many questions that can be set in the area and that a tremendous amount of recycling of questions happens. Hence, there’s a very good chance that some of the questions in this book will appear in the exam paper at the next sitting. So – enjoy the book and use it as part of your preparation, happy in the knowledge that if you’ve prepared yourself adequately you can expect to pass. Robert Howard, Institute of Psychiatry, London
viii
ACKNOWLEDGEMENTS I would like to thank my friends and colleagues who have encouraged me over the years, especially Robert Howard, Dinesh Bhugra, Oyedeji Ayonrinde and Naji Tabet. I am grateful also to my parents for giving me opportunities and for their support. Thank you to Hodder and in particular to Clare Christian for her enthusiasm.
ix
HOW TO USE THIS BOOK For many, the thought of exams is distressing. Right now they probably feel like expensive, stressful and unnecessary obstacles hindering your rightful career progression. This is an ‘exam adjustment reaction’! It is a normal response and will pass. The good news is that almost everyone is in the same position. Attempting to balance busy clinical jobs with family and domestic commitments is an achievement in itself. Fitting examination practice into the equation can be challenging. Whilst reading textbooks is an important component to learning any subject, practising questions is a vital part of passing examinations. With the above in mind, question practice should be snuck into little moments throughout the busy day. As I was advised to practise as many questions as I could lay my hands on, I strongly advise you do the same. Those questions that have you flummoxed should prompt you to look in your textbooks to find out more. This will help you remember for the next time. Included in this book are six practice papers comprising over 1000 questions. Section 1 contains the Part I papers and Section 2 the Part II papers. I would recommend sitting them as mock (timed) examinations if possible, but they can be used as revision aids or to stimulate further reading. Most questions are accompanied by written explanations. I have included references where appropriate should you feel the need to look at papers in more detail. Part II candidates are expected to have retained Part I knowledge, so will benefit from practising all six papers. Clinical and basic science questions are combined in the Part II papers to prevent hypersomnia. Part I candidates will find it useful to peruse the Part II papers, and will be able to use the book again for Part II preparation.
Revision advice Make no excuses for delaying the start of your revision. Be sceptical about tales of those who did not revise for their exams and passed easily, or those who only dedicated 6 weeks to revision. You know yourself and how long you will need. Get into a routine of revising regularly and of doing as many practice exam questions as you can. Practising questions allows for selfassessment and recognition of areas that need further work. For many, question-based revision is more stimulating then ploughing through textbooks. Also, by practising questions repeatedly, you get into the examination mode and the examiners’ mind set, so that you begin to see and predict questions when you are reading texts or journals.
x How to use this book
Remember the more you practise, the luckier you will be in the actual exam. I hope you find these papers helpful and stimulating in your preparation for your forthcoming examinations. Currently the Part I written paper is a 90-minute examination comprising 133 individual statement items (ISIs) and 10 themed extended matching items (EMIs). The Royal College of Psychiatrists recommends spending 60 minutes on the ISIs and 30 minutes on the EMIs. The Part II papers consist of 165 ISIs and 5 themed EMIs. In the 90-minute examination it is recommended that you spend 75 minutes on the ISIs and 15 minutes on the EMIs. I have added an extra EMI to each Part II paper to give you more practice. Good luck. J.S.
section 1: Part I MRcpsych
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ISIs: Questions 3
paper 1
4 Section 1 Paper 1
INDIVIDUAL STATEMENTS 1
D4 receptor blockade in schizophrenia is associated with an antipsychotic effect.
T
F
2
Amisulpride is a selective D1 receptor antagonist.
T
F
3
Bupropion is a nicotinic receptor agonist.
T
F
4
Bupropion is contraindicated in patients with a history of eating disorders.
T
F
5
Clozapine is effective in 80 per cent of patients with schizophrenia who do not respond to conventional neuroleptic therapy.
T
F
6
Lithium has been shown to affect neurogenesis and to increase total grey matter content.
T
F
7
Perfectionism as a personality trait is rarely associated with anorexia nervosa.
T
F
8
Secondary memory has a limited capacity.
T
F
9
The presence of comorbid anxiety in depression is a predictor of suicidality.
T
F
10
Psychotic symptoms are present in 5–10 per cent of patients with severe depression.
T
F
11
Suicide rates increase during wartime.
T
F
12
In psychotherapy, ‘clarification’ offers new formulations of unconscious meaning and motivation.
T
F
13
Psychomotor retardation has been identified as a predictor of a good response to ECT.
T
F
14
Hypoxia increases the permeability of the blood–brain barrier.
T
F
15
A reduction in TV, video and video game usage in 9-year-old children reduces aggressive behaviour.
T
F
16
Approximately 30 per cent of young women with a serious drinking problem have a significant eating disorder at some time.
T
F
17
Ecstasy (MDMA) is a dissociative anaesthetic.
T
F
Individual Statements 5
18
MDMA (Ecstasy) damages the serotonergic nerve terminal.
T
F
19
Tetrachloroethylene is most commonly abused by middle-aged men.
T
F
20
Paracetamol overdose accounts for 27 per cent of suicides by drug ingestion.
T
F
21
Susto is a condition in which it is believed a sudden fright can make the soul leave the body.
T
F
22
BITE is a self-report questionnaire used in bulimia nervosa.
T
F
23
Depression is more commonly associated with bulimia than with anorexia.
T
F
24
Disulfiram exacerbates schizophrenia.
T
F
25
Double depression describes episodes of major depression superimposed on cyclothymia.
T
F
26
Episodes of depression are usually shorter than episodes of mania.
T
F
27
The term ‘atypical neuroleptics’ relates to the failure to produce catalepsy in laboratory animals.
T
F
28
Rabbit syndrome is a movement disorder affecting the lips and peri-oral muscles.
T
F
29
Akinesia is associated with neuroleptic usage.
T
F
30
The Abnormal Involuntary Movement Scale (AIMS) scale is a measure of mental-health-related social disability.
T
F
31
Flumazenil is a benzodiazepine receptor antagonist.
T
F
32
Carbamazepine increases the levels of sodium valproate.
T
F
33
Caffeine causes global cerebral vasoconstriction.
T
F
34
Flashbacks of hallucinations following hallucinogenic usage can occur for months afterwards.
T
F
35
Veraguth’s fold is a feature of schizophrenia.
T
F
36
Mitral valve prolapse is associated with panic disorders.
T
F
37
People with affective disorders may be at an increased risk of developing dementia.
T
F
6 Section 1 Paper 1
38
Tricyclic antidepressants enhance cardiac conduction.
T
F
39
Khat usage is associated with an amphetamine-like psychosis.
T
F
40
Somatopagnosia is the inability of an individual to recognise a neurological deficit in themselves.
T
F
41
Memantine may help protect neurones from elevated glutamate levels.
T
F
42
Eicosapentanoic acid should be used with caution in schizophrenia.
T
F
43
Sixty per cent of patients with schizophrenia regularly smoke.
T
F
44
Abreaction can be performed with a slow infusion of diazepam.
T
F
45
Sildenafil is contraindicated in patients who have hereditary degenerative retinal disorders.
T
F
46
ICD-10 includes body dysmorphic disorder as part of hypochondriacal disorder.
T
F
47
Complications of trichotillomania include carpal tunnel syndrome.
T
F
48
Separation anxiety in children is greatest between the ages of 6 and 9 months.
T
F
49
Tacrine can cause liver damage.
T
F
50
Atasia abasia is the reduced impulse to act and think.
T
F
51
Sodium valproate is well absorbed following an oral administration but is only 30 per cent protein bound.
T
F
52
Opiate antagonists are useful in self-injurious behaviour.
T
F
53
Obsessive–compulsive disorder has a prevalence of 2.5 per cent.
T
F
54
Successful selective serotonin re-uptake inhibitor treatment for obsessive–compulsive disorder means tricyclic antidepressants no longer have a role in this condition.
T
F
55
Zopiclone decreases slow-wave sleep.
T
F
56
Lithium reduces REM sleep.
T
F
57
Anaclitic object-choice occurs when the choice is based on the pattern of childhood.
T
F
Individual Statements 7
58
Globus hystericus is an irrational fear of the world.
T
F
59
Negative symptoms are a risk factor for tardive dyskinesia in patients receiving antipsychotic treatment.
T
F
60
According to the World Health Organisation, 500 million people in the world are affected by depression at any one time.
T
F
61
St Louis hysteria is the same as Briquet’s syndrome.
T
F
62
Living as a woman for a minimum of 1 year is the usual life test required for male-to-female transsexual gender reassignment.
T
F
63
Advancing paternal age appears to be an independent risk factor for schizophrenia.
T
F
64
Unilateral ECT is more potent than bilateral ECT and has more pronounced side effects.
T
F
65
The EEG is useful in diagnosing Alzheimer’s disease.
T
F
66
Alcohol increases alpha activity on EEG tracings.
T
F
67
Akathisia is associated with violence.
T
F
68
Duodenal stenosis is a complication of anorexia nervosa.
T
F
69
The ‘stages of change’ model includes the plateau phase.
T
F
70
Schizophrenia is the most genetically determined psychiatric disorder.
T
F
71
Dysthymia describes a persistent depressed state of at least 24 months’ duration.
T
F
72
Lithium passes poorly into breast milk.
T
F
73
Post-partum recurrence of affective psychosis is estimated at 30–50 per cent.
T
F
74
Renal patients on haemodialysis have a reduced suicide frequency.
T
F
75
Body mass index is height (m2)/weight (kg).
T
F
76
Body fat distribution is waist (cm)/hip (cm).
T
F
77
The psychiatrist should have a fiduciary relationship with his or her patients.
T
F
8 Section 1 Paper 1
78
Sialorrhoea occurs in neuroleptic malignant syndrome.
T
F
79
Patients with seasonal affective disorder can tend towards hypomania in the spring.
T
F
80
The coexistence of pseudodementia and dementia is uncommon.
T
F
81
The onset of grief 1 week after the event is abnormal.
T
F
82
Chronic fatigue syndrome is classified in ICD-10.
T
F
83
Oxazepam is a short-acting benzodiazepine (less than 6 hours).
T
F
84
Women make up 75 per cent of people diagnosed with borderline personality disorder.
T
F
85
‘Borderline’ in borderline personality disorder was coined to describe people on the borderline between psychosis and neurosis.
T
F
86
Counter-conditioning is classical conditioning that occurs through imagery and not real experiences.
T
F
87
The Premack principle is employed in behaviour therapy.
T
F
88
The Thematic Apperception Test (TAT) is a projective test consisting of a set of ten ink blots.
T
F
89
Speedballs are used by drug addicts.
T
F
90
LSD is a synthetic hallucinogen which can be injected intravenously.
T
F
91
Melatonin levels are high during the day and decrease during sleep.
T
F
92
Cognitive therapy helps the individual acquire coping strategies.
T
F
93
Suicide is a form of acting out.
T
F
94
Individuals who have attempted suicide once have a 27-fold greater risk of subsequently committing suicide than the general population.
T
F
95
Hyperprolactinaemia may increase the risk of venous thromboembolism in some patients taking antipsychotic medication.
T
F
96
Dialectical behaviour therapy was developed specifically to treat borderline personality disorder.
T
F
Individual Statements 9
97
Anxiety disorders are the commonest psychiatric disorders seen in diabetic patients.
T
F
98
Cognitive analytic therapy usually lasts for a minimum of 30 sessions.
T
F
99
Deprivation is a cause of speech (language) delay.
T
F
100
Clozapine causes agranulocytosis in 7 per cent of treated subjects.
T
F
101
Narrow angle glaucoma is a contraindication for olanzapine.
T
F
102
Jung described eight basic operations of the mind.
T
F
103
Approximately two-thirds of those with anorexia nervosa have comorbid social phobia.
T
F
104
Low serum phosphate is a complication of re-feeding in anorexia nervosa.
T
F
105
T4 levels are usually increased in anorexia nervosa.
T
F
106
Amitriptyline is a tertiary amine.
T
F
107
Disulfiram reduces the plasma levels of tricyclic antidepressants.
T
F
108
Liddle’s classification of schizophrenia is based on factor analysis of cerebral blood flow patterns.
T
F
109
Amisulpride is a pure D2 antagonist.
T
F
110
Neuroleptic malignant syndrome has not been reported with clozapine or risperidone.
T
F
111
In Kleinian theory, the depressive position is linked to manic defences.
T
F
112
Follow-up studies of schizophrenia show a suicide rate of approximately 20 per cent.
T
F
113
Conversion symptoms usually conform to a physician’s idea of a disease.
T
F
114
Gestalt psychology emphasises the importance of perceiving whole objects and proposes a number of principles to explain how we organise them.
T
F
115
Progressive gait disorder is associated with normal pressure hydrocephalus.
T
F
10 Section 1 Paper 1
116
Features of Parson’s sick role include wanting to remain unwell.
T
F
117
Imperative hallucinations are of little clinical significance.
T
F
118
First rank symptoms are absent in 20 per cent of patients with schizophrenia.
T
F
119
According to studies of child temperament, 2 per cent of children are ‘slow to warm up’.
T
F
120
Memory is profoundly affected in Huntington’s disease relative to other cognitive functions.
T
F
121
Sodium lactate induces symptoms of panic.
T
F
122
The suicide rate is higher amongst the never married than the widowed.
T
F
123
The susceptibility of individuals to develop depression as a result of major stressful life events changes with age.
T
F
124
Freud thought aggression was a fundamental human drive.
T
F
125
ECT up-regulates 5HT2 receptors.
T
F
126
Tetrabenazine is a known cause of depression.
T
F
127
Anorexia nervosa has the highest mortality of any psychiatric disorder.
T
F
128
The seizure threshold lowers during a course of ECT, particularly bilateral ECT.
T
F
129
In ECT the seizure threshold is higher in women.
T
F
130
The lifetime prevalence of a unipolar depressive episode is 17 per cent.
T
F
131
The community prevalence of mania in the elderly is 1.8 per cent.
T
F
132
≥ 35 µg oestrogen daily might increase the risk of depression.
T
F
133
Depression is associated with reduced REM latency.
T
F
EMIs 11
EMIs 1 A B C D E
Procyclidine Clozapine Prednisolone Dantrolene Amphetamine
F G H I J
Fenfluramine Benzodiazepines Chloral hydrate Disulfiram Lithium
A patient not known to you has taken a large overdose of their medication. Which is the most likely drug taken if the patient presents with the following symptoms and signs? 1
Irritability, elation, hyperactivity, dry mouth, reduced concentration, chest pain, arrhythmia, heart block, psychotic symptoms.
2
Slurred speech, poor co-ordination, somnolence, hypotension, hyporeflexia, confusion, coma, respiratory depression.
3
Delirium, drowsiness, tachycardia, arrhythmia, hypotension, hypersalivation, seizures.
4
Headache, rash, peripheral/optic neuropathy, mucous membrane injury, psychotic behaviour.
5
Diarrhoea, vomiting, confusion, drowsiness, tremor, vertical nystagmus, muscle rigidity.
12 Section 1 Paper 1
2 A B C D E F
Somatisation disorder Conversion disorder Hypochondriasis Body dysmorphic disorder Chronic pain syndrome Munchausen’s syndrome
G H I J
Munchausen’s syndrome by proxy Pseudopsychiatric syndrome Malingering Factitious disorder
What is the most likely diagnosis in the following cases? 1
A 27-year-old woman with loss of sensation and power in her lower limbs. Neurological impairment does not map to specific dermatomes and she is not unduly concerned.
2
A 42-year-old bus driver, unemployed for 2 years, claims he is unable to walk following a fall on uneven pavement. Despite the absence of abnormalities on physical examination, he is suing the local authority for compensation.
3
A 21-year-old woman wants corrective surgery as she believes her eyes are spaced too widely apart.
EMIs 13
3 A B C D E F
Simple partial seizures Complex partial seizures Absence seizures (petit-mal) Tonic–clonic seizures Myoclonic seizures Atonic seizures
G H I J
Isolated tonic or clonic seizures Febrile convulsions Reflex epilepsy Psychogenic epilepsy
Select one of the diagnoses above to fit each of the cases below. 1
A 23 year old who does not lose consciousness but has witnessed, brief, sudden drop attacks. They have been progressive and of longer duration more recently.
2
A 19 year old whose seizures are precipitated by the specific stimulus of flickering lights, as in certain television programmes.
3
Developing in childhood or adolescence, mostly after 5 years of age, seizures occur without warning/aura and the subject is often unaware that an attack has happened.
14 Section 1 Paper 1
4 A B C D E
Paranoid Anankastic Histrionic Dependent Borderline
F G H I J
Schizotypal Schizoid Anxious-avoidant Dissocial Narcissistic
Which personality disorder is the individual described most likely to be diagnosed with? 1
A 32 year old with a strong sense of self-importance, shallow mood and a craving for excitement.
2
A 29-year-old man who interprets other people’s actions as deliberately demeaning or threatening.
3
A 37 year old with an indifference to relationships and a restricted range of emotional experience and expression.
EMIs 15
5 A B C D E F
Coma Type 2 diabetes Proteinuria Hypouricaemia Hyperphosphataemia Dehydration
G H I J K
Leucocytosis Hyperthermia Hypercalcaemia Rhabdomyolysis None of the above
With regard to a 35-year-old man with neuroleptic malignant syndrome (NMS) treated with haloperidol: 1
Which of the above was a risk factor for NMS in this gentleman?
2
Which finding is common and diagnostically important?
3
Which finding is pathognomonic of NMS?
4
Which finding can lead to renal failure in NMS?
16 Section 1 Paper 1
6 A B C D E
Over-inclusive thinking Hierarchy of needs Cohesiveness Condensation Loosening of associations
F G H I J
Concrete thinking Drivelling Abstract thinking Depersonalisation Primitive states of mind
Which of the above concepts are associated with the following figures? 1
Cameron
2
Bleuler
3
Schneider
4
Goldstein
5
Piaget
6
Bion
7
Yalom
EMIs 17
7 A B C D E
Paranoid schizophrenia Hebephrenic schizophrenia Catatonic schizophrenia Simple schizophrenia Residual/chronic schizophrenia
F G H I J
Undifferentiated schizophrenia Post-schizophrenic depression Schizoid Schizotypal None of the above
Which diagnosis is being described in each case below? 1
Poor functioning and negative symptoms without preceding positive symptoms.
2
History of prominent persecutory, grandiose delusions and hallucinations present intermittently for 2 weeks.
3
A 25-year-old man with fleeting delusions, disorganised thought and rambling speech who was shy and solitary premorbidly.
18 Section 1 Paper 1
8 A B C D E
Half-life First-order kinetics Pure agonist Antagonist Agonist
F G H I J
Bioavailability Zero-order kinetics Inverse agonist Second-order kinetics Pseudoreversible
The following descriptions relate to one of the pharmacological terms above. 1
Drug elimination is not proportional to the concentration of the drug in the body. The rate of drug elimination is constant.
2
The rate of drug elimination is directly proportional to its plasma concentration.
3
Maximal drug response at less than 100 per cent receptor occupancy.
EMIs 19
9 A B C D E F
Paranoid personality disorder Schizoid personality disorder Dissocial personality disorder Emotionally unstable – impulsive type Emotionally unstable – borderline type Histrionic personality disorder
G H I
Anankastic personality disorder Anxious-avoidant personality disorder Dependent personality disorder
Match each of the following descriptions to the most likely diagnosis. 1
A 32-year-old man who likes to be alone. Neighbours have been friendly, but he shuns them and avoids any conversation. He refuses to clear the rubbish from the front of his house, despite the council’s demands.
2
A 24-year-old woman who can get angry quite easily. She is confrontational and quarrelsome, especially when criticised. Unstable and capricious mood.
3
A 22-year-old woman who feels socially inept, unappealing and inferior to others. Concerned about being criticised or rejected in social situations, she restricts her lifestyle because of a need for physical security.
20 Section 1 Paper 1
10 A B C D E
Language Object constancy Prosopagnosia Praxis Primitive reflexes
F G H I
Memory Frontal executive function Attention and concentration Visual agnosia
What is being tested or demonstrated in the following cognitive tests performed on a 73-year-old man with suspected degenerative dementia? 1
Copying the Rey–Osterreith figure.
2
An inability to name an object when pointed out to him.
3
Ask the patient to repeat a hand sequence of fist–edge–palm, five times with both hands.
ISIs: Answers 21
INDIVIDUAL STATEMENTS: Answers 1
False. The role of D4 in relation to psychosis remains uncertain and D4 receptor antagonists have failed to show an antipsychotic effect. Serretti A et al. Schizophr Bull 1999, 25:609–18.
2
False. Amisulpride is a selective D2/D3 antagonist.
3
False. Bupropion (Zyban) is a nicotinic antagonist used in smoking cessation.
4
True. The Committee on Safety of Medicines advises that bupropion is avoided in patients with eating disorders, a history of seizures, central nervous system tumours and acute symptoms of alcohol or benzodiazepine withdrawal.
5
False. 30–60 per cent. Chong S-A. Schizophr Bull 2000, 26:421–40.
6
True.
7
False. Perfectionism is a robust and discriminating feature of anorexia nervosa. Halmi K et al. Am J Psychiatry 2000, 157:1799–805.
8
False. Secondary or long-term memory has a theoretically unlimited capacity.
9
True. The diagnosis and monitoring of anxiety in depressed patients are an important part of monitoring for suicidal risk. Schaffer A et al. Can J Psychiatry 2000, 45:822–6.
10
False. 10–25 per cent of patients with severe depression.
11
False. Suicide rates decline in wartime and at times of high employment. They increase during economic downturns and high unemployment.
12
False. Clarification involves rephrasing and questioning. Confrontation draws attention to what the patient is doing, e.g. missing appointments. Interpretation offers new formulations of unconscious meaning and motivation.
22 Section 1 Paper 1
13
True. In depression, psychomotor retardation, delusions, history of previous response to ECT are predictors of a good response to ECT.
14
True. Others include fever, inflammation, head injury, hypercapnia and hypertension.
15
True. Robinson T et al. Arch Pediatr Adolesc Med 2001, 155:17–23.
16
True. More commonly bulimia nervosa. Lacey JH, Moureli EJ. Br J Addiction 1986, 81:389–93.
17
False. MDMA (3,4-methylenedioxymethamphetamine) is a hallucinogenic amphetamine. Phencyclidine and ketamine are dissociative anaesthetics.
18
True. PET studies have shown this. McCann UD et al. Lancet 1998, 352:1433–7.
19
False. Tetrachloroethylene is a volatile substance used in solvent cleaning products. It is commonly abused by teenagers. Others include toluene and butanes.
20
False. It accounts for 4 per cent. The National Confidential Inquiry into Suicide and Homicide in the UK has shown prescribed psychotropics to be the most commonly used.
21
True. A culture-bound syndrome of Latin America: ‘If the soul leaves the body it becomes vulnerable to disease’.
22
True. Bulimic Investigatory Test Edinburgh (BITE). Henderson M, Freeman CP. Br J Psychiatry 1987, 150:18–24.
23
True.
24
True. It can (rarely) exacerbate schizophrenia and induce psychosis.
25
False. This is major depression superimposed on dysthymia. Treatment is with antidepressants.
26
False. It’s the other way round.
27
True.
28
True. Associated with neuroleptic-induced extrapyramidal side effects. Often a late feature.
ISIs: Answers 23
29
True. Parkinsonian tremor, muscular rigidity and akinesia are the cardinal features associated with neuroleptic-induced Parkinsonism (DSM-IV).
30
False. AIMS is a measure of neuroleptic-induced motor disturbance.
31
True. Flumazenil reverses the psychophysiological effects of the benzodiazepine agonists.
32
False. It reduces the levels of valproate, warfarin, clonazepam, dexamethasone, doxycycline, haloperidol. The levels of erythromycin are increased.
33
True. With subsequent reduced cerebral blood flow. There is a rebound increase in blood flow after withdrawal!
34
True. This has been shown in several studies looking at depression and sleep.
35
False. Veraguth described a triangle-shaped fold in the nasal aspect of the upper eyelid in patients with depression.
36
False. This was previously thought to be true, but all recent evidence suggests that there is no association.
37
True. Study involving 2007 patients with mania, 11 741 with depression, 81 380 with osteoarthritis and 69 149 with diabetes. However, depression may be an early symptom of dementia. Kessing LV, Nilsson FM. J Affect Disord 2003, 73:261–9.
38
False. Tricyclic antidepressants delay cardiac conduction. There is a dose-dependent effect. This might precipitate complete heart block if there are pre-existing conduction delays.
39
True. Khat is a plant used recreationally mainly in East African countries, although its use is widely recognised in other parts of the world. Khat consumption has been associated with schizophreniform and manic psychoses.
40
False. The description is that of anosognosia. Somatopagnosia is the inability of a person to recognise one of their own body parts.
41
True. Memantine is thought to be an uncompetitive NMDA receptor antagonist, but its precise mechanism of action is complicated and currently uncertain.
24 Section 1 Paper 1
42
False. Eicosapentanoic acid is a fish oil used to some effect in schizophrenia. It has a theoretical role in maintaining neuronal membrane structure.
43
False. Ninety per cent of patients with schizophrenia regularly smoke. Hypothetically, smoking may increase dopamine release, leading to a sense of well-being and reduction in negative symptoms. Goff DC et al. Am J Psychiatry 1992, 149:1189–94.
44
True. Drugs used include barbiturates (amobarbital, thiopentone), diazepam, midazolam. Abreaction is used to create a semi-conscious state, lowering the patient’s defences and allowing them to speak about experiences or emotions. It is useful in distinguishing between dementia and pseudodementia or in hysterical disorders.
45
True. Sildenafil (Viagra) is also contraindicated in patients who have had a recent stroke, myocardial infarction or blood pressure < 90/50 mmHg.
46
True.
47
True. Trichotillomania (recurrent hair pulling) is also associated with infected follicles, trichophagy (hair swallowing) and trichobezoars (hair balls), which can lead to stomach pain and obstruction. Christenson G et al. J Clin Psychiatry 1996, 57:42–7.
48
False. It is greatest between 10 and 18 months. It usually disappears by 3 years.
49
True. An acetylcholinesterase inhibitor – not licensed in the UK.
50
False. Atasia abasia is the inability to stand or walk. It does not fit with organic disease and is often a symptom of conversion disorders.
51
False. Up to 90 per cent is protein bound.
52
True. Where a physiological reward mechanism following self-harm exists.
53
True. 1.9–3.1 per cent (Epidemiological Catchment Area Study). Regier DA et al. J Psychiatr Res. 1990, 24 Suppl 2:3–14.
54
False. Clomipramine is still used widely.
55
False. It increases slow-wave sleep. Benzodiazepines decrease slowwave sleep and REM.
ISIs: Answers 25
56
True. It also delays REM onset.
57
True. Freud distinguished between two types of object-choice, narcissistic and anaclitic. In narcissistic object-choice, the object is chosen on the basis of some real/imaginary resemblance to the self.
58
False. It is a subjective sense of a lump in the throat and difficulty swallowing with no evidence of abnormal anatomy.
59
True. Others include length of exposure to antipsychotic, increased age/elderly, female, head injury, organic brain disease and brain damage.
60
False. 121 million worldwide. 800 000 suicides/year; 450 million people with mental illness. WHO 2001, Mental Health, New Hope (World Health Report), Geneva, WHO.
61
True. Both are names for somatisation disorder.
62
False. The period is 2 years.
63
True. The risk of developing the condition was shown to rise by 30 per cent for every 10-year increase in paternal age. Study of 50 000 adolescent males. Zammit S et al. Br J Psychiatry 2003, 183:405–8.
64
False. It’s the other way round.
65
False. Not really. In Alzheimer’s disease there can be widespread slowing of the trace, slowing of alpha activity and non-characteristic changes; 95 per cent have a non-specific abnormal EEG.
66
True.
67
True. Neuroleptic-induced akathisia leads to restlessness and a sense of discomfort which can precipitate aggressive behaviour.
68
False. Duodenal dilatation is a complication of eating disorders and can be demonstrated by barium meal.
69
False. Model developed by Prochaska and DiClemente. Stages: 1. Precontemplative, 2. Contemplative, 3. Decision, 4. Action, 5. Maintenance, 6. Relapse.
26 Section 1 Paper 1
70
False. Bipolar affective disorder is the most genetically determined disorder – heritability 0.8.
71
True. It involves 2 years of low mood where the diagnostic criteria for a depressive disorder are not met.
72
False. Lithium enters breast milk freely.
73
True. Wieck A et al. BMJ 1991, 303:613–16.
74
False. Their risk is five times greater than that of the general population.
75
False. Weight (kg)/height (m2).
76
True. Ratios of ≥ 1.0 for men and > 0.8 for women are associated with increased morbidity and mortality.
77
True. ‘Acting in the best interests of the patient as stated in the Hippocratic oath’.
78
True. Excess salivation can lead to aspiration if the patient also has dysphagia.
79
True. However, not usually reaching diagnostic severity. Seasonal affective disorder is included in ICD-10 under recurrent depressive disorder.
80
False. Coexistence of these two conditions is common, especially vascular dementia.
81
False. Delayed grief is the onset of grieving 2 weeks after the event. Other abnormal reactions include inhibited grief, chronic grief and complicated grief.
82
False. ‘Fatigue syndrome’ is classified under Neurasthemia.
83
False. It is intermediate acting (6–20 hours). Midazolam is short acting and diazepam is long acting (50–100 hours).
84
True.
85
True.
86
False. This is covert conditioning. Counter-conditioning is when a conditioned stimulus is paired with a new stimulus that produces an incompatible or opposite response.
ISIs: Answers 27
87
True. A desired low-frequency behaviour must be completed before a high-frequency behaviour can be carried out, e.g. you must complete 50 individual statements before you can watch TV.
88
False. The Rorschach test consists of ten ink blots and the subject is asked what each blot might represent. TAT is a test consisting of 20 cards of ambiguous scenes; the subject is asked to create a story about each card. Both are projective tests.
89
True. Speedballs comprise a stimulant and a ‘depressant’ used together intravenously. Heroin and cocaine are abused together in this way.
90
True. Although usually taken orally, it can also be absorbed transdermally, as eye drops, or intravenously.
91
False. Levels are low during the day and high during sleep. Melatonin is a hormone involved in circadian rhythms, which is produced by the pineal gland.
92
True. There are three main goals of cognitive therapy: to relieve symptoms and resolve problems, to acquire coping strategies, and to modify underlying cognitive structures in order to prevent relapse.
93
True. Acting out is a general character trait in which a person is given to relieving any intrapsychic tension by physical action.
94
True. Hawton K, Fagg J. Br J Psychiatry 1988, 152:359–66.
95
True. It may stimulate platelet aggregation and activation. Wallaschofski H et al. Horm Metab Res 2004, 36(1):1–6.
96
True.
97
False. Depression is the commonest, affecting up to 50 per cent of people with poorly controlled type 1 diabetes. Pickup JC (ed.). Brittle Diabetes. Oxford, Blackwell Scientific, 1985, 76–102.
98
False. It lasts for 16 sessions, 24 for borderline personality disorder.
99
True. Others: deafness, dysphasia, dysarthria and learning disability.
100 False. It occurs in 1 per cent of treated patients.
28 Section 1 Paper 1
101 True. 102 False. He described four basic operations of the mind (sensation, intuition, feeling and thinking) – which were considered with the two attitudes (introversion and extraversion) to create eight psychological types. 103 False. The figure is one-third. 104 True. 105 False. T4 and prolactin are unchanged; FSH and LH are reduced; growth hormone and cortisol are increased. 106 True. This is determined by the number of methyl groups attached to the nitrogen atom. A secondary amine has one group, a tertiary amine has two groups. Tertiary amines (ADICT) Secondary amines Amitriptyline Nortriptyline Doxepin Desipramine Imipramine Protriptyline Clomipramine Trimipramine 107 False. Tricyclic antidepressant plasma levels are reduced by anticonvulsants and increased by cimetidine, chlorpromazine and disulfiram. 108 True. 109 False. Sulpiride is pure D2. Amisulpride is D2/D3. 110 False. Neuroleptic malignant syndrome has been reported but is not common. Umbricht D, Kane JM. Schizophr Bull 1996, 22:475. 111
True.
112 False. 10 per cent. 113 False. They conform to the individual’s idea of a disease. 114 True. 115 True. It is associated with progressive gait disorder, urinary incontinence and impaired mental function.
ISIs: Answers 29
116 False. Features include wanting to get better, seeking professional advice, shedding some normal activities/responsibilities and exemption from blame. 117 False. These are command hallucinations, an important clinical feature. 118 True. 119 False. 15%. Easy 40%, Difficult 10%, Not defined 35%. Thomas A, Chess S. J Am Acad Child Psychiatry 1977, 16(2):218–26. 120 False. Memory is relatively spared. Subcortical dementia, distractible, poorly developed EEG (loss of α activity), caudate and putamen atrophy. 121 True. Yes it can. 122 False. Married < never married < widowed < divorced. 123 False. It does not seem to change throughout life. Kessing LV et al. Psychol Med 2003, 33(7):1177–84. 124 True. 125 True. Antidepressants have an opposite effect – down-regulating 5HT2 receptors. 126 True. It is used to control movement disorders, e.g. Huntington’s chorea. It may act by depleting dopamine from nerve endings. 127 True. There is 15 per cent mortality over 20 years. 128 False. ECT increases the seizure threshold. 129 False. It is higher in men. 130 True. The lifetime prevalence of bipolar disorder is 1.2 per cent. 131 False. It is 0.1 per cent. 132 True. Kay KC. Clin Obstet Gynaecol 1984, 11(3):759–86. 133 True.
30 Section 1 Paper 1
EMIs: Answers 1 1
E
2
G
3
B
4
I
5
J
2 1
B
This is a common finding in conversion disorders. The patient’s disorder does not fit the clinicians’ understanding of disease-specific clinical signs.
2
I
3
D
Patients often perceive significant deformities which others consider mild or absent altogether.
1
F
The EEG is very variable and is normal between seizures.
2
I
Seizures can involve a motor component, e.g. sudden limb movements.
3
C
They can be provoked by hyperventilation. Subsequent confusion is uncommon and the disorder usually resolves by adulthood.
3
4 1
C
2
A
3
G
EMIs: Answers 31
5 1
F
Other risk factors include: high-dose neuroleptics two or more neuroleptics depot medication previous NMS electrolyte disturbance male > female age < 20 years age > 60 years CNS dysfunction.
2
H
Recent neuroleptic exposure, hyperthermia, autonomic instability.
3
K
4
J
It is important to check for myoglobinuria.
6 1
A
2
D or E
3
G
4
F
5
H
6
J
7
C
32 Section 1 Paper 1
7 1
D
2
J
3
B
The normal requirement for a diagnosis of schizophrenia (ICD-10) is that at least one of the diagnostic symptoms has been present for most of the time for at least 1 month.
8 1
G
Saturation kinetics: the concentration of the drug in the plasma may be high, but elimination is constant, limited, for example, by enzymatic availability.
2
B
So the greater the plasma concentration, the greater the amount of drug that is metabolised or removed (linear kinetics).
3
C
9 1
B
2
D
3
H
10 1
F
Visual memory (right temporal lobe).
2
I
Visual agnosia: unable to name an object by sight but often able to do so through another sense.
3
G
Luria’s three-step task, a motor sequencing frontal lobe test.
ISIs: Questions 33
paper 2
34 Section 1 Paper 2
INDIVIDUAL STATEMENTS 1
The lack of a confiding relationship is a vulnerability factor for post-traumatic stress disorder.
T
F
2
The point prevalence of schizophrenia is 0.01 per cent.
T
F
3
The lifetime risk of depression is approximately 15 per cent for women.
T
F
4
An ambivalent relationship with ‘a deceased’ is associated with an abnormal grief reaction.
T
F
5
Digit symbol is a verbal assessment used in the Wechsler Adult Intelligence Scale.
T
F
6
Paramnesias are distorted recollections leading to memory falsifications.
T
F
7
Déjà entendu is the illusion of recognising a new thought.
T
F
8
Déjà pensé is the illusion of auditory recognition.
T
F
9
Klein believed that the ego and superego were present from birth.
T
F
10
Carbamazepine has a selective serotonin re-uptake inhibitor-like structure.
T
F
11
Behaviour therapy is the first-choice treatment for nocturnal enuresis in children.
T
F
12
Karl Abraham expanded Freud’s oral and anal stages of development.
T
F
13
Thirty per cent of patients with a first depressive episode go on to have a relapse.
T
F
14
Thurstone described 17 primary abilities.
T
F
15
Winnicott is associated with the Scrabble game.
T
F
16
Object constancy is a component of Margaret Mahler’s developmental theory.
T
F
17
Depersonalisation disorder is a remitting and relapsing disorder.
T
F
Individual Statements 35
18
Chlorpromazine induces its own metabolism.
T
F
19
There is an association between leptin levels and weight gain with certain antipsychotics.
T
F
20
‘Group think’ is to be encouraged in the small group environment.
T
F
21
Moclobemide is selective for monoamine oxidase A.
T
F
22
Pseudohallucinations are under the individual’s control.
T
F
23
Asyndesis is a feature of formal thought disorder.
T
F
24
Buspirone has a moderate sedative effect.
T
F
25
Pseudohallucinations are usually vivid experiences.
T
F
26
A reflex hallucination is a hallucination occurring in more than one sensory field.
T
F
27
Persisting with substance use despite clear evidence of overtly harmful consequences is one of the criteria for the dependence syndrome.
T
F
28
A dynamic formulation suggests a personal meaning of a person’s symptoms in terms of his or her psychological organisation.
T
F
29
In dynamic terms, mania is considered to be a defence against anxiety.
T
F
30
One-third of people committing suicide have presented to the Accident and Emergency department on a previous occasion.
T
F
31
Narcotics Anonymous have a 12-step approach for problem drug users.
T
F
32
Menatetrenone (vitamin K2) may be beneficial in preventing bone loss in patients with anorexia nervosa.
T
F
33
Electric shock sensations are a feature of antidepressant discontinuation syndrome.
T
F
34
Yerkes–Dodson’s theories of motivation relate to three drives – curiosity, competence and reciprocity.
T
F
35
Vitamin B12 deficiency is associated with anxiety and psychosis.
T
F
36
HLA DR2 has an association with sleep disorders.
T
F
36 Section 1 Paper 2
37
A link between fluoxetine use and suicidal behaviour has been suggested.
T
F
38
The majority of people leave therapeutic communities in the first month.
T
F
39
Catharsis is purging of an emotion by experiencing it intensely.
T
F
40
Prolonged maternal separation perinatally leads to impaired attachment behaviour.
T
F
41
Interpersonal therapy has mainly been used for depression.
T
F
42
Socratic questioning is a core feature of dynamic psychotherapy.
T
F
43
The Beck Depression Inventory is a self-report measure.
T
F
44
Interpersonal therapy is a 12-session course of therapy.
T
F
45
Vicarious learning has been shown to lower anxiety.
T
F
46
Disgust is a secondary emotion.
T
F
47
Thurstone’s primary mental abilities include memory.
T
F
48
Topiramate causes weight loss.
T
F
49
Positive reinforcement occurs when a behaviour is strengthened because an aversive stimulus has been escaped or avoided.
T
F
50
Splitting as a defence mechanism is associated with borderline personality disorder.
T
F
51
Free-radical-induced neurotoxicity has been suggested as a hypothesis explaining tardive dyskinesia.
T
F
52
Freud had five theories of anxiety.
T
F
53
Bleuler’s criteria for schizophrenia include autism.
T
F
54
Pimozide is contraindicated in patients with QT prolongation.
T
F
55
The Tower of London Test is a test of parietal lobe function.
T
F
56
Narcolepsy is a dysomnia commonly associated with sleep paralysis and hypnagogic hallucinations.
T
F
57
Priapism is a common side effect of sildenafil.
T
F
58
There is a risk of contact sensitisation with chlorpromazine.
T
F
Individual Statements 37
59
Agoraphobia is described as a fear of empty open spaces.
T
F
60
Carbon monoxide poisoning is a cause of catatonia.
T
F
61
According to the preparedness theory, things feared may have once been dangerous to the human race.
T
F
62
All dreams should be analysed in psychoanalysis.
T
F
63
Roth described phobic anxiety depersonalisation syndrome and considered it a form of anxiety neurosis.
T
F
64
Obsessive compulsive disorder is rarely associated with depressive illness.
T
F
65
Farmers have a low risk of suicide.
T
F
66
Nutmeg abuse is associated with psychosis.
T
F
67
Patients with depression who respond to acute antidepressants reduce the odds of relapse by 70 per cent if they continue treatment.
T
F
68
Risperidone reduces REM sleep in healthy individuals.
T
F
69
Morbid jealousy is a delusional state and not an overvalued idea.
T
F
70
During psychiatric interviewing, probing about suicidal intent probably increases the risk of suicide.
T
F
71
Visual hallucinations occur in oneiroid states.
T
F
72
Tactile hallucinations are a feature of cocaine withdrawal.
T
F
73
Bulimia has one of the highest mortality rates among psychiatric disorders.
T
F
74
Alcohol misuse has been shown to be one of the most consistent predictors of death among patients with anorexia nervosa.
T
F
75
Pentazocine can cause hallucinations.
T
F
76
There is a link between narcolepsy and HLA DR2.
T
F
77
A single use of cannabis will be detected in the urine for up to 27 days.
T
F
78
Amphetamines are not detectable in the urine.
T
F
79
Morphine is a metabolite of heroin.
T
F
38 Section 1 Paper 2
80
Diazepam is a metabolite of oxazepam.
T
F
81
Ego strength is a term coined by Bleuler.
T
F
82
Left–right disorientation occurs with dominant parietal lobe lesions.
T
F
83
There is loss of axillary and pubic hair in anorexia nervosa.
T
F
84
Frontal lobe functions can be impaired by maintenance ECT.
T
F
85
The risk of tardive dyskinesia reduces with increasing age.
T
F
86
Suicide has a significant association with obsessive–compulsive disorder.
T
F
87
Disclosure of information during interview is increased by commenting on interviewee affect.
T
F
88
The risk of completed suicides is higher in women than in men.
T
F
89
Asyndetic thinking is suggestive of schizophrenia.
T
F
90
There is a tendency to explore objects with the mouth in Klüver-Bucy syndrome.
T
F
91
Emergency surgery is a recognised precipitant of delirium tremens.
T
F
92
Gustatory hallucinations are suggestive of functional illness.
T
F
93
Pain is uninfluenced by cultural background.
T
F
94
Cimetidine inhibits metabolism of the benzodiazepines.
T
F
95
Two-thirds of people with Tourette’s disorder meet diagnostic criteria for obsessive–compulsive disorder.
T
F
96
In obsessive–compulsive disorder, pathological thoughts are egosyntonic.
T
F
97
Briquet’s syndrome occurs more commonly in women.
T
F
98
Sighing is a symptom of anxiety.
T
F
99
The fear is often proportional to the threat in phobic states.
T
F
100
Tricyclic antidepressants have direct toxicity on the myocardium.
T
F
101
Edward and Gross are associated with the diagnostic criteria for benzodiazepine withdrawal.
T
F
Individual Statements 39
102
A hysterical fugue has usually resolved by 3 weeks.
T
F
103
Ophthalmoplegia is a rare feature of Wernicke’s encephalopathy.
T
F
104
Waxing and waning of the EEG is seen in drowsiness.
T
F
105
The alpha rhythm is 8–13 Hz in the normal EEG.
T
F
106
Onset before the age of 15 years is a good prognostic indicator in schizophrenia.
T
F
107
Negative symptoms in schizophrenia are associated with a poorer prognosis.
T
F
108
The risk of agranulocytosis with clozapine treatment is dose dependent.
T
F
109
The depressive position is associated with ambivalence towards the mother.
T
F
110
Modelling can result in social facilitation.
T
F
111
Defence mechanisms associated with hysteria include identification.
T
F
112
Visual hallucinations are common in schizophrenia.
T
F
113
Fluent speech is seen in nominal dysphasia.
T
F
114
Couvade syndrome and pseudocyesis are one and the same.
T
F
115
Orofacial dyskinesias are abnormal voluntary movements.
T
F
116
Propranolol is lipophylic.
T
F
117
Benzodiazepines cause retrograde amnesia.
T
F
118
DSM-IV makes use of a five-scale multi-axial system.
T
F
119
Depersonalisation and derealisation rarely occur together.
T
F
120
Dereistic thinking is the same as fantasy thinking.
T
F
121
Primary delusions are rarely preceded by a delusional mood.
T
F
122
Anhedonia is the complete loss of emotion.
T
F
123
Confabulation is a disorder of the temporal sequence of thinking.
T
F
124
Behavioural treatment of phobias is based on habituation.
T
F
40 Section 1 Paper 2
125
Fear of blushing is a cognitive notion involved in cases of social phobia.
T
F
126
Imprinting is a psychological factor involved in simple phobias.
T
F
127
According to Beck’s cognitive therapy, ‘an individual’s affect and behaviour are determined by the way he structures the world’.
T
F
128
Eidetic imagery involves memories stored with photographic-like quality.
T
F
129
The pre-operational stage of development is characterised by the ability to comply with rules.
T
F
130
Bottle-fed babies often show ‘slow to warm up’ personalities.
T
F
131
The transitional object is the ‘good enough mother’ according to Winnicott.
T
F
132
Depersonalisation should be treated in the main by ECT.
T
F
133
Beck’s cognitive triad relates to positive thoughts about self, the present and the future.
T
F
EMIs 41
EMIs 1 A B C D E F
Right frontal lobe Bilateral frontal lobes Left frontal lobe Dominant temporal lobe Non-dominant temporal lobe Bilateral temporal lobes
G H I J K
Dominant parietal lobe Non-dominant parietal lobe Left occipital lobe Right occipital lobe Bilateral occipital lobes
Match the condition or physical sign to the affected brain area. 1
Wernicke’s aphasia
2
Gerstmann’s syndrome
3
Urinary incontinence
4
Agnosia for sounds and some qualities of music
5
Homonymous upper quadrantanopia
6
Anton’s syndrome
7
Balint syndrome
42 Section 1 Paper 2
2 A B C D E
Arbitrary inference Selective abstraction Overgeneralisation Dichotomous thinking Magnification
F G H I
Minimisation Catastrophising Jumping to conclusions Personalisation
Match the histories provided to the cognitive distortions above. 1
A 35-year-old woman with high standards feels she is a complete failure if she is not completely successful in everything she does.
2
A 27-year-old psychiatric junior doctor gave a grand round presentation which was very well received. He feels it was a failure, however, as one slide had a spelling mistake on it.
3
A 22-year-old woman feels hopeless and has difficulty problem solving. She always thinks the worst: ‘If it’s going to happen, it’s going to happen to me’.
EMIs 43
3 A B C D E F G
Regression Repression Reaction formation Isolation Undoing Projection Introjection
H I J K L
Turning against the self Reversal Sublimation Idealisation Identification with the aggressor
Anna Freud described a number of defence mechanisms. Match the descriptions below to the correct defence mechanism. 1
Thinking of doing the opposite to the unconscious desire.
2
An ambivalently seen object is split in two, one object being seen as ideally good and the other as wholly bad.
3
The separation of an idea from its associated affect.
4
The indirect expression of instincts without adverse consequences.
44 Section 1 Paper 2
4 A B C D E
Delusions of reference Delusional misinterpretation Delusional misidentification Delusional perception Delusions of persecution
F G H I J
Delusions of conspiracy Delusional memory Delusional jealousy Delusions of pregnancy Religious delusions
A patient presents to the Accident and Emergency department. He has a number of unusual beliefs, as shown below. Match them to the above psychopathological descriptions. 1
‘People drop hints meant for me and say things with double meanings’.
2
‘I see people that I recognise from a previous life’.
3
‘My neighbour is trying to poison me by passing gas into my flat’.
4
‘I see messages for me in the newspapers and on the television’.
EMIs 45
5 A B C D E
Changing perceptions Dulled perception Heightened perception Derealisation Depersonalisation
F G H I
Unfamiliarity Dysmorphophobia Déjà vu Jamais vu
A patient describes their symptoms to you. Choose the most appropriate definition. 1
‘I feel as though I’m not a real person, not part of the living world’.
2
‘I feel like I’m acting in a play with all the lines already written down for me’.
3
‘Other people seem to be acting a part, like actors in a play or like puppets’.
4
‘I feel unreal to myself when I look in a mirror or at a photograph’.
46 Section 1 Paper 2
6 A B C D E F
Likert scale Semantic differential Thurstone scale Pervasive communication Attribution theory Cognitive dissonance
G H I J
Schachter’s cognitive labelling theory Symbolic order James Lange theory Cannon–Bard theory
Which of the above is being described below? 1
Used to measure attitudes; presentation of a range of statements from which the subjects tick those they agree with.
2
A strive for consistency between cognitions thought to be related to each other.
3
Emotion derives from cortical perception and the physiological changes are hypothalamus driven and secondary.
EMIs 47
7 A B C D E
Democratisation Introjection Division of labour Altruism Mirror phenomena
F G H I
Pairing Reactive motive Double bind Reframing
Match the statements to the appropriate response above. 1
This forms part of Whitaker’s ‘focal conflict theory’.
2
This forms part of Bion’s ‘basic assumption theory’.
3
One of Yalom’s therapeutic factors.
4
One of Foulke’s ‘group therapeutic factors’.
5
One of the four characteristics ideally in place in a therapeutic community according to Rapaport.
48 Section 1 Paper 2
8 A B C D E
Universality Altruism Instillation of hope Imparting information Corrective recapitulation of primary family group
F G H I J K
Socialising techniques Vicarious learning Interpersonal learning Group cohesiveness Catharsis Existential factors
Which of the above curative factors is described below? 1
Patients can feel improved or learn about themselves by helping fellow members.
2
The member realises that he is not unique in his awfulness.
3
Arousal of affect and expression by the patient.
EMIs 49
9 A B C D E F
Negativism Ambitendence Forced grasping Echopraxia Flexibilitas cerea Opposition
G H I J K
Jerkiness Freezing Automatic obedience Complex mannerisms Posturing
Which catatonic behaviour is described in each of the cases below? 1
A 37-year-old man keeps a leg in one position during voluntary movement.
2
A 56-year-old man is unable to complete a movement after seeming to try and again failing to complete.
3
In a 45-year-old woman, light pressure anywhere results in movement of her body in that direction.
50 Section 1 Paper 2
10 A B C D E
Hyperthyroidism Hypothyroidism Cushing’s syndrome Hyperparathyroidism Hypoparathyroidism
F G H I J
Diabetes mellitus Phaeochromocytoma Hypoglycaemia Wilson’s disease Porphyria
Patients present with the following features; what is your diagnosis in each case? 1
A 42-year-old woman with an elevated serum calcium has low mood, reduced energy and motivation. Her husband first noticed a change in her mood 3 months ago.
2
A 36-year-old man presents to his general practitioner with incongruous behaviour and a change in personality. An MRI shows ventricular dilatation, brain-stem atrophy and basal ganglia hypodensities. Penicillamine is initiated following diagnosis.
3
A 55-year-old man with a history of ‘attacks’ which include headaches, perspiration, palpitations and marked anxiety.
ISIs: Answers 51
INDIVIDUAL STATEMENTS: Answers 1
False. Brown and Harris’s vulnerability factors relate to depression. (1) Lack of a confiding relationship. (2) Unemployment. (3) ≥ 3 children aged under 14 years of age living at home. (4) Loss of mother under age 11 years.
2
False. The prevalence is 1 per cent.
3
True. The risk is 9–26 per cent in women, 5–12 per cent in men.
4
True. It is also associated with dependent and insecure attachments.
5
False. Verbal: similarities, arithmetic, digit span, vocabulary, information and comprehension. Performance: object assembly, picture arrangement, block design, picture completion and digit symbol.
6
True. For example confabulation, déjà vu, déjà entendu, déjà pensé, jamais vu, retrospective falsification.
7
False. This is déjà pensé.
8
False. This is déjà entendu.
9
True.
10
False. It has a tricyclic antidepressant-like structure.
11
True.
12
True.
13
False. The figure is closer to 70 per cent.
14
False. He described seven: (1) verbal comprehension, (2) number, (3) word fluency, (4) inductive reasoning, (5) memory, (6) perceptual speed, (7) spatial orientation.
15
False. He is associated with the squiggle game. Also with transitional object, holding environment, potential space, at-onement, primary mental preoccupation, regression to dependence, going on being, object usage.
16
True. Normal autism 0–2 months, symbiosis 2–5 months, differentiation 5–10 months, practising 10–18 months, rapprochement 18–24 months, and object constancy 2–5 years.
52 Section 1 Paper 2
17
False. It tends to be chronic and persistent. Baker D et al. Br J Psychiatry 2003, 182:428–33.
18
True. As does carbamazepine, the phenothiazines and chloral hydrate.
19
True. Leptin may be associated with olanzapine and clozapine induced weight gain. Atmaca M et al. J Clin Psychiatry 2003, 64:598–604.
20
False. The individual decisions of members of a group are suppressed in favour of the consensus. This can lead to flawed decision making.
21
True.
22
False.
23
True. It is lack of connection between thoughts.
24
False. It is rarely sedative.
25
True.
26
False. It is a hallucination associated with a stimulus in a different sensory modality.
27
True. ICD-10.
28
True.
29
False. It is a defence against depression – ‘manic defence’.
30
True. Gairin I et al. Br J Psychiatry 2003, 183:28–33.
31
True.
32
True. Vitamin K is necessary for the normal calcification of bone. Iketani T et al. Psychiatry Res 2003, 48:259–69.
33
True. Also dizziness, low mood, insomnia, anxiety and agitation.
34
False. This is Bruner’s theory. Yerkes–Dodson curve relates optimum performance with level of arousal.
35
True. It is associated with anxiety, depression, psychosis, acute organic reaction and dementia.
ISIs: Answers 53
36
True. Almost all cases of narcolepsy are associated with HLA DR2.
37
True. The Committee on Safety of Medicines has advised that selective serotonin re-uptake inhibitors and venlafaxine should not be used in the under-18s to treat depression because of a potential increased risk of self-harm and suicide.
38
True. Up to 75 per cent leave in the first month.
39
True.
40
False. Bonding may be affected. Attachment up to 6 months is fairly indiscriminate.
41
True. It is usually 12–16 weekly sessions. It guides patients to understand current problems and helps them to find solutions. It also shares some features of dynamic psychotherapy.
42
False. This is the ‘guided discovery’ associated with cognitive behaviour therapy helping individuals challenge their thoughts or beliefs.
43
True.
44
True.
45
True.
46
False. Disgust is a primary emotion. Secondary emotions are combinations of primary emotions, e.g. love = joy + acceptance.
47
True. Memory, verbal comprehension, number, word fluency, inductive reasoning, perceptual speed and spatial orientation.
48
True. It is an anti-epileptic.
49
False. This is negative reinforcement.
50
True. Borderline – splitting into ‘good’ and ‘bad’ objects.
51
True. Theories include DA hypersensitivity, free-radical-induced neurotoxicity, GABA insufficiency and NA dysfunction.
52
False. He had three theories: (1) manifestations of repressed libido, (2) representation of the birth experience, (3) primary anxiety plus signal anxiety.
53
True.
54 Section 1 Paper 2
54
True. It is an antipsychotic medication. An ECG should be done before administration.
55
False. It is a test of frontal lobe function.
56
False. Only 25 per cent have hypnagogic hallucinations.
57
False. It is rare. Others include dyspepsia, headache, flushing, dizziness and nasal congestion.
58
True. Care is needed if it is handled regularly.
59
False. It is a fear of crowds, public places, travelling away from home and travelling alone (ICD-10).
60
True.
61
True.
62
False.
63
True.
64
False. There is a 67 per cent lifetime risk of comorbid depressive illness.
65
False. Farmers have a high risk of suicide and suicidal thoughts. They have access to a number of potentially lethal methods. Thomas HV et al. Occup Environ Med 2003, 60:181–6.
66
True. Nutmeg, a common household spice, is associated with psychosis if taken in excess. It is thought to have a similar chemical structure to serotonin antagonists such as reserpine. Kelly BD et al. Schizophr Res 2003, 60(1):95–6.
67
True. Continuing antidepressant treatment reduces the odds of depressive relapse by around two-thirds. Geddes JR et al. Lancet 2003, 361:653–61.
68
True. Sharpley AL et al. J Clin Psychiatry 2003, 64:192–6.
69
False. Morbid jealousy can be a delusion or an overvalued idea.
70
False.
71
True. These are vivid elaborate scenic hallucinations occurring in schizophrenia and altered states of consciousness.
ISIs: Answers 55
72
False. Cocaine ‘bug’ occurs in cocaine intoxication. Withdrawal involves dysphoria, anxiety, irritability, depression, fatigue and drug craving.
73
False. This is true of anorexia nervosa.
74
True. Keel PK et al. Arch Gen Psychiatry 2003, 60:179–83.
75
True. It is an opioid analgesic that can cause occasional hallucinations.
76
True.
77
False. Single use: 3 days; daily use: 10 days; heavy daily use: 21–27 days.
78
False. They are detectable in the urine for up to 21⁄2 days.
79
True.
80
False. Oxazepam is a metabolite of diazepam.
81
False. The term was coined by Freud.
82
True. Dysphasia, dyslexia, constructional apraxia, visual disorientation and general intellectual impairment (plus Gerstmann’s syndrome) also occur.
83
False. However, there is delayed secondary sexual development if pre-pubertal.
84
True. Maintenance ECT in this study was characterised by normal long-term memory but impaired short-term memory and frontal functions. Rami-Gonzalez L et al. Psychol Med 2003, 33:345–50.
85
False. There is a greater risk in the elderly.
86
True.
87
True.
88
False.
89
True. It involves lack of adequate connection between two consecutive thoughts.
90
True. The syndrome involves hyperorality, hypersexuality, hypermetamorphosis and hyperphagia.
56 Section 1 Paper 2
91
True.
92
False. Gustatory and visual hallucinations are suggestive of organic illness.
93
False.
94
True.
95
True. Tourette’s and obsessive–compulsive disorder have a similar age of onset and overlap in symptomatology.
96
False. They are ego-dystonic.
97
True. It involves multiple somatic symptoms in different areas.
98
True. The symptoms include shortness of breath, dizziness, syncope and paraesthesia, amongst others.
99
False. It is out of proportion.
100
True.
101
False. Associated with alcohol dependence (1976). They described compulsion, difficulties in controlling substance-taking behaviour, psychological withdrawal, tolerance, neglect of alternative leisure and persistence.
102
True.
103
False. This is a characteristic finding. There is also nystagmus, ataxia, clouding of consciousness and peripheral neuropathy.
104
True.
105
True.
106
False. It is associated with a poor prognosis.
107
True.
108
False.
109
True. This is a Kleinian concept. The infant (or patient in analysis) realises that both his love and hate are directed towards the same object – his mother.
110
True. It is associated with Albert Bandura. Positive outcome modelling is used in a variety of areas, including social skill development and parent training.
ISIs: Answers 57
111
True. Denial, projection and identification.
112
False.
113
True. The patient has difficulty naming things, but his or her speech is fluent.
114
False. Couvade syndrome: the male complains of obstetric symptoms during his partner’s pregnancy. Pseudocyesis: a false pregnancy affecting men or women.
115
False. These are involuntary movements.
116
True. Hence it crosses the blood–brain barrier readily. Propranolol causes nightmares. Atenolol is less lipid soluble.
117
False. They tend to cause anterograde amnesia. Benzodiazepine’s mode of action is related to the opening of chloride channels facilitating the action of GABA.
118
True.
119
False. They commonly occur together.
120
True.
121
False.
122
False. Anhedonia is loss of the ability to experience pleasure.
123
True. Korsakoff commented on the ‘confusion of temporal sequence of events and memories jumbled up and recalled inappropriately’.
124
True.
125
True.
126
False. It is the early rapid learning that allows a newborn or newly hatched animal to develop an attachment to its mother.
127
True. A person’s structure of the world is based on cognitions that are based on assumptions or schemas developed from their previous experiences.
128
True.
129
True. Rules in this stage, according to Piaget, are sacrosanct: ‘bad doing should be punished’.
58 Section 1 Paper 2
130
False.
131
False. The transitional object is a toy/object to which the child is attached.
132
False.
133
False. This concerns ‘negative thoughts’.
EMIs: Answers 59
EMIs: Answers 1 1
D
Difficulty in comprehending the meaning of words.
2
G
Dyscalculia, agraphia, finger agnosia, right–left disorientation.
3
B
4
E
5
D/E
6
K
A failure to acknowledge blindness.
7
K
Triad of optic ataxia, oculomotor apraxia and simultanagnosia.
2 1
D
2
B
You could answer magnification to this question as well. Maximising the importance of a negative event.
3
G
Need to focus in therapy on the evidence that the worst does not happen.
3 1
C
2
K
3
D
4
J
For example anger is sublimated into painting.
60 Section 1 Paper 2
4 1
A
2
C
3
E
4
A
5 1
E
2
E
3
D
Often depersonalisation and derealisation occur together.
4
E
Depersonalised perception of self.
6 1
C
2
F
3
J
Decrease dissonance by changing behaviour and dismissing information and by adding new thoughts to support one set of cognitions.
Note. Likert scale – agreement/disagreement on a five-point scale. Semantic differential – two adjectives/verbs at either end of a line which the subject marks (like visual analogue scale).
EMIs: Answers 61
7 1
G
The group organises around ‘disturbing motive/avoided relationship’, ‘reactive motive/calamitous relationship’.
2
F
Bion claimed primitive anxieties prevent groups working effectively through (i) pairing, (ii) fight/flight and (iii) dependence.
3
D
Interpersonal input, catharsis, cohesiveness, self-understanding, interpersonal output, existential factors, universality, instillation of hope, altruism, family re-enactment, guidance and identification.
4
E
Mirror phenomenon = group member like you.
5
A
Democratisation, permissiveness, reality confrontation, communalism.
8 1
B
2
A
3
J
9 1
H
2
B
3
I
62 Section 1 Paper 2
10 1
D
2
I
Penicillamine is a copper chelating agent used in the treatment of Wilson’s disease.
3
G
Phaeochromocytoma is usually a benign tumour producing catecholamines. It causes periods of crisis lasting minutes with symptoms as described.
ISIs: Questions 63
paper 3
64 Section 1 Paper 3
INDIVIDUAL STATEMENTS 1
Academic under-achievement is associated with school refusal.
T
F
2
Discarding breast milk expressed up to 9 hours after a dose of sertraline reduces infant exposure by 17 per cent.
T
F
3
Depression is associated with a prolonged REM latency.
T
F
4
A shortened and lowered cortisol peak is associated with depression.
T
F
5
Higher order conditioning uses a conditioned stimulus as an unconditioned stimulus.
T
F
6
Children from lone parent families have been shown to be significantly more likely to suffer mental illness than other children.
T
F
7
The World Health Organisation ‘5 well being index’ is a poor tool for detecting depression.
T
F
8
Outcomes in schizophrenia are worse in developing countries.
T
F
9
Myasthenia gravis often improves if the patient is taking lithium.
T
F
10
Morbid jealousy is more common in women than in men.
T
F
11
Learned helplessness is a concept derived from animal studies using escapable aversive stimuli.
T
F
12
Mirror gazing is a recognised feature of hebephrenic schizophrenia.
T
F
13
Failed habituation to glabellar tapping is an important clinical sign in Huntington’s disease.
T
F
14
Carbamazepine can increase plasma haloperidol concentrations.
T
F
15
Lithium has been found to improve Parkinson’s disease.
T
F
16
Lithium is associated with leucopenia.
T
F
17
Normal weight bulimia is associated with reduced sexual activity.
T
F
Individual Statements 65
18
Muscarinic receptor availability is significantly reduced in untreated schizophrenic patients.
T
F
19
The prevalence of delusional disorders is greater in women than in men.
T
F
20
Patients with anorexia nervosa rarely show obsessional behaviours outside their eating disorder.
T
F
21
The male peak age of onset in schizophrenia is 5–10 years before the female peak.
T
F
22
Piaget’s pre-operational stage is associated with animism.
T
F
23
Fears in the first year of life include a fear of animals.
T
F
24
Maternal deprivation is associated with infantile autism.
T
F
25
Depersonalisation is associated with the sense that the passage of time has changed.
T
F
26
Motor clumsiness is common in Asperger’s syndrome.
T
F
27
Post-traumatic stress disorder is not a condition of childhood.
T
F
28
Heavy smoking enhances clozapine metabolism.
T
F
29
Narcolepsy is usually associated with hypnagogic hallucinations.
T
F
30
The Stroop test assesses frontal lobe function.
T
F
31
Waxing and waning of the alpha rhythm (EEG) is associated with drowsiness.
T
F
32
Clozapine is associated with elevations in serum triglyceride.
T
F
33
Anxiety disorders rarely begin in old age.
T
F
34
Deliberate self-harm is commonest in the 22–28-year age range.
T
F
35
Amoxapine may act as an atypical antipsychotic.
T
F
36
The Hamilton cuff method was used in ECT to see if a seizure was occurring.
T
F
37
The overall lifetime prevalence of generalised anxiety disorder is 12 per cent.
T
F
38
Two-thirds of patients with obsessional disorders of recent onset improve within a year.
T
F
66 Section 1 Paper 3
39
Psychosis is the commonest psychiatric disturbance associated with Cushing’s syndrome.
T
F
40
Clozapine treatment has shown potential for reducing suicidal behaviour in schizophrenia.
T
F
41
Neuroleptic malignant syndrome is a cause of delirium.
T
F
42
Cannabis confers a seven-fold increase in an individual’s relative risk of subsequently developing schizophrenia.
T
F
43
The Cloniger type 2 alcohol dependent is usually less than 25 years old.
T
F
44
Delirium tremens is associated with leucocytosis and deranged liver function.
T
F
45
A history of seizures is an indication for inpatient alcohol detoxification.
T
F
46
Carbon dioxide poisoning is a potential cause of Korsakoff’s syndrome.
T
F
47
Quetiapine can be useful in the management of depressive symptoms in patients with psychosis.
T
F
48
Cognitive behaviour therapy involves time-limited (8–20), 1-hour weekly sessions.
T
F
49
Cognitive behaviour therapy is a problem-orientated treatment based on the ‘now and then’.
T
F
50
Collaborative empiricism is part of the approach in cognitive behaviour therapy.
T
F
51
In psychotherapy, confrontation involves rephrasing and questioning.
T
F
52
Interpretation in psychotherapy offers new formulations of unconscious meaning and motivation.
T
F
53
In the psychotherapeutic process, clarification draws attention to what the patient is doing, sometimes on a regular basis.
T
F
54
Paranoid personality disorder is more common in males and people of lower social class.
T
F
55
Borderline personality disorder is more prevalent in younger age groups (19–34 years).
T
F
Individual Statements 67
56
At 15-year follow-up, most subjects with borderline personality disorder no longer meet the criteria for the condition.
T
F
57
Compared to risperidone, olanzapine appears to be associated with a reduced risk of developing diabetes mellitus.
T
F
58
Transference is important in psychoanalysis.
T
F
59
Transference is overlooked in brief dynamic psychotherapy.
T
F
60
An ability to tolerate intimacy is a good prognostic indicator for analytic therapy.
T
F
61
Counter-transference is a hindrance in psychoanalytical treatment.
T
F
62
Family therapy is of use in the treatment of young people with anorexia.
T
F
63
In cognitive analytic therapy, the patient reads traps, dilemmas and snags in the file and identifies which apply to them.
T
F
64
A neurocognitive subtype of schizophrenia has been proposed based on impaired memory.
T
F
65
Operant conditioning is linked with Skinner and his rats.
T
F
66
Children observing an adult being aggressive with a large inflated doll are unlikely to mimic this behaviour.
T
F
67
A 4–9 month old uses one word, but is saying more than one word in meaning.
T
F
68
‘Group think’ occurs when members of a group are led to suppress their own dissent in the interests of the group consensus.
T
F
69
The ‘Premack principle’ holds that the frequency with which we engage in an activity is indicative of how rewarding it is.
T
F
70
In Erickson’s psychosocial stages of development, intimacy versus stagnation represents early adulthood.
T
F
71
Anaclitic depression refers to the state into which an infant falls following separation from a secure attachment.
T
F
72
Gestalt psychology is related to the preferential perception of organised wholes.
T
F
73
Short-term memory has a limited capacity of 5+/–2 chunks.
T
F
68 Section 1 Paper 3
74
Episodic and semantic memory are examples of declarative memory.
T
F
75
Peripheral neuropathy is not an essential feature of Korsakoff’s syndrome.
T
F
76
Anterograde amnesia is the memory loss for events occurring before the onset of a lesion.
T
F
77
Verbal memory is particularly affected in the first 2–3 hours following ECT.
T
F
78
Benzodiazepines impair learning and the acquisition of information in explicit tests of episodic memory.
T
F
79
The Renfrew scheme tests expressive language.
T
F
80
Night terrors occur in REM sleep, late in the night, and are remembered in the morning.
T
F
81
A time-limited, structured, problem-orientated, collaborative process linking the present with the past describes cognitive behaviour therapy.
T
F
82
The clearance of a drug is the rate at which the body eliminates a drug and is represented by the equation: CL = 0.69 × Vd/t1⁄2.
T
F
83
Rawlins and Thompson classified adverse drug reactions.
T
F
84
Normal intellectual functioning may be a protective factor against psychosis.
T
F
85
Risperidone is associated with priapism.
T
F
86
Major depression and dysthymic disorder affect 5–10 per cent of older adults in primary care.
T
F
87
The suicide rate in Japan is one of the lowest in the world.
T
F
88
Women with anorexia have lower than normal plasma leptin levels.
T
F
89
The risk of tardive dyskinesia is increased in a patient who has other extrapyramidal side effects from antipsychotic medication.
T
F
90
Approximately 25 per cent of patients with tardive dyskinesia will have a spontaneous remission.
T
F
Individual Statements 69
91
Almost 5 per cent of people who have a first episode of schizophrenia will not go on to have further episodes.
T
F
92
Risk genes have not been identified for schizophrenia.
T
F
93
Nefazodone inhibits the re-uptake of serotonin and also selectively blocks serotonin receptors.
T
F
94
Psychosis may accompany less severe depression.
T
F
95
Cannabis use among young people significantly increases their risk of developing depression and schizophrenia in later life.
T
F
96
Fifty per cent of extrapyramidal side effects appear within the first 5 days of commencing neuroleptic treatment.
T
F
97
Patients experiencing a first episode of schizophrenia can lose up to 13 per cent of grey matter during the first year of illness.
T
F
98
Dhat is considered an exotic ‘neurosis of the orient’.
T
F
99
The traditional cut-off score for dementia, using the MMSE in mixed neuropsychiatric samples, is < 24/30.
T
F
100
Mentally ill people are six times more likely to be murdered than other individuals in the general population.
T
F
101
The risk of suicide among individuals with a family history of completed suicide is equivalent to that of people without a family history.
T
F
102
Olanzapine is associated with hyperlipidaemia in patients with schizophrenia.
T
F
103
The SCOFF questionnaire is used for the detection of eating disorders.
T
F
104
Reduced brain serotonin is found in impulsive bulimic individuals.
T
F
105
There is no current evidence for susceptibility loci for anorexia nervosa.
T
F
106
The risk of suicide for women with anorexia nervosa is ten times greater than that of healthy controls.
T
F
107
Carbamazepine blocks calcium channels, producing a reduced rate of recovery from excitatory stimuli.
T
F
70 Section 1 Paper 3
108
Sodium valproate blocks GABA hydroxylase, thereby inhibiting GABA degeneration.
T
F
109
Cyclopyrolones act adjacent to the GABA complex.
T
F
110
Vigabatrin inhibits GABA-aminotransferase and is used to treat partial seizures.
T
F
111
Pindolol is a beta blocker and 5HT1a antagonist.
T
F
112
Donepezil is an irreversible inhibitor of central acetylcholinesterase.
T
F
113
Interferon treatment for hepatitis C is associated with depression.
T
F
114
A possible link between apolipoprotein D and psychosis has been demonstrated.
T
F
115
Milnacipran is an antidepressant with similar efficacy to imipramine.
T
F
116
Family intervention has little impact in reducing relapse and readmission rates in schizophrenia.
T
F
117
Borderline personality disorder cannot be treated with psychotherapy.
T
F
118
Spectinomycin increases blood levels of lithium.
T
F
119
Intermediate signs of lithium toxicity include chronic renal failure.
T
F
120
Pimozide is a thioxanthene.
T
F
121
Trazodone is a sedating antidepressant.
T
F
122
Mianserin can cause agranulocytosis.
T
F
123
Dextropropoxyphene leads to increased carbamazepine blood levels.
T
F
124
Treatment-resistant schizophrenia is defined as a failure to achieve acceptable remission of positive symptoms despite an adequate trial of two different classes of antipsychotic in adequate doses for at least 6 weeks.
T
F
125
Rabbit syndrome is a potential complication of phenothiazine usage.
T
F
Individual Statements 71
126
Tiagabine only inhibits glial GABA uptake.
T
F
127
Bioavailability is the fraction of the dose which proceeds unaltered from the site of administration to the systemic circulation.
T
F
128
The Klüver-Bucy syndrome is associated with memory improvement.
T
F
129
The Klüver-Bucy syndrome is associated with blunting of emotions.
T
F
130
The Klüver-Bucy syndrome is associated with parietal lobe damage.
T
F
131
The Klüver-Bucy syndrome is associated with unrestrained exploring.
T
F
132
Secondary mania occurs with steroids.
T
F
133
Secondary mania has been reported with levodopa.
T
F
72 Section 1 Paper 3
EMIs 1 A B C D E F
Swing questions Batch living requires core and cluster developments Recapitulations A division of depression into Types I and II Multi-thematic questions Total institutions are characterised by binary management
G H
I J
Cognitive analytical therapy Cognitive dysfunctions lead to a form of primitive thinking in depression Obsessional phenomena Repressed memories of unhappy childhood experiences
1
Which of the above was suggested by Goffman?
2
Which of the above relates to Beck’s formulation of depression?
3
Which of the above is a component of a good psychiatric interview technique?
EMIs 73
2 A B C D E
Couvade syndrome Latah Dissocial personality Anankastic personality Munchausen’s syndrome
F G H I J
Paranoid personality disorder Transsexualism Post-traumatic stress disorder Dissociative stupor Social phobia
Match each of the statements below to one of the above. 1
This disorder is associated with a fictional character who told wild stories.
2
This has an association with obsessive–compulsive disorder.
3
This is characteristically associated with little or no remorse.
4
This has a female prevalence of 1 in 100 000.
5
This disorder is associated with super-ego lacunae.
74 Section 1 Paper 3
3 A B C D E
Paranoid schizoid position Transference Ego strength Operant conditioning Agoraphobia
F G H I J
Tangential thinking Circumstantiality Acting out Time out Super-ego
Match each of the descriptions below to the most suitable term above. 1
This arises from the resolution of the Oedipal complex.
2
This involves not being able to integrate the person as a whole object.
3
This often manifests with the ability to maintain long-term relationships.
EMIs 75
4 A B C D E
Haloperidol Ibuprofen Clozapine Sulpiride Chlorpromazine
F G H I J
Flupentixol Lamotrigine Phenytoin Vigabatrin Mirtazapine
Answer the following. 1
Which of the above drugs increases lithium levels?
2
Which drug at low dose may have an alerting effect in schizophrenia?
3
Which drug is an example of a thioxanthene?
4
Which of these drugs inhibits GABA transaminase?
76 Section 1 Paper 3
5 A B C D E
WAIS National Adult Reading Test (NART) Mill Hill vocabulary test Raven’s progressive matrices WISC-R
F
G H I J
Wechsler Preschool and Primary Scale of Intelligence (WPPSI) Spearmans – (g) Stanford Binet Cattell Hebb
Which of the above: 1
Is a general intelligence factor?
2
Is associated with two types of intelligence (A and B) – genetically based potential (A) and effective intelligence (B)?
3
Involves specifically, diagram completion?
4
Is used for preschool and primary school children (4–61⁄2 years), including non-verbal and verbal components?
5
Is associated with ‘fluid and crystallised ability’?
EMIs 77
6 A B C D E
Citalopram Moclobemide Reboxetine Venlafaxine Mirtazapine
F G H I J
Nefazodone Milnacipran Ranitidine Gabapentin L-tryptophan
Which of the above drugs: 1
Is a selective noradrenergic re-uptake inhibitor?
2
Is a reversible inhibitor of monoamine oxidase type A?
3
Is a serotonin and noradrenaline re-uptake inhibitor?
4
Is a combined 5HT2 antagonist and 5HT re-uptake inhibitor?
5
Is a selective serotonin re-uptake inhibitor?
6
Is associated with eosinophilia–myalgia syndrome?
7
Has an isomer available which can be used to treat panic disorder?
78 Section 1 Paper 3
7 A B C D E F
Mydriasis Hyperphagia Hypersalivation Weight loss Stimulant Depressant
G H I J K
Anti-anxiety Local anaesthetic Antidepressant Antipsychotic Anti-obesity
This question relates to cocaine. Answer the following from the list above. 1
Is a feature of cocaine intoxication.
2
May occur with long-term cocaine usage.
3
A description of cocaine’s central action.
4
An effect for which cocaine can be used clinically.
EMIs 79
8 A B C D E
Alcohol Nicotine LSD PCP Methylenedioxymethamphetamine
F G H I J
Cocaine Cannabis Benzodiazepines Opiates Caffeine
Match each of the statements below to the most suitable answer above. 1
Is a serotonin analogue at 5HT2 receptors.
2
Increases intracellular concentration of cAMP and increases cerebral blood flow.
3
Causes a release of serotonin from the cortical system originating in the raphe nucleus.
4
Causes REM rebound and nightmares on withdrawal.
80 Section 1 Paper 3
9 A B C D E
Pick’s disease Fragile X syndrome General learning disability Nightmares Mania
F G H I J
Parkinsonism Chronic fatigue syndrome Asperger’s syndrome Agoraphobia Late paraphrenia
Select from the above the condition that best fits each of the statements below. 1
Excess Candida albicans in the gastrointestinal tract has been implicated as a possible cause.
2
This can be diagnosed prenatally.
3
This is characteristically associated with stilted speech.
EMIs 81
10 A B C D E
Alpha activity Beta activity Delta activity Theta activity Lambda waves
F G H I J
Mu waves V waves Gamma activity Spikes Sequential sharp waves
Which of the above EEG features relates to each of the descriptions below? 1
Frequency of between 8 and 13 Hz.
2
Occurs with ocular movements.
3
Attenuated with eye opening.
4
The predominant feature in 2–5 year olds.
5
Waveform activity increases with alcohol use.
82 Section 1 Paper 3
INDIVIDUAL STATEMENTS: Answers 1
False.
2
True. Stowe ZN et al. J Clin Psychiatry 2003, 64:73–80.
3
False. It is associated with shortened REM latency (the time between falling asleep and the first period of REM).
4
False. It is associated with a prolonged and raised cortisol peak.
5
True.
6
True. This was shown in a study looking at 65 000 single-parent children and 920 000 two-parent children in Stockholm. The relative risk of mental illness amongst the single-parent children was 2.1 for boys and 2.5 for girls. Weitoft GR et al. Lancet 2003, 361:289–95.
7
False. WHO-5 was thought to improve family doctors’ ability to detect depression. Henkel V et al. BMJ 2003, 326:200–1.
8
False.
9
False. It worsens, especially muscle weakness.
10
False. It is more common in men – also called the Othello syndrome.
11
False. The studies used inescapable aversive stimuli.
12
True. The age of onset is usually 15–25 years.
13
False. It is a clinical sign in Parkinson’s disease. The forehead is tapped with the examiner’s finger and blinking habituation is observed.
14
False. It reduces plasma haloperidol levels.
15
False. Lithium can worsen Parkinson’s disease.
16
False. It is associated with leucocytosis.
ISIs: Answers 83
17
False. It is associated with normal or increased sexual activity.
18
True. SPECT studies have shown this, adding further evidence for the involvement of the muscarinic system in schizophrenia. Raedler TJ et al. Am J Psychiatry 2003, 160:118–27.
19
False.
20
False.
21
True. Peak ages of onset are 15–25 years (male) and 25–35 years (female).
22
True. They believe everything is ‘living’.
23
False. Animal fear occurs at the age of 3–6 years.
24
False.
25
True. Many complain of a distortion in their perception of time and space.
26
True.
27
False. Cases do occur.
28
True.
29
False. Hypnagogic and hypnopompic hallucinations occur in approximately 25 per cent of patients with narcolepsy.
30
True. The Stroop test involves identifying the ‘colour’ words are printed in and not what they actually say. For example, if the word ‘blue’ is printed in the colour red, the correct response is red.
31
True.
32
True. It is often useful to measure the baseline lipid profile.
33
True. They usually develop at an earlier age.
34
False. It is commonest in the 15–24-year age range.
84 Section 1 Paper 3
35
True. Amoxapine is a tricyclic antidepressant. It has a similar receptor occupancy profile to several of the newer atypical antipsychotics. Tardive dyskinesia is a recognised side effect. Apiquian R et al. Schizophr Res 2003, 59:35–9.
36
True. A blood pressure cuff is inflated to above systolic pressure in one arm after the anaesthetic but before the muscle relaxant. Hence a seizure can be seen in the isolated limb.
37
False. The prevalence is about 5 per cent.
38
True. One-third run a chronic but fluctuating course.
39
False. Affective disorders are the most common. Psychiatric symptoms occur in 50–80 per cent of cases.
40
True. This was shown in a preliminary study of 980 patients with schizophrenia or schizotypal disorders. Meltzer HY et al. Arch Gen Psychiatry 2003, 60:82–91.
41
True. Other potential causes include hypoxia, infection, metabolic disturbances, iatrogenic, vitamin deficiencies (thiamine, B12) and heavy metals.
42
False. It confers a twofold increase. Arseneault L et al. Br J Psychiatry 2004, 184:110–17.
43
True. Cloniger Type 2 (male limited). Higher genetic component and antisocial behaviour. Usually less than 25 years. Impulsive and antisocial traits.
44
True. It is also associated with electrolyte imbalance and dehydration. The EEG shows an increase in fast activity.
45
True.
46
False. The cause is carbon monoxide poisoning.
47
True. Quetiapine was shown to be better than risperidone at reducing depressive symptoms, with fewer extrapyramidal side effects. Sajatovic M et al. J Clin Psychiatry 2002, 63:1156–63.
48
True.
49
False. It is based on ‘here and now’.
ISIs: Answers 85
50
True. This is a systematic collection of information through selfmonitoring, diaries and problem lists.
51
False. This is clarification.
52
True.
53
False. This is confrontation.
54
True. Tyrer P, Duggan C, Coid C. Br J Psychiatry 2003, 182(Suppl. 44):s1–35.
55
True. Tyrer P, Duggan C, Coid C. Br J Psychiatry 2003, 182(Suppl. 44):s1–35.
56
True. Tyrer P, Duggan C, Coid C. Br J Psychiatry 2003, 182(Suppl. 44):s1–35.
57
False. Researchers looked at data from 19 153 patients receiving at least one prescription of olanzapine and 14 793 who received risperidone between January 1997 and December 1999; 319 patients taking olanzapine developed diabetes, compared to 217 taking risperidone. Caro JJ et al. J Clin Psychiatry 2002, 63:1135–9.
58
True. Transference is the process by which the patient displaces feelings on to his or her therapist, re-enacting experiences from earlier influential relationships.
59
False. Freud originally found the transference process to be an irritant, only later believing it to be an essential part of therapy.
60
True.
61
False. Counter-transference refers to the therapist’s attitudes towards the patient. It was also initially thought by Freud to be a hindrance.
62
True.
63
True. This type of therapy was developed by Anthony Ryle.
86 Section 1 Paper 3
64
True. Patients with impaired memory exhibited more positive symptoms than their peers with good memory. McDermid Vaz SA, Heinrichs RW. Psychiatry Res 2002, 113: 93–105.
65
True. Skinner devised a chamber box in which a rat would have to press a lever to receive a reward.
66
False. They did mimic the behaviour. This was the experiment performed by Bandura in 1963 to demonstrate social learning theory.
67
False. This is the speech stage of a 9–18 month old (holophasic speech). A 4–9-month-old baby babbles, repeating syllables and making sounds.
68
True. Janis IL (1982). Groupthink Psychological studies of policy decisions and fiascos. Boston: Houghton Mifflin. They often arrive at poor decisions this way.
69
True. It is sometimes used as a part of the therapeutic approach in eating disorders.
70
False. Intimacy versus isolation represents early adulthood; generativity versus stagnation represents middle age.
71
True. The term was coined by Spitz to describe the state of protest, despair and detachment into which infants fall when separated from their mothers. Spitz RA. Psychoanal Study Child 1946, 2:313–342
72
True. It relates to the law of closure (seeing as a whole) and the law of continuity (see as a line).
73
False. It has a limited capacity of 7+/–2 chunks.
74
True. They are examples of declarative or explicit memory. Episodic is personal memories, e.g. autobiographical. Semantic memory is memory for knowledge and general information.
75
True.
76
False. This is retrograde amnesia. Anterograde amnesia is the impairment of learning new material.
77
True.
78
True. This can be reversed by benzodiazepine antagonists.
ISIs: Answers 87
79
True. It involves naming multiple pictures or telling the story of a picture.
80
False. This is a description of nightmares. Night terrors occur as a rapid shift from stage 4 sleep to very light stage 1 sleep – they are not remembered by the child.
81
False. This describes cognitive analytical therapy as developed by Ryle.
82
True. Vd = volume of distribution; t1⁄2 = half-life of the drug.
83
True. Type A: common, dose related, early onset. Type B: rare, dose independent, late onset.
84
True. Poor intellectual functioning might represent a vulnerability marker of brain dysfunction or an early stage of an evolving pathologic process that eventually leads to schizophrenia. Reichenberg A et al. Am J Psychiatry 2002, 159:2027–35.
85
True. Risperidone is a potent α-adrenergic antagonist. This action may interfere with detumescence. Munarriz R et al. N Engl J Med 2002, 347:1890–1.
86
True. Oxman TE et al. Psychosomatics 1990, 31:174–80.
87
False. It is one of the highest – 25 per 100 000 population. Terao T et al. Lancet 2002, 360:1892.
88
True.
89
True. It is also an increased risk with long-term high-dose neuroleptic treatment, in females, and in old age.
90
True.
91
False. The figure is about 30 per cent.
92
False. At least six susceptibility genes have been identified, which are thought to interact with environmental factors. In one example, researchers found that 21 per cent of a schizophrenia sample group had a polymorphism of the Nogo gene containing a CAA insert. This compared to just 3 per cent of the control samples. Novak G et al. Mol Brain Res 2002, 107:183–9.
93
True.
88 Section 1 Paper 3
94
True. In a study of 19 000 subjects, psychosis was often associated with severe depression, but also in up to 10 per cent of those with only two depressive symptoms. The authors suggest that psychosis may be missed in patients with mild to moderate depression. Ohayon MM, Schatzberg AF. Am J Psychiatry 2002, 159:1855–61. Note. According to ICD-10, psychosis is only classified with severe depressive episodes if they meet the other criteria for depression.
95
True. Three studies published in the BMJ suggest that cannabis use among psychologically vulnerable adolescents represents a potentially serious risk to mental health. Patton GC et al. BMJ 2002, 325:1195–8. Zammit S et al. BMJ 2002, 325:1199–201. Arseneault L et al. BMJ 2002, 325:1212–13.
96
False. Ninety per cent appear within the first 5 days of treatment. Casey DE. Acta Psychiatr Scand 1994, 89(S380):14–20.
97
False. Three per cent of grey matter was lost in an MRI study of whole brain. The authors postulate that the decreases in grey matter volume may be explained by apoptosis and atrophy. Cahn W et al. Arch Gen Psychiatry 2002, 59:1002–10.
98
True. It is a culture-bound syndrome (semen loss anxiety).
99
True. MMSE is affected by age, educational level, cultural background, social class, literacy and language.
100 True. Records of the Danish Psychiatric Case Register were looked at. A quarter of all deaths among mentally ill patients were due to unnatural causes, with 1 per cent due to murder, 73 per cent to suicide and 26 per cent to accidental causes. Hiroeh U et al. Lancet 2001, 358:2110–12. 101 False. The risk of suicide among individuals with a family history was 2.58 compared with controls. Oin P et al. Lancet 2002, 360:1126–30. 102 True. Koro CE et al. Arch Gen Psychiatry 2002, 59:1021–6. 103 True. The SCOFF questionnaire is based on the following questions. Do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat?
ISIs: Answers 89
Have you recently lost more than one stone in a 3-month period? Do you believe yourself to be fat when others say you are too thin? Would you say that food dominates your life? One point is given for every ‘yes’; a score of 2 indicates a likely case of anorexia nervosa or bulimia. 104 True. Researchers believe that impulsivity is associated with alterations in 5HT mechanisms. Steiger H et al. Psychol Med 2001, 31:85–95. 105 False. Chromosome 1p has been implicated in eating disorder susceptibility. Grice DE et al. Am J Hum Genet 2002, 70:787–92. 106 False. The risk is 57 times greater. (International Conference on Eating Disorders, Boston, USA, 2002.) 107 False. It blocks sodium channels. 108 False. GABA transaminase is blocked. 109 True. Examples include zopiclone, zolpidem. 110 True. It is used to treat partial seizures with or without secondary generalisation and is commonly associated with visual field defects as a side effect. 111
True. It has been used by some as an adjunct in refractory depression.
112 False. It is a reversible inhibitor. 113 True. Of 39 hepatitis C patients receiving interferon treatment, 33 per cent developed major depression. Hauser P et al. Mol Psychiatry 2002, 7:942–7. 114 True. Apolipoprotein D is involved in the binding and transport of cholesterol, steroid hormones (progesterone, pregnenolone, and arachidonic acid), which are all critical in brain growth and repair. Plasma ApoD levels were significantly higher in first episode psychotic patients compared to controls. Mahadik SP et al. Schizophr Res 2002, 58:55–62. 115 True. Milnacipran is a new antidepressant with essentially equal potency for inhibiting the re-uptake of both serotonin and noradrenaline. Van Amerongen AP. J Affect Disord 2002, 72:21–31.
90 Section 1 Paper 3
116 False. Leff J. Acta Psychiatr Scand 1994, 384(Suppl.):133–9. Lam D. Psychol Med 1991, 21(2):423–41. 117 False. 118 True. It is a bactericidal antibiotic. 119 False. This is a late sign. Others include spasms, coma and fits. 120 False. It is a diphenylbutylpiperidine. 121 True. 122 True. A full blood count is recommended every 4 weeks for the first 3 months. It has fewer and milder antimuscarinic and cardiac side effects than amitriptyline. 123 True. It is a mild opioid analgesic, often combined with paracetamol as coproxamol. 124 False. Three different classes of antipsychotic are tried before being classified as treatment-resistant schizophrenia. 125 True. It is an oral dyskinesia. 126 False. It inhibits both neuronal and glial uptake. Tiagabine is used as an adjunctive treatment for partial seizures. 127 True. 128 False. It is associated with memory impairment. 129 True. 130 False. It is associated with bilateral temporal lobe impairment. 131 True. 132 True. Steroid treatment is associated with the risk of neuropsychiatric side effects, including psychosis. 133 True. Levodopa is the amino acid precursor of dopamine. It is used in the treatment of Parkinson’s disease. Its side effects include involuntary movements and psychiatric symptoms, including psychosis and mania.
EMIs: Answers 91
EMIs: Answers 1 1
F
2
H
3
C
Summarising and stating again the main points. Swing questions and questions on multiple themes are not considered best technique.
1
E
Baron von Munchausen.
2
D
Anankastic personality traits, not the personality disorder.
3
C
‘Incapacity to experience guilt or to profit from experience’.
4
G
More commonly associated with male gender.
5
C
Super-ego: that part of the ego in which parental and societal values are incorporated.
2
3 1
J
2
A
3
C
According to Klein, the paranoid-schizoid position constitutes the infant trying to master its death instinct and precedes the depressive position.
92 Section 1 Paper 3
4 1
B
Lithium levels are increased by: thiazide diuretics, NSAIDs, metronidazole, spectinomycin, acetylcholinesterase inhibitors, methyldopa.
2
D
3
F
Flupentixol, zuclopenthixol.
4
I
Vigabatrin, valproate.
5 1
G
Charles Spearman (1927) suggested that an individual’s performance on a test of intellectual ability is determined by two factors: the g factor (a general factor) and the s factor (specific to a particular task).
2
J
3
D
They are supposedly less sensitive to cultural differences, but can also be used for those with communication difficulties.
4
F
Wechsler Preschool and Primary Scale of Intelligence (WPPSI).
5
I
Fluid intelligence is based on performance of relatively culture-free tasks. Crystallised intelligence depends on information already acquired, so is culture dependent.
EMIs: Answers 93
6 1
C
2
B
3
D/G
4
F
5
A
6
J
Patients needed regular blood monitoring and to be registered with the Optimax Information and Clinical Support Unit (OPTICS) until 2005.
7
A
Escitalopram.
Milnacipran has been available in the USA for 6 years. It acts on noradrenaline and serotonin – almost equally (a 3:1 NA to serotonin balance). It is not yet available in the UK. In contrast, venlafaxine tends to act much more on serotonin than noradrenaline (a 1:30 NA to serotonin ratio). Nefazodone is now rarely used in the UK.
Note. Mirtazapine is a presynaptic α2-antagonist, increasing central noradrenergic and serotonergic neurotransmission.
7 1
A
Others include: fever/chills sinus tachycardia/arrhythmia increased/low blood pressure dry mouth, anorexia, nausea and vomiting psychomotor agitation/retardation hyperactivity, irritability, aggressiveness convulsions, confusion, coma.
2
D
Paranoid ideation, depression and weight loss.
3
E
4
H
94 Section 1 Paper 3
8 1
C
2
J
3
E
4
H
Lysergic acid diethylamide (LSD). A hallucinogen.
MDMA or Ecstasy – a synthetic drug with both stimulant and hallucinogenic properties.
9 1
G
2
B
Also called Martin–Bell syndrome. It affects 1:1000 general male population and is associated with learning disability.
3
H
A pervasive developmental disorder.
1
A
Alpha (8–13 Hz), beta (> 13 Hz), delta (< 4 Hz), theta (4–8 Hz). Alpha activity is most prominent over the occipital region.
2
E
3
A
4
D
5
A
10
Alpha activity is attenuated with eye opening and accentuated by eye closure.
Note. Alpha activity is seen to diminish with age.
section 2: Part II MRcpsych
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ISIs: Questions 97
paper 4
98 Section 2 Paper 4
INDIVIDUAL STATEMENTS 1
Secondary mania has been associated with bromide.
T
F
2
In anorexia nervosa, superior mesenteric artery syndrome is a medical complication.
T
F
3
Leucopenia with relative monocytosis is a recognised feature of anorexia nervosa.
T
F
4
20 to 30 per cent of children with attention deficit hyperactivity disorder do not respond to stimulant treatment.
T
F
5
Inhaled 35 per cent carbon dioxide has been used to distinguish between generalised anxiety disorder and panic disorder.
T
F
6
Plasma homovanillic acid (pHVA) levels are reduced in prodromal schizophrenic patients.
T
F
7
Persistent cognitive decline post coronary artery bypass grafting is uncommon.
T
F
8
Individuals with depression have platelet abnormalities that may predispose them to ischaemic heart disease.
T
F
9
In patients with coronary artery disease, symptoms of anxiety and depression are predictors of poorer long-term functioning.
T
F
10
Patients treated for schizophrenia have an increased risk of obstructive sleep apnoea.
T
F
11
P300 latency is increased in schizophrenia.
T
F
12
Crowding in psychiatric wards is associated with increased aggressive behaviour.
T
F
13
Incidence rates of hepatitis C are lower amongst individuals with severe mental illness.
T
F
14
Amoxapine has both antidepressant and antipsychotic effects.
T
F
15
Social rhythm disruption is associated with manic episodes.
T
F
16
There is a high correlation between sex addiction and substance misuse.
T
F
Individual Statements 99
17
The blood oxygenation level dependent (BOLD) effect forms the basis of SPECT.
T
F
18
LAAM is used in the treatment of opioid dependence.
T
F
19
Depressed children have low growth hormone responses to GHRH compared to control subjects.
T
F
20
There is an increased prevalence of withdrawn behaviour, impaired social functioning and anxiety-related characteristics among relatives of autistic probands.
T
F
21
Institutional rearing protects children who are susceptible to a pattern of hyperactivity.
T
F
22
Specific reading retardation occurs with equal frequency in boys and girls.
T
F
23
Marchiafava-Bignami disease is characterised by visuospatial impairment.
T
F
24
Retrospective ruminative jealousy is a syndrome in which the patient is preoccupied with the past sexual activity of the present partner but without delusions of infidelity.
T
F
25
Cerebrospinal fluid tests for syphilis are positive in almost all patients with neurosyphilis.
T
F
26
Dialysis dementia occurs in 15 per cent of long-term dialysis patients.
T
F
27
In the UK a magistrate’s intervention is needed prior to enforced nasogastric feeding in anorexic patients.
T
F
28
Suicide is more common in bipolar II patients than bipolar I patients.
T
F
29
Fifty per cent of patients with dysthymia also suffer recurrent major depression.
T
F
30
Anti-thyroid antibodies are present in 15 per cent of cases of depression.
T
F
31
L-Tryptophan is the precursor of the neurotransmitter noradrenaline.
T
F
32
Following ECT, post-synaptic β-adrenergic receptors are downregulated.
T
F
100 Section 2 Paper 4
33
Lithium potentiates the effects of the non-depolarising neuromuscular blockers, such as suxamethonium.
T
F
34
Stimulation of the amygdala causes placidity in animal studies.
T
F
35
Autoantibodies to serotonin are pathognomonic of fibromyalgia.
T
F
36
Amnesia is the rarest dissociative feature.
T
F
37
Multiple personality disorder is most common in late adolescence and young adulthood.
T
F
38
The later the onset of multiple personality disorder, the worse the prognosis.
T
F
39
An estimated 5000 people die each year worldwide through autoerotic asphyxiation.
T
F
40
Memory impairment is the commonest cognitive complaint in patients with multiple sclerosis.
T
F
41
Flashbacks of hallucinations following hallucinogenic usage can occur for months afterwards.
T
F
42
An increase in the QTc interval of 30 ms from baseline after antipsychotic treatment is a definite cause for concern.
T
F
43
Lithium has been used to treat gout.
T
F
44
Seventy per cent of survivors of intracerebral haemorrhage have post-stroke depression.
T
F
45
Selective serotonin re-uptake inhibitors produce minor degrees of tachycardia.
T
F
46
Chronic caffeinism starts at 1000 mg of caffeine per day.
T
F
47
ECT is best avoided in drug-resistant Parkinsonism.
T
F
48
Olanzapine is associated with increased leptin levels.
T
F
49
Maternal smoking during pregnancy has been associated with attention deficit hyperactivity disorder in offspring.
T
F
50
DSM-IV has criteria for the diagnosis of substance-induced persisting dementia.
T
F
51
A history of enuresis is associated with pyromania.
T
F
Individual Statements 101
52
A history of malaria is a risk factor for the development of neuroleptic malignant syndrome.
T
F
53
First-born children have been found to have higher IQs than their younger siblings.
T
F
54
Vasopressin has been shown to stimulate appetite.
T
F
55
ANOVA is used to compare two or more groups of observations.
T
F
56
The non-acute porphyrias are not associated with neuropsychiatric complications.
T
F
57
Fasting can precipitate an episode of acute intermittent porphyria.
T
F
58
Sternbach’s diagnostic criteria refer to the neuropsychiatric features of lupus.
T
F
59
Five per cent of women with a puerperal psychosis relapse with a subsequent childbirth.
T
F
60
There is a reduced response of growth hormone to clonidine in depression.
T
F
61
Cocaine increases slow-wave sleep and REM sleep.
T
F
62
Nightmares occur regularly in 1 per cent of the adult population.
T
F
63
Disulfiram treatment confers maximum benefit with regular supervision.
T
F
64
Acamprosate is a DOPA analogue used in the management of alcohol abstinence.
T
F
65
Tricyclics are second-line treatment in attention deficit hyperactivity disorder patients unresponsive to stimulants.
T
F
66
Dantrolene has been used successfully in the treatment of neuroleptic malignant syndrome.
T
F
67
The modern concept of autism derives from Kanner’s description in the 1940s.
T
F
68
Klinefelter syndrome affects 1 in 700 live births and has the XYY karyotype.
T
F
69
Lesch Nyhan syndrome is due to a deficiency of hypoxanthineguanine phosphoribosyl transferase.
T
F
102 Section 2 Paper 4
70
Patients with Diogenes syndrome have 14 days to appeal against Section 47 of the National Assistance Act 1948 (UK).
T
F
71
An enduring power of attorney is a legal device allowing individuals to assign an attorney to manage their finances in the event of them becoming mentally incapacitated.
T
F
72
A child of a patient with late-onset Alzheimer’s disease has a risk of 1 in 5 to 1 in 6 of developing the illness.
T
F
73
Holders of a driving licence have a duty to disclose relevant mental illness lasting more than 3 months to the Driver and Vehicle Licensing Agency (DVLA).
T
F
74
Anti-Borna disease virus antibodies have been associated with mood disorders.
T
F
75
Insanity caused by intoxication or substance dependence can lead to a defence of insanity in court.
T
F
76
Frigophobia is the fear of corpses.
T
F
77
Cruelty to animals in childhood is a poor indicator of later violence against humans.
T
F
78
Phase IV of the clinical development stage of drug development is called post-marketing surveillance.
T
F
79
The Z test is a parametric test that examines the difference between an observed sample mean and a known population mean.
T
F
80
Logistic regression analysis cannot adjust confounders.
T
F
81
Naltrexone can be used to prevent relapse in patients with a history of opiate dependence.
T
F
82
Suicide is the leading cause of maternal death.
T
F
83
Standard deviation is equal to variance squared.
T
F
84
Statistical significance relates to events occurring by chance fewer than 1 in 20 times.
T
F
85
Posterior probability is the probability of an individual having an attribute after an event occurs.
T
F
86
Unrestricted random sampling is a technique that ensures an equal number of subjects is allocated to each group.
T
F
Individual Statements 103
87
Bias is a systematic tendency that distorts inferred population values.
T
F
88
In an intention-to-treat analysis, trial dropouts are regarded as treatment failures and included in the analysis.
T
F
89
A distribution with its longer tail to the right is positively skewed.
T
F
90
A distribution with its longer tail to the left is negatively skewed.
T
F
91
A statistically significant test result is a value that is equal to or smaller than a chosen level of significance.
T
F
92
Power is the probability of not making a type I error.
T
F
93
In ecological studies, information about exposure and outcome is not gathered for each individual subject.
T
F
94
After two or more depressive episodes, the risk of further relapse approximates to 45 per cent.
T
F
95
At the age of 5 years, 10 per cent of children are wet at night.
T
F
96
Autogenic training is a machine-based technique that allows patients to detect related physiological signs of stress or anxiety and modify the signal and subsequently their behaviour.
T
F
97
Stimulant drugs can cause growth impairment.
T
F
98
Clonidine can reduce hyperactivity and impulsivity in autistic children.
T
F
99
Trichotillomania is an impulse control disorder.
T
F
100
In kleptomania, the urge to steal tends to be ego-dystonic, unlike the majority of shoplifters.
T
F
101
Topiramate is used in the treatment of bipolar disorders.
T
F
102
Topiramate causes increased appetite and weight gain.
T
F
103
A third of autistics are likely to develop epilepsy during their lives.
T
F
104
Erectile dysfunction occurs in 80 per cent of men with diabetes.
T
F
105
Eye movement desensitisation and reprocessing is used to treat panic disorder.
T
F
104 Section 2 Paper 4
106
Personality disorders are estimated to occur in at least 10 per cent of the population.
T
F
107
Lysergic acid is a 5HT2 agonist.
T
F
108
Psychic determinism relates to the assumption that our feelings, behaviours, thoughts and symptoms are not random or arbitrary.
T
F
109
Vaginismus usually responds poorly to the available treatment options.
T
F
110
A transient stress reaction can lead to episodes of shoplifting.
T
F
111
Approximately 25 per cent of patients receiving antipsychotics have ECG abnormalities.
T
F
112
Parametric tests give better statistical power than non-parametric tests for similar sample sizes.
T
F
113
Conduct disorders are associated with reading retardation.
T
F
114
Shoplifting is most common in females with previous convictions.
T
F
115
Criminal responsibility is assumed in a child of 10 years of age.
T
F
116
Antidepressants increase EEG delta activity.
T
F
117
Childhood-onset schizophrenia is defined as onset of psychosis by 12 years of age.
T
F
118
An association between raised interleukin-2 activity and depression has been shown.
T
F
119
In the EEG, α waves are most prominent over the frontal lobes.
T
F
120
20–25 per cent of patients with psychiatric diagnoses other than schizophrenia have first-rank symptoms.
T
F
121
The social drift hypothesis suggests that the stresses related to socioeconomic deprivation are risk-increasing factors for schizophrenia.
T
F
122
Patients switched to clozapine from typical antipsychotics show a reduction in basal ganglia volume.
T
F
123
Schizophrenic patients have impaired skin-conductanceorientating responses to novel stimuli.
T
F
Individual Statements 105
124
Epileptic twilight state is associated with marked perseveration of speech.
T
F
125
Sawtooth waves are associated with stage III sleep.
T
F
126
A cross-sectional study is a survey of the frequency of a disease or risk factor in a defined population at a given time.
T
F
127
Relative risk can be expressed as: incidence in exposed population/incidence in non-exposed population.
T
F
128
If the 95 per cent confidence interval for a treatment contains zero, the results are significantly different from no intervention.
T
F
129
The likelihood ratio for a test result compares the likelihood of that result in patients with disease to the likelihood of that result in patients without the disease.
T
F
130
A meta-analysis is a systematic review and summary of the medical literature.
T
F
131
The number needed to treat is the inverse of the absolute risk reduction.
T
F
132
Electromyogram burst amplitudes of less than 650 mV are associated with psychosis in Alzheimer’s disease.
T
F
133
Ondansetron may be an effective monotherapy for obsessive–compulsive disorder.
T
F
134
Serious violence as an ictal phenomenon is common.
T
F
135
Exhibitionism can be classified into two groups.
T
F
136
Castration was banned from use in recidivist sex offenders in the UK in the 1950s after several high-profile cases.
T
F
137
Cyproterone acetate has been used for aggression in severe mental impairment.
T
F
138
There is an increased prevalence of schizophrenia in those convicted of homicide and other crimes of violence compared to the general population.
T
F
139
Anxiety states and neurotic depression are the rarest neuroses associated with offenders.
T
F
140
19 per cent of remand prisoners have a mental disorder.
T
F
106 Section 2 Paper 4
141
The amygdala has a role to play in aggression.
T
F
142
Testamentary capacity requires knowledge of the nature and extent of one’s property.
T
F
143
DSM-IV classifies bipolar I disorders as episodes of mania alternating with depression.
T
F
144
Women with recurrent depression are at risk of reduced bone density and osteoporosis.
T
F
145
Psychiatric illness causes or contributes to 12 per cent of all maternal deaths.
T
F
146
Untreated, the average duration of post-natal depression is 2 years.
T
F
147
A 2-week washout period is required when stopping fluoxetine for a monoamine oxidase inhibitor.
T
F
148
The incidence of obsessive–compulsive disorder is equal between the sexes.
T
F
149
The median age for a first depressive episode is 27 years.
T
F
150
The presence of aggression is associated with meaningful EEG changes.
T
F
151
Antichymotrypsin has been implicated as a possible susceptibility gene for Alzheimer’s disease.
T
F
152
The amyloid β peptide linked to cognitive impairment in lateonset Alzheimer’s disease appears to explain the cognitive impairment seen in schizophrenia.
T
F
153
Measles can lead to a progressive dementia.
T
F
154
Benzodiazepines act at specific benzodiazepine receptors.
T
F
155
Coprophagia is a feature of Gilles de la Tourette’s syndrome.
T
F
156
Alpha lipoic acid is of benefit in Alzheimer-type dementia.
T
F
157
Excessive preoccupation with fantasy and introspection is consistent with a schizoid personality disorder.
T
F
158
Hypoplasia of the cerebellar vermis and cerebellar hemispheres has been described in autism.
T
F
Individual Statements 107
159
Adverse parenting in childhood is associated with an increased risk of depressive disorders in adult life.
T
F
160
Depressed children are no more likely than controls to have nondepressive adult psychiatric disorders.
T
F
161
African-Caribbean people living in England are at higher risk of developing an illness that meets the operational criteria for schizophrenia than the populations in their countries of origin in the Caribbean.
T
F
162
The MECP2 gene causes Rett’s syndrome.
T
F
163
Eighty-two per cent of children in public care in the UK are of ethnic origin.
T
F
164
The drug treatment of choice for social phobia is a selective serotonin re-uptake inhibitor.
T
F
165
Family therapy is as effective as methadone in the treatment of opiate dependence.
T
F
108 Section 2 Paper 4
EMIs 1 A B C D E
Analysis of variance Binomial distribution Discriminant analysis F-test Heterogeneity
F G H I J
Kurtosis Null hypothesis Receiver operating curve Factor analysis of variance Halo effect
Which of the above is being described below? 1
A test of three or more normally distributed independent groups compared on a single continuous measure.
2
A term used to describe the greater than expected difference in study results.
3
Represents a continuum of all the possible values of the cut-off point along the separator variable of a test.
EMIs 109
2 A B C D E
Hawthorne effect Obsequiousness bias Sampling bias Confounding Residual confounding
F G H I J
Significance bias Publication bias Observer bias Recall bias Significance bias
Which of the above is being described in each of the following statements? 1
Participants improve their responses because they believe that interest has been taken in them.
2
Participants change their genuine responses to what they believe the researchers are interested in.
3
A factor which systematically affects all the dependent variables and is associated with the independent variables.
110 Section 2 Paper 4
3 A B C D E
Stratification Systematic sampling Observational studies Cross-sectional studies Longitudinal studies
F G H I J
Retrospective studies Prospective studies Experimental studies Sequential studies Quasi-experimental studies
Match each of the descriptions below to one of the above. 1
In this type of study, each subject is observed once.
2
In this type of study, observations are collated with no artificial manipulation of important independent variables.
3
A study in which the information refers to outcomes occurring throughout the follow-up period.
4
Parallel and cross-over studies are examples of this type of study approach.
EMIs 111
4 A B C D E
Dominant parietal lobe lesion Dementia with Lewy bodies Corpus callosum tumour Delirium tremens Non-dominant parietal lobe lesion
F G H I
Wernicke’s encephalopathy Parkinson’s disease Prefrontal lobe tumour Korsakoff syndrome
What is the most likely diagnosis in each case described? 1
A 67-year-old man who lives alone and is not known to psychiatric services attends the emergency room. He is dishevelled, agitated, sweaty, has a coarse tremor, and is tachycardic.
2
A 25-year-old man with a history of generalised convulsions and anosmia. On examination, he has a unilateral grasp reflex, facial and tongue weakness.
3
A 58-year-old man with unilateral inattention, dressing apraxia and astereognosis.
112 Section 2 Paper 4
5 A B C D E
Thrombocytopenic purpura Microcephaly Blue eyes, fair complexion Underdeveloped secondary sexual characteristics Macro-orchidism
F G H I J
Brushfield’s spots Hydrocephalus Adenoma sebaceum Hypogonadism Epilepsy
Which of the above are associated with each of the following conditions? 1
This feature is associated with Down’s syndrome.
2
This feature is associated with XXY syndrome.
3
This is a feature of Martin–Bell syndrome.
4
This is a feature of Prader–Labhart–Willi syndrome.
5
This is found in 50 per cent of children with tuberous sclerosis by the age of 5 years.
6
This is commonly found in phenylketonuria.
EMIs 113
6 A B C D E
Acetylcholine Noradrenaline Serotonin Glutamate GABA
F G H I J
Glycine Histamine Dopamine Monoamine oxidase N-methyl-D-aspartate
1
The nucleus basalis of Meynert is associated primarily with which of the above?
2
The locus ceruleus is associated primarily with which of the above?
3
The raphe nucleus is associated primarily with which of the above?
4
The release of which of the above is inhibited by lamotrigine?
114 Section 2 Paper 4
INDIVIDUAL STATEMENTS: Answers 1
True.
2
True. Superior mesenteric artery syndrome is an uncommon but wellrecognised clinical entity characterised by compression of the third, or transverse, portion of the duodenum against the aorta by the superior mesenteric artery, resulting in complete or partial duodenal obstruction.
3
False. Leucopenia with relative lymphocytosis is recognised.
4
True. Due to medication inefficacy or unacceptable adverse effects. Connor D et al. Clin Pediatr 2000, 39:15–25.
5
True. Patients with generalised anxiety disorder do not react adversely to breathing 35 per cent carbon dioxide, unlike patients with panic disorder. Perna G et al. J Clin Psychiatry 1999, 60:379–84.
6
False. Levels of pHVA (the major metabolite of dopamine) are an indicator of central dopamine activity. Prodromal patients have been shown to have elevated levels of pHVA compared to controls. Sumiyoshi T et al. Biol Psychiatry 2000, 47:428–33.
7
False. Cognitive decline following coronary artery bypass grafting is common and is persistent in many patients. Newman N et al. N Engl J Med 2001, 344:395–402.
8
True. Studies have shown that: psychological stress can influence the balance between formation and dissolution of thrombi platelet activation is altered in depression plasma levels of thrombus-promoting factors are significantly increased in elderly patients with depression. Nemeroff C. Am Heart J 2000, 140:57S–62S.
9
True. Depression and anxiety were more predictive of functional status than coronary arteriography at 1 year. Sullivan M et al. Am J Cardiol 2000, 86:1135–8.
10
True. Long-term neuroleptic use can lead to obesity, which is a risk factor for obstructive sleep apnoea. Winkelman J. J Clin Psychiatry 2001, 62:8–11.
ISIs: Answers 115
11
True. This is a cognitive event-related potential shown to have reduced amplitude and prolonged latency in schizophrenia.
12
True. Especially verbal aggression Ng B et al. Psychiatry Serv 2001, 52:521–5.
13
False. There are higher incidence rates of hepatitis C and B and HIV in individuals with severe mental illness. Rosenberg S et al. Am J Public Health 2001, 91:31–7.
14
True. It is a tricyclic antidepressant related to the antipsychotic loxapine. Vega W et al. J Clin Psychopharmacol 2000, 20:504–19.
15
True. Social rhythm disruptions are alterations in routine such as eating, sleeping and exercise, and may be associated with the initiation of affective episodes. Malkoff-Schwartz S et al. Psychol Med 2000, 30:1005–16.
16
True. A correlation has been shown of up to 80 per cent in some studies. Sexual addiction is not a diagnosable disorder in DSM-IV or ICD-10, but has developed as a concept over the last 20 years.
17
False. BOLD effect is acquired in fMRI.
18
True. Levo-acetyl alpha methadol (LAAM) has been used with some efficacy.
19
True. This is a finding replicated in many studies. This may represent a trait marker. Dahl R et al. Biol Psychiatry 2000, 48:981–8.
20
True. A study looking at 99 probands with autism found particular traits may aggregate among relatives of autistic individuals. Murphy M et al. Psychol Med 2000, 30:1411–24.
21
False. Roy P et al. J Child Psychol Psychiatry 2000, 41:139–49.
22
False. It occurs with greater frequency in boys.
23
False. Marchiafava-Bignami disease is characterised by ataxia, epilepsy, dysarthria and impaired consciousness. It is a slowly progressive form of dementia associated with heavy alcohol consumption. Spastic paresis also occurs.
116 Section 2 Paper 4
24
True.
25
True.
26
False. It has become much rarer with the introduction of aluminiumfree dialysates.
27
False. The House of Lords ruled that nasogastric feeding in eating disorders constituted treatment of a psychiatric disorder and as such can be used (Riverside Health NHS Trust v. Fox 1994).
28
True. Bipolar I: episodes of depression and mania. Bipolar II: episodes of depression and hypomania.
29
True. The Epidemiological Catchment Area Study showed this (1988).
30
True. They are present in 9–20 per cent of cases.
31
False. L-Tryptophan is an essential amino acid and the precursor of serotonin.
32
True. This also happens with antidepressant treatment. ECT affects all the neurotransmitter systems in some way.
33
True. Hence care should be taken in patients receiving ECT who are also taking lithium. Also, lithium may lower the seizure threshold and lead to prolonged seizures.
34
False. Studies have shown that stimulation of the amygdala causes aggression and ablation leads to placidity.
35
False. Serotonin antibodies are widely found in the population. They might be increased in patients with certain psychiatric conditions such as schizoaffective psychosis. Schoff K et al. Psychiatry Res 2003, 121(1):51–7.
36
False. Amnesia is the commonest symptom and occurs in almost all of the dissociative disorders.
37
True. Multiple personality disorder or dissociative identity disorder is also more common in women (90–100 per cent of cases).
38
False. The earlier the onset of multiple personality disorder, the worse the prognosis. Much debate exists as to the authenticity of multiple personality disorder. It is very difficult to treat.
ISIs: Answers 117
39
False. The figure is 50–100 people per year. Mild hypoxia is purported to heighten orgasm intensity.
40
True. It occurs in 40–60 per cent of patients.
41
True. DSM-IV recognises a syndrome called hallucinogen persisting perception disorder.
42
False. Although this would be of some concern, a 60 ms QTc increase is a definite cause for concern. QT interval prolongation is a risk factor for torsade de points, which is associated with sudden death. Bednar RR et al. Prog Cardiovasc Dis 2001, 43:1–45.
43
True. It was used for this purpose in the 1800s.
44
False. 30–40 per cent of survivors of intracerebral haemorrhage have post-stroke depression. Katona C, Livingston G. Lancet 2000, 356:91–2.
45
False. Selective serotonin re-uptake inhibitors tend to cause minor bradycardia. Roose SP et al. Arch Gen Psychiatry 1987, 44:273–5.
46
False. This is considered toxic caffeinism. Chronic caffeinism is between 600 and 750 mg of caffeine per day.
47
False. ECT can be used in drug-resistant Parkinsonism. Anderson K et al. Acta Neurol Scand 1987, 76:191–9.
48
True. Leptin is produced by fat cells. Olanzapine-associated weight gain may be related to increased leptin levels.
49
True. Maternal smoking during pregnancy remained a significant influence when other potential confounders were taken into account. Thapar A et al. Am J Psychiatry 2003, 160:1985–9.
50
True. These are coded according to the substance involved, e.g. alcohol, inhalant, sedatives, hypnotics.
51
True. Others include poor academic performance, learning disability, attention deficit hyperactivity disorder, speech problems, cruelty to animals, visual and other physical defects.
52
False. Risk factors include high-dose neuroleptic medication, rapid increase in dose, parenteral/depot medication, organic brain disease,
118 Section 2 Paper 4
Parkinson’s disease, dehydration, electrolyte disturbance, psychomotor agitation, history of catatonia and previous neuroleptic malignant syndrome. 53
True. This is possibly due to greater parental interaction with the first child.
54
False. Vasopressin (and oxytocin) are involved in the regulation of mood. Both are synthesised in the hypothalamus and released in the posterior pituitary.
55
True.
56
True. Unlike the acute porphyrias such as acute intermittent porphyria, variegate porphyria, hereditary coproporphyria.
57
True. It is also caused by drugs (e.g. barbiturates, sulphonamides, oral contraceptive pill), acute infections and alcohol.
58
False. They refer to the serotonin syndrome (serotonin hyperstimulation). At least three of the following should be present for a definite diagnosis: agitation/restlessness, sweating, diarrhoea, fever, hyperreflexia, lack of coordination, mental state changes (confusion, hypomania), myoclonus, shivering, tremor.
59
False. The figure is 20 per cent.
60
True.
61
False. Cocaine reduces slow-wave sleep and REM. Excessive sleep occurs on withdrawal.
62
True.
63
True. Disulfiram is an irreversible inhibitor of aldehyde nicotinamide adenine dinucleotide (NAD) reductase. It increases acetaldehyde from incomplete alcohol metabolism, leading to a flushed face, tachycardia, nausea, vomiting and hypotension. Hughes JC, Cook CC. Addiction 1997, 92:381–95.
64
False. Acamprosate is a GABA analogue. It has a possible anti-craving effect. It is licensed for 1 year’s treatment in the UK.
65
True. In specialist settings, imipramine, clomipramine, nortriptyline and desipramine are sometimes used.
ISIs: Answers 119
66
True. Dantrolene is a skeletal muscle relaxant, reducing duration and mortality in neuroleptic malignant syndrome. Other drugs include amantadine, bromocriptine and benzodiazepines.
67
True. ‘A disorder characterised by delayed and abnormal development of social relationships and language’.
68
False. XXY = Klinefelter syndrome. It affects 1 in 500 births. Affected males lack secondary sexual characteristics and are infertile. They have behavioural difficulties, psychiatric disorders and low IQ. XYY occurs 1 in 700 births. Affected males are tall and have behavioural problems.
69
True. It leads to hyperuricaemia. Clinical features are choreoathetosis and self-mutilation (commonly of the lips and face).
70
False. Diogenes syndrome = senile squalor syndrome. This act allows the person to be removed from their home with no right of appeal.
71
True.
72
True. Liddell M et al. Br J Psychiatry 2001, 178(1):7–11.
73
True.
74
True. Hayato T et al. Psychiatry Res 2003, 120:201–6.
75
True.
76
False. It is a culture-bound syndrome associated with fear of the cold, loss of energy and compulsive wearing of many layers of clothing.
77
False. Childhood cruelty to animals has predictive value for later aggression against humans. Felthous A et al. Am J Psychiatry 1987, 144:710–17.
78
True. Phase Phase Phase Phase Phase
79
True.
1: 2: 3: 4: 5:
normal volunteers give pharmacodynamic data etc. patients confirm pharmacodynamic data etc. patients used in clinical trials. post-marketing surveillance. ongoing trials.
120 Section 2 Paper 4
80
False. It can be, and is, used to adjust for confounders.
81
True. It is an opioid antagonist, given to former addicts in an attempt to prevent relapse.
82
True. 1997–1999 Report of the Confidential Enquiries into Maternal Deaths (2001).
83
False. SD = √variance.
84
True. < 5 per cent or p < 0.05.
85
True. Prior probability is the probability of an individual having an attribute before an event occurs.
86
False. This is restricted randomisation. In unrestricted randomisation and sampling, selection is with replacement; each member of a population has a calculable, known and equal probability of being selected.
87
True.
88
True.
89
True.
90
True. Skewness describes the symmetry of a distribution with respect to its mean.
91
True. Usually, by convention, α = 0.05 (5 per cent).
92
False. Power is the probability of not making a type II error, i.e. the probability of rejecting a false null hypothesis.
93
True. Ecological studies are used to generate a hypothesis between an exposure and outcome based on aggregated data.
94
False. There is > 90 per cent risk; 50 per cent after one episode.
95
True. At 5 years, 3 per cent of children are wet during the day.
96
False. Biofeedback is described. Autogenic training is a series of structured suggestions that promote body suggestions associated with relaxing.
ISIs: Answers 121
97
True. For example Ritalin in children. It is important to give regular drug holidays and to chart their growth.
98
True. It is thought to have some effect in reducing hyperkinetic behaviour.
99
True. It is compulsive pulling of one’s own hair. Other impulsive disorders include intermittent explosive disorder, pyromania, kleptomania and compulsive gambling.
100 True. 101 True. Although it is currently not a first-line treatment. 102 False. It causes anorexia and weight loss. 103 True. 104 False. The figure is 50 per cent. McCulloch DK et al. Diabetologia 1980, 18(4):279–83. 105 True. Eye movement desensitisation and reprocessing, developed by Francine Shapiro, was initially used for post-traumatic stress disorder but is now also used for other anxiety disorders. 106 True. Oldman J. JAMA 1994, 272:1770–6. 107 True. This is LSD. 108 True. 109 False. Specific treatment techniques and exercises are extremely effective. 110 True. This is reactive shoplifting. 111
True. Thomas S. Adverse Drug React Toxicol Rev 1994, 13:77–102.
112 True. 113 True. 114 True.
122 Section 2 Paper 4
115 True. In the UK, 10–14 year olds are assumed to know the difference between right and wrong (e.g. Thomson and Venables, the Jamie Bulger case). 116 True. They also increase beta and theta activity. 117 True. It is rare, and usually severe, and has been shown to be continuous with the adult disorder. 118 True. 119 False. They are most prominent over the occiput: accentuated by eye closure, attenuated by eye opening. 120 True. 121 False. This is the social-causation hypothesis. The social drift hypothesis suggests that individuals drift down to lower socioeconomic classes as a consequence of social and occupational incompetence associated with schizophrenia. 122 True. It may be due to clozapine’s low potential for extrapyramidal side effects and tardive dyskinesia. Chakos MH et al. Lancet 1995, 345:456–7. 123 True. About 50 per cent fail to produce it and others fail to habituate. 124 True. Epileptic twilight state: impaired consciousness, several hours (rarely > 1 week), visual hallucinations, abnormal affective states (panic, terror, anger, ecstasy), psychomotor retardation with marked perseveration of speech. 125 False. Stage V: REM/sawtooth. Stage I: theta waves. Stage II: sleep spindles and K complexes. Stage III: delta waves, 20–50 per cent. Stage IV: delta > 50 per cent. 126 True. 127 True. 128 False. Results are not significantly different from ‘no treatment’. 129 True.
ISIs: Answers 123
130 False. This is an overview. A meta-analysis is an overview that uses quantitative methods to summarise the results. 131 True. 132 True. They occurred in 69 per cent of psychotic Alzheimer’s disease patients compared to 17 per cent without psychosis. The authors suggest it may help identify individuals susceptible to developing psychosis. Caliguiri MP et al. Neurology 2003, 61:954–8. 133 True. 5HT3 antagonists have been found to act as anxiolytics in selected animal models of anxiety and a small sample of obsessive–compulsive disorder patients. It is currently licensed for use in peri-operative nausea or that associated with chemotherapy. 134 False. It is very rare. 135 True. Type 1: 80 per cent, inhibited young men, not physically dangerous. Type 2: 20 per cent, less inhibited, more psychopathic. 136 False. Castration has never been used in the UK. 137 True. It is used in hypersexuality, indecent exposure, unwanted fantasies, aggression, male contraception. 138 True. 139 False. They are the commonest. 140 False. The figure is 63 per cent. Brooke D et al. BMJ 1996, 313:1524–7. 141 True. 142 True. Testamentary capacity: must be of sound mind and (1) know the nature and extent of their property; (2) know the persons having a claim on it and the relative strengths of their claims; (3) be able to express themselves clearly and without ambiguity. 143 True. Bipolar II disorder: episodes of hypomania alternating with depression. 144 True. These risks are related to prolonged hypercortisolaemia. Michelson D et al. N Engl J Med 1996; 335(16):1176–81.
124 Section 2 Paper 4
145 True. Why Mothers Die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1997–1999. London, Royal College of Obstetricians and Gynaecologists, 2001. 146 False. The average duration is 7 months. It can persist for 1 year in 30 per cent of cases. 147 False. A washout period of 5 weeks is required. 148 True. But more adolescent boys are affected than adolescent girls. 149 True. 150 False. It is rarely associated with meaningful changes. Stone J, Moran G. Psychiatr Bull 2003, 27:171–2. 151 True. But it has not consistently been shown to have a significant role. 152 False. Cognitive decline in the course of schizophrenia is distinct from the neuropathological processes linked to β amyloid in Alzheimer’s disease. 153 True. It can lead to subacute sclerosing pan-encephalitis. 154 True. The receptors are on the GABA channel. 155 False. Coprolalia (obscenities) is a feature. Coprophagia = ingesting faeces. 156 False. Currently there is no evidence base for benefits associated with this antioxidant. Sauer J et al. Cochrane Review, Cochrane Database, 2004. 157 True. Plus few if any activities giving pleasure, emotional coldness, limited capacity to express warm feelings, no close or confiding relationships, little interest in sex, apparent indifference to praise/criticism, solitary, insensitivity to prevailing social norms and conventions. 158 True. It has been described in neuropathological and neuroimaging studies. 159 True.
ISIs: Answers 125
160 True. Harrington R et al. Arch Gen Psychiatry 1990, 47(5):465–73. 161 True. Mandy S et al. Br J Psychiatry 2001, 178(Suppl. 40):S60–8. 162 True. Rett’s syndrome is a pervasive developmental disorder affecting girls. Amir RE et al. Nat Genet 1999, 23:185–8. 163 False. 82 per cent are white, 7 per cent are black, 6 per cent are of mixed race, 2 per cent are Asian, 3 per cent are of ‘other’ races. Department of Health. Children Looked After in England 2000/2001. London, HMSO, 2001. 164 True. Ballenger JC et al. J Clin Psychiatry 1998, 59:54–60. 165 False.
126 Section 2 Paper 4
EMIs: Answers 1 1
A
2
E
Related to meta-analysis.
3
H
Receiver operating curve analysis can be used to determine the optimal cut-off point of a particular test.
2 1
A
2
B
3
D
A confounder is associated with both a determinant and the outcome but is not causative. An example would be the association between alcohol consumption and lung carcinoma. Smoking is the cause, alcohol is the confounder, commonly associated but not causative.
Note. Publication bias occurs with the publication of positive study findings over negative ones.
3 1
D
2
C
3
G
Whereas retrospective studies refer to outcomes occurring in the time before the study.
4
H
Parallel: e.g. two groups, (1) the study group, (2) control. Crossover, more than two groups: subjects change groups during the study, e.g. from control to experimental group.
EMIs: Answers 127
4 1
D
It usually occurs following alcohol withdrawal in dependent people. A short-lived confusional state is accompanied by a number of features including delusions, hallucinations, confusion, clouding of consciousness, agitation and fear.
2
H
3
E
Astereognosia is the inability to recognise an object through touch alone.
1
F
Brushfield’s spots on the iris.
2
D
3
E
Also called fragile X syndrome.
4
I
More commonly called Prader–Willi syndrome.
5
H
6
C
5
6 1
A
2
B
3
C
4
D
It is of particular importance in Alzheimer’s disease, which is associated with a cholinergic deficit (cholinergic hypothesis of memory dysfunction).
It is an anti-epileptic used increasingly for its mood-stabilising properties in mood disorders. It is (rarely) associated with serious skin reactions, including Stevens–Johnson’s rash and also leucopenia.
128 Section 2 Paper 2
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???? 129
paper 5
130 Section 2 Paper 5
INDIVIDUAL STATEMENTS 1
Hypericum perforatum is superior to placebo in treating mild to moderate depression.
T
F
2
The pedunculopontine nuclei are relatively preserved in late-onset dementia.
T
F
3
Tetrahydrocannabinol has been shown to be effective and safe in the treatment of tics.
T
F
4
Reboxetine causes significant sexual dysfunction compared to the selective serotonin re-uptake inhibitors.
T
F
5
Negative predictive value is the proportion of people who are negative on the test who actually do not have the disorder.
T
F
6
Reliability is the ability of a test to measure what it purports to measure.
T
F
7
Saltatory nerve conduction is an abnormal finding in neurophysiological testing.
T
F
8
The resting cell membrane is relatively impermeable to Na+.
T
F
9
There are five layers to the cerebral neocortex.
T
F
10
Late-onset obsessive–compulsive disorder in males has a poor prognosis.
T
F
11
Childhood disintegrative disorder is a rare form of disruptive behaviour associated with the pervasive developmental disorders.
T
F
12
The rate of suicide in the prison population is thought to be 10–20 times greater than that of the general population.
T
F
13
Post-ictal psychosis often begins after a lucid period.
T
F
14
Brief dynamic psychotherapy is rarely prescribed as first-line therapy.
T
F
15
The neuropsychological effects of stimulant abuse appear to persist for up to a year after having stopped usage.
T
F
16
Benzodiazepines increase beta waves.
T
F
Individual Statements 131
17
Axis II in DSM-IV relates to general medical conditions.
T
F
18
Olanzapine is more likely to cause impotence than chlorpromazine.
T
F
19
Pseudobulbar palsy is not associated with the development of dementia.
T
F
20
Erectile dysfunction affects at least 2 per cent of men.
T
F
21
DSM-IV includes diagnostic criteria for male erectile disorder.
T
F
22
Dyspareunia has been reported to occur in up to 5 per cent of women aged 20–40 years.
T
F
23
The treatment of dyspareunia is usually pharmacological.
T
F
24
The reticular formation is associated with sleep and arousal.
T
F
25
Gilles de la Tourette syndrome is associated with coprolalia.
T
F
26
In an action potential, sodium and chloride ions pass into the cell and phosphate and potassium pass out.
T
F
27
High systolic blood pressure is a possible risk factor for Alzheimer’s dementia.
T
F
28
Raised plasma homocysteine is an independent risk factor for the development of dementia and Alzheimer’s disease.
T
F
29
Buprenorphine has little benefit in the treatment of heroin addiction.
T
F
30
Twilight states may be associated with unexpected violent acts.
T
F
31
Sleep walking and night terrors occur in REM sleep.
T
F
32
Paradoxical sleep is associated with abnormal EEG rhythms.
T
F
33
The hypothalamic nuclei can be divided into anterior, intermediate and posterior nuclei.
T
F
34
Stimulation of the septohippocampal formation causes sedation.
T
F
35
Treatment with low-dose risperidone reduces aggression, agitation and psychosis in dementia.
T
F
36
The substantia nigra is a structure within the midbrain.
T
F
37
The facial nerve carries parasympathetic neurones.
T
F
132 Section 2 Paper 5
38
In manic defence the individual defends himself against anxiety, isolation and psychosis.
T
F
39
Hyponatraemia is associated with selective serotonin re-uptake inhibitor and venlafaxine use in the elderly.
T
F
40
Changes in thalamus blood flow have been shown following treatment response to venlafaxine.
T
F
41
Globus hystericus is a fear that the world is ‘going mad’.
T
F
42
Family therapy for schizophrenia has been associated with reduced relapse rates.
T
F
43
Recurrent major depression is a risk factor for subclinical atherosclerosis in middle-aged women.
T
F
44
Measuring cerebrospinal fluid tau protein can help differentiate old-age depression from Alzheimer’s disease.
T
F
45
The anterior spinal artery is a branch of the basilar artery.
T
F
46
Wilson’s disease is a cause of reversible dementia.
T
F
47
Lip smacking and chewing are seen in temporal lobe epilepsy.
T
F
48
There is diffuse flattening of the EEG in Huntington’s disease.
T
F
49
Reduction in grey matter is a rare finding in schizophrenia.
T
F
50
Frontal lobe function involves an ability to switch mental tasks.
T
F
51
Half of narcolepsy sufferers have major affective disorders.
T
F
52
Agoraphobia follows a fluctuating course.
T
F
53
A conversion reaction often relieves anxiety in conversion disorders.
T
F
54
Phantom limb pain is a long-standing conversion disorder.
T
F
55
Weight gain has been reported with flupentixol.
T
F
56
Object agnosia is associated with a lesion of the left occipital cerebral cortex.
T
F
57
The incidence of schizophrenia is between 18 and 50 per 100 000 of the population.
T
F
58
The Wilcoxon test is suitable for detecting differences between two repeated measures.
T
F
Individual Statements 133
59
In older hospitalised patients, depression seems to be associated with a greater occurrence of adverse drug reactions.
T
F
60
Steroids may improve negative, depressive and anxiety symptoms in schizophrenia.
T
F
61
Dementia is inevitable in all those living beyond 90 years of age.
T
F
62
Eighty per cent of depressive episodes receive no treatment.
T
F
63
Dreaming only occurs in REM sleep.
T
F
64
Accidental injuries are common in people with somnambulism.
T
F
65
Tangles are extracellular bodies found in Alzheimer’s dementia.
T
F
66
Lithium undergoes mainly renal elimination.
T
F
67
Benzodiazepines increase fast-wave EEG activity.
T
F
68
Learning-disabled people with schizophrenia often respond poorly to neuroleptic medication.
T
F
69
Gilles de la Tourette syndrome is associated with specific EEG abnormalities.
T
F
70
Pimozide is used commonly for the treatment of simple tics in children.
T
F
71
Mortality following ECT is similar to that following general anaesthesia for small procedures.
T
F
72
The majority of episodes of delirium recover in less than 4 weeks.
T
F
73
A diagnosis of delirium is unlikely if there is disturbance of the sleep/wake cycle.
T
F
74
Nystagmus is a recognised feature of acute alcohol intoxication.
T
F
75
‘Forced thinking’ can be a symptom in temporal lobe epilepsy.
T
F
76
Increased appetite can develop within a few hours of cocaine withdrawal.
T
F
77
Lithium inhibits tau phosphorylation.
T
F
78
There is an association between dental caries and antidepressants.
T
F
79
Apolipoprotein D has been implicated in Alzheimer’s disease among African Americans.
T
F
134 Section 2 Paper 5
80
The therapist indulges in Socratic questioning in cognitive therapy.
T
F
81
Faecal soiling in an infant is associated with faecal retention.
T
F
82
There is an association between sexual pleasure and pathological fire setting.
T
F
83
The prevalence of dyslexia is higher in inner city areas.
T
F
84
Periods of REM sleep lengthen during the natural course of sleep.
T
F
85
Sexual exhibitionism usually progresses to sexual attacks.
T
F
86
Elderly people with subjective memory complaints and objective cognitive impairment have a high risk of developing Alzheimer’s dementia.
T
F
87
A three-step procedure (self-report memory complaints, tests of global cognitive functioning, and domain-specific cognitive tests) has a positive predictivity of 90 per cent for Alzheimer’s disease and dementia at 3 years.
T
F
88
A traumatic brain injury during childhood or adolescence could more than double an individual’s chance of developing psychiatric disorders.
T
F
89
Impaired serotonergic function does not contribute to cognitive decline in Alzheimer’s disease.
T
F
90
Approximately 10 per cent of reversible cases of dementia are truly reversible.
T
F
91
Fluctuating cognition, visual hallucinations and Parkinsonism are all required for a diagnosis of dementia with Lewy bodies.
T
F
92
Profound cerebellar signs are found in Creutzfeldt–Jakob disease.
T
F
93
NMDA receptor antagonists are used in the treatment of dementia.
T
F
94
Autistic children lack ‘theory of mind’.
T
F
95
Case control studies are seldom subject to recall bias.
T
F
96
Cocaine damages brain circuits associated with the sense of pleasure.
T
F
Individual Statements 135
97
Eighty per cent of manic patients respond to lithium treatment.
T
F
98
Cerebellar degeneration occurs in association with chronic alcohol abuse.
T
F
99
Third ventricle petechiae occur with chronic alcohol consumption.
T
F
100
In Alzheimer’s disease, low levels of acetyltransferase are found in the nucleus basalis of Meynert.
T
F
101
There is an association between anorexia nervosa and shoplifting.
T
F
102
Psychotropics can play a role in the pathologically jealous individual.
T
F
103
Venlafaxine is associated with polyarthralgia.
T
F
104
White matter hyperintensities observed on MRI scanning are common in late-onset depression.
T
F
105
Venlafaxine can cause a dose-related rise in blood pressure.
T
F
106
The Brief Psychiatric Rating Scale (BPRS) is unsuitable for rating minor psychiatric disorders.
T
F
107
Conner’s rating scale is used as a measure of hyperactivity.
T
F
108
An REM latency of 90 minutes is found in normal adults.
T
F
109
Children of school-going age are the commonest subjects of Munchausen’s syndrome by proxy.
T
F
110
Fluctuations in attention would indicate a diagnosis of Alzheimer’s disease rather than dementia with Lewy bodies.
T
F
111
A clinically significant interaction is likely between a tricyclic antidepressant and tranylcypromine.
T
F
112
Transcranial magnetic stimulation can reduce auditory hallucinations.
T
F
113
Hallucinations are more frequent in dementia with Lewy bodies than in Alzheimer’s disease.
T
F
114
In autism, failure to develop useful speech by the age of 5 years is a predictor of poor outcome.
T
F
115
Approximately 5 per cent of 3 year olds have a specific language delay.
T
F
136 Section 2 Paper 5
116
Methylphenidate inhibits the dopamine transporter mechanism.
T
F
117
Tics affect 20 per cent of children.
T
F
118
Tics are more pronounced in sleep.
T
F
119
Tricyclic antidepressants are useful in childhood depression.
T
F
120
Prolonged interferon-alpha therapy for hepatitis C may induce depressive symptoms and major depression.
T
F
121
Childhood-onset schizophrenia is associated with progressive loss of cerebellar volume in adolescence.
T
F
122
Rivastigmine is a selective inhibitor of buteryl cholinesterase.
T
F
123
Elderly women are more likely than their male counterparts to commit suicide.
T
F
124
Late-onset paraphrenia has an equal sex distribution.
T
F
125
The prevalence of Alzheimer’s disease is greatest in rural areas.
T
F
126
Diogenes syndrome is associated with end-stage personality disorder.
T
F
127
Leukoariosis is associated with cognitive decline.
T
F
128
Parietal lobe symptoms are a poor prognostic indicator in Alzheimer’s disease.
T
F
129
Formication can occur in cocaine usage.
T
F
130
Alcohol misuse leads to demyelination of the corpus callosum.
T
F
131
Very late-onset schizophrenia-like psychosis is diagnosed at age 80 or above.
T
F
132
In the elderly, drugs have shorter half-lives.
T
F
133
Liquid Ecstasy is an illicit drug used by ‘ravers and body builders’.
T
F
134
Bilateral hippocampal destruction leads to Korsakoff’s syndrome.
T
F
135
Peripheral neuropathy is a clinical feature of Wernicke’s encephalopathy in less than 30 per cent of cases.
T
F
136
The falsification of memory in clear consciousness occurs in Wernicke’s encephalopathy.
T
F
Individual Statements 137
137
Omega-3 fatty acids may have a role in treating borderline personality.
T
F
138
Caution is needed before prescribing an acetylcholinesterase inhibitor to a patient with atrial fibrillation.
T
F
139
Charles–Bonnet syndrome is characterised by poorly formed visual hallucinations.
T
F
140
Depressed elderly people do not benefit from a team approach to care.
T
F
141
Nalbuphine is used by athletes to control anxiety before a competition.
T
F
142
Finkelhor created a risk factor checklist for sexual abuse.
T
F
143
In forensic samples, borderline personality disorder shows comorbidity with antisocial personality disorder.
T
F
144
Dextromoramide is an opioid drug.
T
F
145
Tetrahydrocannabinol and its metabolites can be detected in the urine for several weeks after use.
T
F
146
Cocaine is a central nervous system depressant inducing calmness and sleep.
T
F
147
Post-stimulant perception disorder (or ‘flashbacks’) frequently occurs with cocaine usage.
T
F
148
Phencyclidine is usually smoked, but can be taken orally, intravenously or inhaled.
T
F
149
Lamotrigine may be an effective option for the treatment of depression in epilepsy.
T
F
150
Divalproex is used in the treatment of acute mania associated with bipolar disorder.
T
F
151
Men who experience sexual dysfunction due to the use of selective or non-selective serotonin re-uptake inhibitors may benefit from sildenafil.
T
F
152
Incremental validity indicates whether the measurement being assessed is superior to other measurements in approaching true validity.
T
F
153
Face validity is a subjective judgement as to whether a test or measure appears to measure the feature in question.
T
F
138 Section 2 Paper 5
154
The bias occurring when the researcher has clues about whether the subject is in the case or control group is called selection bias.
T
F
155
Studies are generally considered worthwhile if the power is at least 80 per cent.
T
F
156
The relative risk is the ratio of the risk of an outcome in one experimental group divided by the risk of the outcome in the other group.
T
F
157
The Z statistic represents the deviation from the mean value in standard deviation units.
T
F
158
The process of ensuring that all subjects recruited into a trial have equal chances of being allocated to the treatment or control groups is called distribution.
T
F
159
Departures from the symmetry in a frequency distribution are known as skewness.
T
F
160
In a normal distribution, mode > median > mean.
T
F
161
The kappa is a chance-corrected measure of agreement.
T
F
162
In an intention to treat analysis, data only on those who actually received the treatment to which they were allocated are included.
T
F
163
Likelihood ratio is equal to the sensitivity over 1 minus the specificity.
T
F
164
Bias is a random error.
T
F
165
Kurtosis is a normal distribution that appears too flat or too ‘peaky’.
T
F
EMIs 139
EMIs 1 A B C D E F
Stein–Leventhal disease Parkinson’s disease Guillain–Barré syndrome Multiple sclerosis Pseudobulbar palsy Wilson’s disease
G H I J K
Kennedy’s syndrome Dementia with Lewy bodies Dysmnesic syndrome Neurosyphilis None of the above
Choose the most suitable of the above for each of the following. 1
A patient with this disorder is found to have a trinucleotide repeat.
2
A patient with this condition is told that he has associated Uthoff’s phenomenon.
3
A patient’s decline is arrested with penicillin, with possible slight improvement.
4
This condition is associated with periungual fibromas.
140 Section 2 Paper 5
2 A B C D E F
Trichotillomania Affective disorders Hyperkinetic disorder Conduct disorder Autism Tic disorder
G H I J
School refusal Asperger’s syndrome Pervasive developmental disorders Early-onset schizophrenia
Which of the above disorders applies to each of the following? 1
This is the commonest childhood psychiatric disorder.
2
A subtype of this disorder is called oppositional defiant disorder, according to ICD-10.
3
Strict exclusion diets have been used in an attempt to treat the symptoms of this condition, with varying success.
4
The onset of this condition is associated with three age-related peaks in incidence.
5
Its severity gradually improves so that by early adulthood there is commonly complete or partial resolution.
EMIs 141
3 A B C D E F
Ash leaf-shaped macules which fluoresce under ultraviolet light Bilateral acoustic neuromas Maculopapular rash Blue naevi Cherry-red spot Axillary freckling
G H I J K
Hypertension Ejection systolic murmur Transposition of the great arteries Broad tongue Brushfield’s spots
Answer the following. 1
A 7 year old with mental retardation, seizures and facial angiomas is found to have what else on physical examination?
2
A 12 year old is found to have more than six café au lait macules and four Lisch nodules. In addition, she was found to have what on physical examination?
3
A 22 year old found to have an abnormality on chromosome 22 presents with a cranial meningioma and spinal tumour in addition to what from the above?
142 Section 2 Paper 5
4 A B C D E
7–10 days 1–2 days 3–9 days 4–7 days 10–15 days
F G H I
15–25 25–35 40–50 50–65
days days days days
Match each of the following depot preparations with its time to peak plasma concentration following administration. 1
Flupentixol decanoate
2
Fluphenazine decanoate
3
Haloperidol decanoate
4
Pipothiazine palmitate
5
Zuclopenthixol decanoate
6
Zuclopenthixol acetate
EMIs 143
5 A B C D E
Cannabis Cocaine Diazepam Heroin LSD
F G H I J
Temazepam Methadone Amphetamine Ecstasy Codeine
Match the appropriate drug to each of the statements below. 1
This drug has an elimination half-life of 28 hours.
2
This drug has an elimination half-life of 48 hours.
3
This drug has an elimination half-life of 2 minutes.
4
This drug has an elimination half-life of 6 hours.
5
This drug has an elimination half-life of 1 hour.
6
This drug has an elimination half-life of 10 hours.
144 Section 2 Paper 5
6 A B C D E F
Feighner criteria Kappa coefficient Friedman test Kruskal–Wallis test Mann–Whitney test Wilcoxon test
G H I J
Kendall’s correlation coefficient Parson’s correlation coefficient Ratio scaling Discriminant validity
Which of the above is: 1
A non-parametric test of differences in repeated observations on more than two occasions?
2
A non-parametric test of differences in medians of two or more independent groups?
3
A non-parametric correlation coefficient?
4
A non-parametric test of the difference between the medians of two paired sets of observations (usually before and after an intervention)?
ISIs: Answers 145
INDIVIDUAL STATEMENTS: Answers 1
True. St John’s wort.
2
False. The pedunculopontine nuclei are a part of the cholinergic system, projecting to the thalamus. They commonly degenerate.
3
True. Muller-Vahl KR et al. J Clin Psychiatry 2003, 64(4):459–65.
4
False. It might be of benefit for patients at risk of sexual dysfunction with selective serotonin re-uptake inhibitors. Clayton AH et al. Int Clin Psychopharmacol 2003, 18(3):151–6.
5
True.
6
False. This is the definition of validity. Reliability is the level of agreement between different sets of observations.
7
False. It is normal nerve conduction, jumping from nodes of Ranvier.
8
True.
9
False. There are six layers: molecular/plexiform, external granular, external pyramidal, internal granular, internal pyramidal/ganglionic, multiform/polymorphic.
10
False.
11
False. Childhood disintegrative disorder is a form of dementia occurring in early life, often associated with lipidoses or other progressive brain pathology.
12
True.
13
True. The commonest psychotic features in such patients are hallucinations and delusions.
14
False.
15
True. Toomey R et al. Arch Gen Psychiatry 2003, 60:303–10.
16
True. Barbiturates and benzodiazepines increase beta and reduce alpha activity.
146 Section 2 Paper 5
17
False. Axis II relates to personality.
18
False.
19
False. Pseudobulbar palsy involves spastic weakness of pharyngeal musculature causing dysphasia and dysarthria with emotional lability and dementia.
20
True.
21
True.
22
False. Dyspareunia occurs in 10–20 per cent of 20–40 year olds. It is genital pain associated with sexual intercourse.
23
False. It is usually psychological.
24
True. Brainstem formation is probably involved in sleep, consciousness, movement and motivation.
25
True. Coprolalia is verbalised obscenities.
26
False. Sodium and phosphate move in, potassium and chloride pass out of the cell.
27
True. In a cohort of 1270 elderly people, 339 developed dementia over a 6-year period. Both low diastolic and high systolic pressures were associated with increased risk of Alzheimer’s disease and dementia. Qui C et al. Arch Neurol 2003, 60:223–8.
28
True. Seshadri S et al. N Engl J Med 2002, 346:476–83.
29
False. Buprenorphine has both agonist and antagonist activity and may be effective in the treatment of heroin addiction. It can also precipitate withdrawal symptoms in those with opioid dependency. Kakko J et al. Lancet 2003, 361:662–8.
30
True. They are associated with temporal lobe epilepsy and organic states.
31
False. They occur in non-REM sleep. REM sleep is associated with nightmares.
32
False. Paradoxical sleep is fast mixed frequency activity of low voltage (similar to awake trace) occurring in REM sleep – hence its name. It is a normal finding.
ISIs: Answers 147
33
True.
34
False. The septohippocampal formation is a ‘chief pleasure pathway’. It is also a cholinergic supply to the hippocampus.
35
True. These are the findings from a trial of 345 patients randomised to either risperidone or placebo. However, recent guidance suggests that the increased risk of cerebrovascular accidents associated with certain atypical neuroleptics means that they are now contraindicated for behavioural management in patients with dementia! Brodaty H et al. J Clin Psychiatry 2003, 64:134–43.
36
True. The midbrain comprises the tectum, tegmentum (cerebral peduncle, red nucleus and substantia nigra) and the CNS cerebri.
37
True.
38
False. Manic defence is a form of defensive behaviour against anxiety, guilt and depression by (1) denial, (2) phantasy of omnipotent control, (3) identification, (4) projection.
39
True. In a study of 199 elderly patients taking either venlafaxine or a selective serotonin re-uptake inhibitor, 39 per cent were hyponatraemic. These medications can cause hponatraemia in any individuals. Kirby D et al. Int J Geriatr Psychiatry 2002, 17:231–7.
40
True. Davies J et al. Am J Psychiatry 2003, 160:374–6.
41
False. It is subjective difficulty in swallowing.
42
True.
43
True. This was shown in a study of 336 women in the USA. Jones DJ et al. Arch Gen Psychiatry 2003, 60:153–60.
44
True. Buerger K et al. Am J Psychiatry 2003, 160:376–9.
45
False. The anterior spinal and vertebral arteries join to form the basilar artery. The basilar artery has five branches (superior cerebellar, pontine, basilar, labyrinthine and anterior inferior cerebellar).
46
True. The dementia is potentially reversible, although some cognitive deficit is common.
148 Section 2 Paper 5
47
True. Other features are illusions, hallucinations, déjà vu, jamais vu, depersonalisation, and affective experiences.
48
True.
49
False.
50
True. In the Stroop test, the word ‘blue’ is written in red on paper and the subject is asked to say what colour it is.
51
True. Narcolepsy: excessive daytime somnolence, sudden onset of REM sleep accompanied by cataplexy or sleep paralysis. Twenty-five per cent of sufferers have associated hypnopompic or hypnogogic hallucinations.
52
True.
53
True.
54
False. It is the sensation of pain in a body part that has been lost or amputated. Sensation usually fades with time.
55
True.
56
True. Left occipital cortex: right homonymous hemianopia, alexia, colour naming defect, object agnosia. Right occipital cortex: left homonymous hemianopia, visual illusions and hallucinations, loss of topographical memory and visual orientation.
57
True.
58
True.
59
True. Onder G et al. Arch Intern Med 2003, 163:301–5.
60
True. Dehydroepiandrosterone (DHEA) was demonstrated to improve these symptoms in a small study of 30 patients. Strous RD et al. Arch Gen Psychiatry 2003, 60:133–41.
61
False. Of those people who live beyond 90 years of age, many are unaffected by dementia. Boeve B et al. Neurology 2003, 60:477–80.
62
True.
ISIs: Answers 149
63
False. Dreaming usually occurs in REM, but can occur in non-REM sleep.
64
False. Somnambulists (sleepwalkers) occasionally harm themselves, so their environment should be made safe before they sleep.
65
False. Tangles are intracellular. Remember people usually ‘tango’ inside.
66
True. Clearance is therefore reduced in the elderly and with renal impairment.
67
True. They increase β and reduce α. In overdose there is prominent fast activity.
68
True.
69
False. It is associated with non-specific EEG changes.
70
False. It is not commonly used in the treatment of tics. It has been used in the treatment of Tourette’s syndrome, but is not recommended for use in children and is associated with ECG abnormalities.
71
True.
72
True.
73
False. This is a characteristic finding, as are daytime drowsiness, nocturnal worsening of symptoms, disturbing dreams or nightmares.
74
True.
75
True. It is a compulsion to think on specific topics.
76
True. Others include dysphoric mood, fatigue, vivid unpleasant dreams, insomnia/hypersomnia and psychomotor retardation or agitation (DSMIV).
77
True. In cell lines, lithium has been shown to inhibit tau phosphorylation. It is thought that inhibition of glycogen synthase kinase-3 accounts for this effect. Lithium is now being investigated for a potential therapeutic role in Alzheimer’s dementia.
78
True. Antidepressants can cause dry mouth (xerostomia). This can lead to oral complications, including dental caries. Keen JJ Jr. J Am Dent Assoc 2003, 134:71–80.
150 Section 2 Paper 5
79
True. Apolipoprotein D has recently been implicated in Alzheimer’s disease among African-American people. Further studies will be needed to confirm this.
80
True.
81
True.
82
True.
83
True.
84
True.
85
False. Most exhibitionists do not commit violent sexual acts, nor do they interfere with children. Rooth G. Arch Sex Behav 1973, 2(4):351–63.
86
True. Alzheimer’s disease is thought to affect 50–60 per cent of all dementia patients.
87
True. In a study of 1435 people aged 75–95, single questions were asked about memory complaints and assessment was by MMSE and neuropsychological testing. Palmer K et al. BMJ 2003, 326:245.
88
True. Timonen N et al. Psychiatry Res 2002, 113:217–26.
89
False. The serotonergic system is impaired in Alzheimer’s disease, which may contribute to both cognitive and non-cognitive symptoms. Porter RJ et al. Psychol Med 2003, 33:41–9.
90
True. By the time the majority are diagnosed, a degree of irreversible cognitive impairment will have occurred.
91
False. Two of these are required for probable Lewy body dementia, one for a possible diagnosis.
92
True. In addition to extrapyramidal signs and myoclonus.
93
True. Memantine is used in the treatment of Alzheimer’s disease.
94
True. This is the ability to form an idea of what others are thinking.
ISIs: Answers 151
95
False.
96
True. Dopamine neurones in cocaine users may be damaged or destroyed. This may predispose to depression. Littel KY et al. Am J Psychiatry 2003, 160:47–55.
97
True. But response can take up to 3 weeks. Other medications are often needed acutely for more immediate response (neuroleptics, benzodiazepines).
98
True.
99
True.
100 True. It relates to the cholinergic deficit in Alzheimer’s dementia. 101 True. Sufferers are most likely to steal food. 102 True. Especially if they are of a delusional nature. Response to treatment is often disappointing and drug adherence poor. 103 True. It is also associated with myalgia. 104 True. 105 True. Blood pressure monitoring is advisable, especially if there is preexisting hypertension. 106 True. It is an instrument with 16 items scored on a seven-point scale. 107 True. 108 True. 109 False. It usually involves younger children. 110 False. This is more likely to be dementia with Lewy bodies. 111
True. Co-administration of a tricyclic antidepressant and an MAOI can lead to a toxic reaction.
112 True. Repetitive transcranial magnetic stimulation reduced auditory hallucinations resistant to conventional treatment in a small study of schizophrenic and schizoaffective patients. Hoffman RE et al. Arch Gen Psychiatry 2003, 60:49–56.
152 Section 2 Paper 5
113 True. 114 True. Those with an IQ of 70 or above and who use communicative language by the age of 5 years have a better prognosis. 115 True. 116 True. It is a central nervous system stimulant used for attention deficit hyperactivity disorder. Dexamphetamine is also used. 117 False. They affect 5–10 per cent of children. 118 False. They disappear in sleep. 119 False. They fell out of general favour after meta-analyses showed they were no better than placebo in depression. They are also associated with significant side effects. 120 True. Bonaccorso S et al. J Affect Disord 2002, 72:237–41. 121 True. In 50 childhood-onset cases and 50 controls, affected individuals showed greater loss of cerebellar volume. 122 False. It is a dual inhibitor of acetylcholinesterase and buterylcholinesterase. 123 False. 124 False. It is 4–20 times more common in women (depending on which study). 125 False. Alzheimer’s has been shown by a number of studies to be commoner in urban areas. Baker FM et al. Int J Geriatr Psychiatry 1993, 8:379–85. 126 True. Diogenes syndrome has been considered by some to be the endstage of a personality disorder, manifesting itself in the form of senile reclusiveness. 127 True. It is a form of vascular dementia associated with reduced white matter density. 128 True. Others include marked language impairment and poor cognitive function.
ISIs: Answers 153
129 True. Formication is tactile hallucinations. 130 True. Clinical features of the Marchiafava-Bignami disease include ataxia, epilepsy, dysarthria and impaired consciousness. There is demyelination of the corpus callosum, optic tract and cerebellar peduncles. 131 False. Criteria for very late onset schizophrenia: > 60 years fantastic, persecutory, referential or grandiose delusions +/– hallucinations absence of primary affective disorder MMSE no less than 25/30 no clouding of consciousness no neurological illness or alcohol dependence. 132 False. They have longer half-lives as a function of reduced renal clearance and distribution. 133 True. Also called gamma-hydroxybutyrate, it is an endogenous fatty acid found in all cells; it potentiates cerebral dopaminergic systems. 134 True. 135 False. Peripheral neuropathy occurs in up to 80 per cent of cases. 136 False. This is confabulation and is a feature of Korsakoff’s syndrome. 137 True. According to the results of a small study suggesting that E-EPA may be efficacious for the treatment of moderately disturbed women with borderline personality disorder. Zanarini MC, Frankenburg FR. Am J Psychiatry 2003, 160:167–9. 138 True. Caution is needed in patients with sick sinus syndrome or conduction abnormalities, but it is not absolutely contraindicated. 139 False. It occurs in the elderly. Defining characteristics: well-formed visual hallucinations (vivid), preserved intellectual competence, clear consciousness, insight maintained. 140 False. Forty-five per cent of people in the team approach group had at least a 50 per cent reduction in symptoms of depression, compared with only 19 per cent in the standard care group. Unutzer J et al. JAMA 2002, 288:2836–45.
154 Section 2 Paper 5
141 True. Nalbuphine hydrochloride (Nubain) is an opioid used to increase the pain threshold or as an anti-anxiety drug. It can cause both dependence and psychiatric side effects. 142 True. The eight strongest independent predictors are: having a stepfather having lived without mother not being close to mother mother not finishing secondary school having a sex-punitive mother no physical affection from father low income family two or fewer friends in childhood. 143 True. Tyrer P et al. Br J Psychiatry 2003, 182(Suppl. 44):s1–35. 144 True. 145 True. 146 False. Cocaine is a central nervous system stimulant. 147 False. Post-hallucinogen perception disorder (‘flashbacks’) occurs with hallucinogenic drugs such as LSD and DMT (dimethyltryptamine). 148 True. Phencyclidine (PCP) is a hallucinogen with both depressant and stimulant effects. 149 True. A small study concluded that lamotrigine may be a good option for patients with epilepsy and concomitant mood disorders. Kalogjera-Sackellares D, Sackellares JC. Epilepsy Behav 2002, 3:510–16. 150 True. Divalproex sodium is a compound of sodium valproate and valproic acid. 151 True. Numberg HG et al. JAMA 2003, 289:56–64. 152 True. 153 True. 154 False. This is observer bias.
ISIs: Answers 155
155 True. Power is the probability of demonstrating a significant difference between groups when one exists. 156 True. 157 True. The Z statistic is the non-standardised normal deviate. 158 False. This is randomisation, the point being to eliminate the bias of influencing subject allocation. 159 True. A frequency distribution may be either positively or negatively skewed. 160 False. In a normal distribution, mode = median = mean. 161 True. It is primarily a measure of reliability. 162 False. Data on all randomised subjects are analysed within the groups to which they have been assigned whether or not they actually received the treatment to which they were allocated. 163 True. The likelihood ratio is the likelihood that a positive test result will be observed in a patient with, as opposed to a patient without, the disorder. 164 False. Bias is an example of a systematic error. 165 True.
156 Section 2 Paper 5
EMIs: Answers 1 1
G
An inherited neuromuscular disorder with increased CAG repeats and associated with psychiatric disturbances.
2
D
Symptoms are exacerbated by heat.
3
J
4
K
This is tuberous sclerosis.
1
D
Four per cent prevalence in the Isle of Wight study; boys:girls 3:1.
2
D
3
C
4
G
5–6 years (starting school), 11–12 (secondary school) and early teens.
5
F
Up to 90 per cent improve within 5 years.
1
A
This is tuberous sclerosis, affecting 1 in 6000 births. Skin lesions include ash-leaf macules, fibrous forehead plaques, adenoma sebaceum and periungual fibromata.
2
F
This is characteristic of type I neurofibromatosis, a neurocutaneous syndrome (Von Recklinghausen). Complications include malignant skin lesions, spinal tumours, gastrointestinal neurofibromas and epilepsy.
3
B
This is type II neurofibromatosis. It is rare in children, with minimal skin signs. It is associated with acoustic neuromas, cranial meningiomas and spinal tumours.
2
3
EMIs: Answers 157
4 1
A
2
B
3
C
4
A
5
D
6
B
In clinical practice we consult the formulary, but an idea of peak plasma concentration is important in terms of clinical response and adverse effects.
5 1
A
2
C
3
D
4
I
5
B
6
F
6 1
C
2
D
Also called the Kruskal–Wallis ANOVA.
3
G
A correlation coefficient is a summarising value describing a relationship between variables.
4
F
158 Section 2 Paper 3
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ISIs: Questions 159
paper 6
160 Section 2 Paper 6
INDIVIDUAL STATEMENTS 1
An independent variable (in addition to the one under examination) that has a systematic influence on the dependent variable is called an attributer.
T
F
2
The null hypothesis is a prediction that there is no relationship between the independent and dependent variables.
T
F
3
A type I error is the error of rejecting the null hypothesis when it is true.
T
F
4
To reduce the chance of a type I error one chooses a lower value of p (probability).
T
F
5
χ2 test is a significance test which has the effect of comparing two or more independent proportions.
T
F
6
The power of a study is determined by dividing the standard deviation by the clinically significant difference and then crossreferencing this ratio with a table of power for a given number of subjects.
T
F
7
The number needed to treat is 1 × absolute risk reduction.
T
F
8
The positive predictive value of a test is the proportion of subjects with positive test results who actually have the disease.
T
F
9
Asymmetrical funnel plots indicate either publication bias or exaggeration of treatment effects in small studies of low quality.
T
F
10
Failure to reject a false null hypothesis is called a type II error.
T
F
11
A trial is ‘double blind’ if neither the subject nor the investigator knows the outcome.
T
F
12
Validity refers to the extent to which a measure really does measure what it sets out to measure.
T
F
13
Construct validity assesses the extent to which a new measure can predict future variables.
T
F
14
The variation of individual studies according to the participant characteristics, study design and conduct of the study is termed heterogeneity.
T
F
Individual Statements 161
15
The odds ratio closely approximates to the risk ratio in a cohort study.
T
F
16
In epidemiological studies, four possible explanations for an association exist.
T
F
17
Cohort studies are prone to selection bias arising from incomplete follow-up and confounding.
T
F
18
Power is the probability that a type II error will not be made.
T
F
19
Inadequate sample size is indicated by the relatively large width of the corresponding confidence interval.
T
F
20
The p value on its own implies a great deal about the magnitude of any difference between treatments.
T
F
21
Psychostimulants have been used since the 1930s to attenuate hyperactivity and improve cognitive performance.
T
F
22
Kanner first described autism in a series of papers in the early nineteenth century.
T
F
23
Seventeen per cent of 5 year olds have functional (non-organic) enuresis.
T
F
24
An IQ range of 20–34 represents a profound learning disability.
T
F
25
A flattened occiput is characteristic of Down’s syndrome.
T
F
26
In Down’s syndrome, the feet have a wide gap between the first and second toes and a plantar furrow extending posteriorly.
T
F
27
Regular attempts to defecate plus laxatives are usually successful in the management of encopresis.
T
F
28
A crime requires both an actus rea and mens rea.
T
F
29
Not guilty of a criminal act by reason of insanity would require fulfilment of the McManus Rules (1815).
T
F
30
Infanticide is when a parent causes the death of their child under 12 months of age.
T
F
31
Fitness to plead is dependent upon the fulfilment of the Pritchard Criteria.
T
F
32
Of those children diagnosed with autism, 20 per cent have medical conditions known to be associated with autism.
T
F
162 Section 2 Paper 6
33
Rett’s syndrome occurs in 90 per cent of girls.
T
F
34
MRI may have a role in the diagnosis of psychosis before the expression of frank psychotic symptoms.
T
F
35
Adults with attention deficit hyperactivity disorder can be differentiated from healthy individuals using EEG measures.
T
F
36
The five-axis classification of the International Classification of Diseases was developed to provide a thorough and complete description of a patient’s psychiatric illness, medical problems and overall functioning.
T
F
37
Task-focused attention leads to more social anxiety in blushing anxious, socially anxious and social phobic individuals.
T
F
38
Inositol depletion has been implicated in the mechanism of action of lithium, carbamazepine and valproate.
T
F
39
Late-life depression has a greater negative outcome for men than for women.
T
F
40
Sildenafil citrate is used in male sexual dysfunction.
T
F
41
Cerebrospinal levels of tau protein and β-amyloid 42 are putative biomarkers to predict dementia outcome.
T
F
42
The majority of patients with multiple sclerosis have comorbid depression.
T
F
43
Nefazodone has been useful in pathological gambling.
T
F
44
Mothers under the age of 35 who have children with Down’s syndrome are at increased risk of Alzheimer’s disease.
T
F
45
Gait abnormalities are associated with an increased risk of vascular dementia.
T
F
46
Melatonin is produced by the pineal gland.
T
F
47
Children under 16 years of age do not have the capacity to consent to an intervention.
T
F
48
In Huntington’s chorea, disease onset is usually in the 50s.
T
F
49
In Huntington’s disease, there is bilateral wasting of caudate and putamen nuclei with generalised fronto-temporal wasting.
T
F
Individual Statements 163
50
Lamotrigine-induced arrhythmias are minimised by gradual dose titration.
T
F
51
Hypometabolism in the caudate nuclei has been demonstrated in women with somatisation disorder.
T
F
52
Restlessness is a side effect of Hypericum perforatum.
T
F
53
Lower levels of serotonin alpha-2 (5HT2a) receptors in the prefrontal cortex and hippocampus have been linked to suicidal behaviour.
T
F
54
There is an association between neurological soft signs in childhood and adult psychosis.
T
F
55
Low interleukin-6 levels are associated with major depression in cancer patients.
T
F
56
An increase in acute psychiatric presentations was noted during the transition into the new millennium.
T
F
57
The selective serotonin re-uptake inhibitors aggravate the motor symptoms of depressed people with Parkinson’s disease.
T
F
58
Outpatients with post-traumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD) have a more severe clinical profile than outpatients with PTSD or BPD alone.
T
F
59
Donepezil reduces REM latency in depressed patients.
T
F
60
Adolescent depression is more common among girls than boys.
T
F
61
Transdermal selegiline shows benefits for major depression.
T
F
62
Hydroxyzine is ineffective in generalised anxiety disorder.
T
F
63
Lithium uncouples GTP-binding protein from stimulation of adenylate cyclase and/or phospholipase-c.
T
F
64
Meta-analyses show that psychological treatments produce effect sizes of 0.8–1.0.
T
F
65
Galantamine was originally derived from the tulip.
T
F
66
Lesions in the floor of the fourth ventricle are found in Wernicke’s encephalopathy.
T
F
67
Supratentorial hypertrophy is seen in Korsakoff’s state.
T
F
164 Section 2 Paper 6
68
Olanzapine is safe in the elderly patient with dementia.
T
F
69
Thioridazine increases the QT interval.
T
F
70
Amiodarone increases the QT interval.
T
F
71
Tricyclic antidepressants increase the QT interval.
T
F
72
Hypocalcaemia reduces the QT interval.
T
F
73
Quinidine increases the QT interval.
T
F
74
Cholesterol can be raised in anorexia nervosa.
T
F
75
Selective serotonin re-uptake inhibitors should be used with caution in patients over 80 years of age.
T
F
76
The suicide rate in prisoners is greatest immediately following reception into prison.
T
F
77
Tricyclic antidepressants cause fetal malformation if taken in pregnancy.
T
F
78
Piracetam is used as an adjunctive treatment for cortical myoclonus.
T
F
79
Being able to ‘follow the evidence’ is a requirement for fulfilment of the Pritchard criteria.
T
F
80
Trihexyphenidyl reduces the symptoms of Parkinsonism induced by antipsychotic drugs.
T
F
81
Grapefruit juice increases plasma concentrations of buspirone.
T
F
82
Aripiprazole was withdrawn in the 1960s because of an association with neutropenia and agranulocytosis.
T
F
83
Clozapine is reserved for treatment-resistant schizophrenia because of the cost implications.
T
F
84
The majority of psychiatric drugs are metabolised by cytochrome P450.
T
F
85
Schizophrenia is associated with cognitive impairment.
T
F
86
Agranulocytosis occurs in 2 per cent of patients in the first year of treatment with clozapine.
T
F
87
Treatment response rates to clozapine in patients having failed to respond to therapeutic trials of two antipsychotics (at least one being atypical) are 70–80 per cent.
T
F
Individual Statements 165
88
Zotepine is one of only three atypical neuroleptics to lower the seizure threshold.
T
F
89
Breast-feeding whilst taking clozapine is acceptable if it is taken at the lowest therapeutic levels possible.
T
F
90
Aripiprazole causes clinically significant prolactin elevation when taken at therapeutic levels.
T
F
91
Risperidone is associated with increased risk of stroke in the elderly with dementia.
T
F
92
Attention-deficit hyperactivity disorder does not appear in ICD-10.
T
F
93
Studies show that attention deficit hyperactivity disorder in childhood is highly heritable.
T
F
94
Psychiatric comorbidity is almost 80 per cent in children with attention deficit hyperactivity disorder.
T
F
T
F
95
‘Advance statements’ are legally binding with regard to future healthcare choices should a serious illness develop which causes the individual to lose capacity or the ability to make their wishes known.
T
F
96
An elevated risk of suicide has been reported in association with migraine.
T
F
97
In people with psychosis, there is a marked excess of victimising experiences.
T
F
98
Individuals with schizotypal personality disorder use mental health services extensively.
T
F
99
Traditionally, an ECT-induced seizure should last 15 seconds on the EEG tracing to be therapeutic.
T
F
100
Up to 1 in 10 transpeople have a mental illness.
T
F
101
Motivational interviewing principles include confrontation rather than empathy.
T
F
102
Catatonic symptoms occur in autistic spectrum disorders.
T
F
103
Antidepressant monotherapy in bipolar depression is associated with worsening of symptoms.
T
F
104
Rapid cycling bipolar disorder describes six or more episodes of depression, mania, mixed state or hypomania in the preceding year.
T
F
T
F
166 Section 2 Paper 6
105
Dialectical therapy was originally developed as a training manual for treating dissocial personality disorder.
T
F
106
Selective serotonin re-uptake inhibitors are known to cause arthralgia.
T
F
107
Tramadol enhances serotonergic and adrenergic pathways.
T
F
108
The risk of fatal agranulocytosis with clozapine treatment is 1 in 5000.
T
F
109
Vitamin E is a useful adjunctive treatment in Alzheimer’s disease.
T
F
110
Ten per cent of bipolar patients develop the illness after the age of 50.
T
F
111
Depression is likely to be a symptom of cognitive decline rather than an independent risk factor.
T
F
112
The elderly have the second highest risk of completed suicide when compared to other age groups.
T
F
113
The lifetime risk to an individual of developing a bipolar disorder is approximately 5 per cent if they have no affected relatives.
T
F
114
ECT treatment causes a rise in prolactin levels.
T
F
115
Depersonalisation disorder has an equal sex distribution.
T
F
116
Child-onset dysthymic disorder has a better outcome than major depression.
T
F
117
Adults seem to be more sensitive than children to the effects of trauma.
T
F
118
Lithium use in pregnancy is associated with fetal hypoglycaemia.
T
F
119
In neurosyphilis, the Argyll Robertson pupil is only seen in 15 per cent of cases.
T
F
120
Symptoms of heroin withdrawal usually start 24 hours after the last drug dose.
T
F
121
Lofexidine is a synthetic long-acting opiate used in opiate withdrawal.
T
F
122
Selective serotonin re-uptake inhibitors are a cause of premature ejaculation.
T
F
Individual Statements 167
123
The stop–start technique is used for male premature ejaculation.
T
F
124
Abreaction is the emotional release or discharge after recalling a painful experience.
T
F
125
Pseudologia phantastica is a delusional belief that someone is deeply in love with you.
T
F
126
Amphetamine withdrawal is usually associated with mixed mood features.
T
F
127
Ecstasy is not associated with long-term brain damage.
T
F
128
Ultradian rapid cycling bipolar disorder relates to abrupt shifts in mood within a 72-hour period.
T
F
129
There is an association between ultra-rapid cycling bipolar disorder and 22q11.2 deletion syndrome.
T
F
130
Low body weight is a risk factor for antidepressant-induced hyponatraemia.
T
F
131
Social phobia has a lifetime prevalence of 1 per cent.
T
F
132
Memantine given together with an acetylcholinesterase inhibitor may benefit some patients with Alzheimer’s dementia.
T
F
133
Psychological debriefing is the gold standard therapy in postdisaster counselling.
T
F
134
Central dopaminergic neurones reside mainly in the mesencephalon in three neuronal groups: the retrobulbar area, the substantia nigra and the ventral tegmental area.
T
F
135
Electra complex involves sexual feelings towards the mother whilst feeling hostility towards the father.
T
F
136
Methanol consumption is associated with 20 per cent mortality.
T
F
137
Patients with general paresis of the insane commonly present with grandiosity.
T
F
138
There is an over-representation of people with epilepsy in the prison population.
T
F
139
Unemployment is a risk factor for completed suicide in men.
T
F
140
The production of melatonin increases with age.
T
F
168 Section 2 Paper 6
141
Chlorpromazine is a more potent antipsychotic than haloperidol.
T
F
142
Reboxetine is associated with weight gain.
T
F
143
Two per cent of patients with complex partial epilepsy have psychotic symptoms.
T
F
144
Catalepsy is a common feature of the narcolepsy syndrome.
T
F
145
Primary gain is achieved in conversion disorders.
T
F
146
Victim empathy is a widely used component of sex offender treatment.
T
F
147
Psilocybin is associated with hallucinogenic properties.
T
F
148
Self-mutilation occurs most commonly in the context of depression.
T
F
149
Seasonal affective disorder is associated with weight loss, reduced appetite and insomnia.
T
F
150
Light therapy for winter depression is most effective in the early morning.
T
F
151
Tryptophan depletion has been used to investigate depression.
T
F
152
ECT has been shown to be effective in childhood depression.
T
F
153
Cluttering is a disorder of speech usually occurring in childhood or adolescence.
T
F
154
Typically, in childhood selective mutism the child talks freely to his or her parents.
T
F
155
In sibling rivalry disorder, the older child can lose previously acquired skills.
T
F
156
ECT can precipitate epilepsy.
T
F
157
Childhood perfectionism is a risk factor for developing an eating disorder.
T
F
158
The brain-derived neurotrophic factor (BDNF) gene is thought to be a susceptibility gene for anorexia nervosa.
T
F
159
The theory of kindling relates to eating disorders.
T
F
160
The commonest symptom pattern in obsessive–compulsive disorder relates to pathological doubt.
T
F
Individual Statements 169
161
Glutamate release is stimulated by nicotine.
T
F
162
Anger is recognised as the first phase in the psychological adjustment to dying.
T
F
163
Lycanthropy is the delusion of being a wolf.
T
F
164
Alexithymia is the inability to interpret the emotions of others.
T
F
165
Lithium causes thyroid enlargement in 5 per cent of patients.
T
F
170 Section 2 Paper 6
EMIs 1 A B C D E
Prolactin Somatostatin Calcitonin Angiotensin Oxytocin
F G H I J
Parathormone Cortisol Thyrotropin releasing factor Substance P Neurotensin
Which of the above relates most closely to each of the statements below? 1
This is an adenohypophyseal hormone.
2
In the striatonigral pathway, this substance is thought to act as a neurotransmitter involved in pain perception.
3
Release is increased by nipple stimulation.
EMIs 171
2 A B C D E
Redistribution Zero-order kinetics Half-life Bioavailability Steady state
F G H I J
Volume of distribution Therapeutic index Plasma index Acetylation Conjugation
Which term is being described in each of the following? 1
The fraction of administered drug reaching the systemic circulation without having been metabolised.
2
Is represented by the equation: mass of drug in the body at a given time/plasma concentration of the drug at a given time.
3
A process in which the rate of drug elimination is constant.
172 Section 2 Paper 6
3 A B C D E
Exhibitionism Fetishism Transsexualism Transvestic fetishism Sexual masochism
F G H I J
Frotteurism Paedophilia Voyeurism Hypersexuality Sexual sadism
Each description below relates to a diagnosis above. 1
Arousal by non-living objects, usually items of clothing or garments. These are often held, rubbed or smelt.
2
Sexual arousal by touching or rubbing against a non-consenting individual.
3
Sexual arousal from being hurt, humiliated, threatened or made to suffer in some way.
EMIs 173
4 A B C D E
Pseudodementia Vascular dementia Alzheimer’s dementia Dementia in Parkinson’s disease Alcohol-related dementia
F G H I J
Lead intoxication Lewy body dementia Huntington’s dementia Pick’s disease Creutzfeldt–Jacob disease
In each of the following cases, which of the above is the most likely diagnosis? 1
A short history of rapidly progressive cognitive decline. Making little effort on cognitive testing, with an inconsistent performance.
2
Post-mortem examination has revealed intracytoplasmic neurofibrillary tangles, extracellular senile plaques, granulovacuolar degeneration and amyloid deposition in blood vessel walls.
3
A 54-year-old man has become increasingly disinhibited and lacking in judgement. His wife complains that he is increasingly apathetic and inappropriately jocular. He has reasonable memory.
4
A 73-year-old woman with a mini-mental score of 23/30. She has a resting tremor and showed marked sensitivity when given neuroleptic medication for visual hallucinations.
5
An EEG tracing shows asymmetry, localised slow waves and sparing of background activity.
174 Section 2 Paper 6
5 A B C D E
Alzheimer’s disease Dementia with Lewy bodies Pick’s disease Vascular dementia Dementia in Parkinson’s disease
F G H I J
Huntington’s disease Creutzfeldt–Jacob disease Punch drunk syndrome Paralysis agitans Wilson’s disease
Which of the above disorders relates to each of the descriptions below? 1
Knife blade gyri are characteristic.
2
An association with REM sleep behaviour disorder has only recently been described.
3
Perforation of the septum pallucidum is a macroscopic feature.
4
It is characterised by selective loss of discrete neuronal populations with progressive degeneration of efferent neurones of the neostriatum, with sparing of dopamine afferents.
EMIs 175
6 A B C D E
Kraeplin 1894 Bleuler 1911 Mayer 1921 Roth and Morrisey 1952 Fish 1960
F G H I J
Post 1966 Grahame 1984 Murray-Parks 1988 Kendell 1976 Paykel 1971
Match each of the following to its rightful owner. 1
Separated four groups of depressives using cluster analysis.
2
Suggested that late paraphrenia is just schizophrenia in old age.
3
Described ‘persistent persecutory states’ – schizophrenic syndrome, schizophreniform syndrome and paranoid hallucinosis.
4
Dementia praecox, a disorder of emotion and volition.
5
Depression represents a continuum with varying degrees of melancholic and neurotic symptoms.
176 Section 2 Paper 6
INDIVIDUAL STATEMENTS: Answers 1
False. This is the definition of a confounder.
2
True.
3
True.
4
True. For example 0.001, a more stringent criterion for rejecting the null hypothesis.
5
True. But the mathematics involves raw data, not proportions.
6
False. It is the other way round: clinically significant difference/standard deviation.
7
False. 1/absolute risk reduction.
8
True.
9
True. Sterne JA et al. BMJ 2001, 323:101–5.
10
True. In other words, missing a true association.
11
False. A trial is double blind if neither subject nor investigator knows the treatment condition to which the subject has been randomised.
12
True.
13
False. This description is for predictive validity. Construct validity is the extent to which the construct that the measure looks to address is a real and coherent entity.
14
True.
15
True.
16
False. Five possible explanations exist: (1) reverse causality, (2) bias, (3) confounding, (4) chance, (5) causality.
17
True. In addition they are very time consuming, expensive and are generally unsuitable for the study of rare outcomes.
ISIs: Answers 177
18
True. In general the larger the study, the greater its power – or the greater the power desired, the larger the study must be.
19
True.
20
False.
21
True. Bradley H. Am J Psychiatry 1937, 94:577–85.
22
True. Kanner’s original paper describes 11 children seen over the course of 5 years who struck him as sharing fascinating peculiarities, including delayed echolalia, pronoun reversal, failure to use speech to communicate, an anxious desire to preserve sameness and repetitious behaviours.
23
False. It is present in 10 per cent of 5 year olds, 5 per cent of 10 year olds and 1 per cent of 15 year olds.
24
False. Mild learning disability 50–70, moderate 35–49, severe 20–34, and profound < 20.
25
True. Microcephaly, brachycephaly and flattened occiput are characteristic.
26
True. Other features are short fingers and clinodactyly (incurvature) of the fifth finger, which often only has two phalanges.
27
True. An additional technique is retraining the child with behavioural techniques, e.g. star charts. Washouts and manual evacuation are rarely needed.
28
True. Actus rea (guilty act), mens rea (guilty mind).
29
False. The McNaughten Rules (1843) require that ‘at the time of committing the act, the party accused was labouring under such a defect of reason, from the disease of the mind, as not to know that what he was doing was wrong’.
30
False. Infanticide is the death of a child before 12 months of age caused by the mother through ‘disturbed balance of her mind’, having not fully recovered from the effect of lactation consequent upon the birth of the child (Section 1(1) Infanticide Act 1938).
31
True. The Pritchard Criteria: the defendant can understand the charge, instruct a lawyer, challenge a juror, plead to the charge and follow the evidence.
178 Section 2 Paper 6
32
False. The figure is 10 per cent. For example conditions such as fragile X syndrome or tuberous sclerosis.
33
False. Rett’s syndrome only occurs in girls. Features include regression and deceleration of head growth, handwashing stereotypies, episodic hyperventilation, unprovoked laughter and worsening mobility.
34
True. Patients who developed psychosis showed a reduction in grey matter in the left parahippocampal, fusiform, orbitofrontal and cerebellar cortices. Pantelis C et al. Lancet 2003, 361(9354):281–8.
35
True. A number of studies have shown this. One showed that adults with attention deficit hyperactivity disorder (ADHD) could be distinguished from healthy and non-ADHD individuals based on elevated theta activities, more total power and a higher theta:beta ratio. The researchers compared quantitative EEGs from 50 ADHD patients, 50 non-ADHD and 50 healthy participants. Bresnehan S, Barry R. Psychiatry Res 2002, 112(2):133–44.
36
False. This refers to the axis system employed by the Diagnostic and Statistical Manual (DSM).
37
False. Self-focused attention leads to increased state social anxiety, and task-focused attention reduces state social anxiety.
38
True. Inositol depletion has been implicated in the mechanism of action of these drugs and provides clues to the molecular basis of bipolar affective disorder. Williams RS et al. Nature 2002, 417:292–5.
39
True. Depression was associated with mortality for men but not for women in a study of 1947 men and women aged 70+. Depression may be an early sign of impending physical decline, or it may incur a physiological response that predisposes to cardiovascular disease or cancer. Anstey KJ, Luszcz MA. Psychosom Med 2002, 64:880–8.
40
True. Sildenafil citrate is Viagra.
41
True. Although at an early stage of research, tau levels were significantly higher in patients who progressed to probable Alzheimer’s disease or progressive mild cognitive impairment. Riemenschneider M et al. Arch Neurol 2002, 59:1729–34.
ISIs: Answers 179
42
False. In one study, 32 per cent had a diagnosis of depression and 42 per cent had depressive symptoms. Chwastiak L et al. Am J Psychiatry 2002, 159:1862–8.
43
True. Pallanti S et al. J Clin Psychiatry 2002, 63:1034–9.
44
True. Mothers who were under 35 years of age when their children with Down’s syndrome were born were four to five times more likely to develop Alzheimer’s disease than control mothers. Schupf N et al. Neurology 2001, 57:979–84.
45
True. In a study of 422 people, those who originally had an unsteady gait were twice as likely to develop vascular dementia, while those with frontal gait had a more than fourfold increased risk. The highest risk was associated with hemiparetic gait: affected people were 13 times more likely to develop this type of dementia. Verghese J et al. N Engl J Med 2002, 347:1761–8.
46
True.
47
False. Following the Gillick case, the courts have held that children with sufficient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention will also have the capacity to consent to that intervention. Sometimes referred to as ‘Gillick competent’, a child under 16 may therefore have capacity to consent to some interventions but not to others.
48
False. It is usually in the 30s to 40s. Chromosome 4. Mutation of trinucleotide repeats (CAG). Normally there are 11–24 repeats, whereas in Huntington’s disease there are 42–86 repeats.
49
True. Psychiatric manifestations include reactive affective disorders and personality disturbance including psychosis.
50
False. Lamotrigine is associated with potentially severe skin rashes which are minimised by gradual dose titration. It is used as adjunctive therapy, and may benefit rapid cyclers and bipolar depressed.
51
True. This was the first study showing changes in brain metabolism in chronically somatising women. It was a small study comparing only 10 cases with 17 controls. Hakala M et al. Psychol Med 2002, 32:1379–85.
180 Section 2 Paper 6
52
True. Also nausea, fatigue, restlessness, rash and photosensitivity. It is also called St John’s wort. It can be purchased over the counter and is widely used as an antidepressant in Germany.
53
False. 5HT2a receptor expression was more abundant in the prefrontal cortex and hippocampus of adolescent suicide victims than in control subjects. However, this was a small study (15 suicide victims and 15 controls). Ghanshyam N et al. Am J Psychiatry 2002, 159:419–23.
54
True. There is a significant association with adult schizophrenia (p = 0.042) and it is modestly associated with affective psychosis. Leask SJ et al. Br J Psychiatry 2002, 181:387–92.
55
False. The association is with higher levels. Interleukin 6 is a proinflammatory cytokine with the capacity to induce a syndrome of ‘sickness behaviour’ sharing many of the features of depression, including anhedonia, fatigue, anorexia, reduced activity and altered sleep patterns. Dominique L et al. Am J Psychiatry 2001, 158:1252–7.
56
False. A multicentre international study showed no millennium effect. Sauer J et al. Int J Soc Psychiatry 2002, 48(2):122–5.
57
False. An open label study using paroxetine in depressed patients with Parkinson’s disease did not appear to modify motor function. Ceravolo R et al. Neurology 2000, 55:1216–18.
58
False. In a study of 101 patients with borderline personality disorder, 121 with post-traumatic stress disorder and 48 with both, having both did little to exacerbate existing pathology or dysfunction. Zlotnick et al. Am J Psychiatry 2002, 159:1940–3.
59
True. However, donepezil was not shown to increase REM time or reduce slow-wave sleep. Perlis ML et al. Biol Psychiatry 2002, 51:457–62.
60
True. Twenge JM, Nolen-Hoeksema S. J Abnorm Psychol 2002, 111:578–88.
61
True. A small study showed a 46 per cent greater improvement compared to placebo. Selegiline is a monoamine-oxidase B inhibitor used in severe Parkinsonism in conjunction with levodopa to reduce ‘end of dose’ deterioration. Bodkin JA, Amsterdam JD. Am J Psychiatry 2002, 159:1869–75.
ISIs: Answers 181
62
False. Hydroxyzine is a sedating antihistamine. It has anti-anxiety properties and has been shown to be an alternative to benzodiazepines in some studies. Llorca PM et al. J Clin Psychiatry 2002, 63:1020–7.
63
True.
64
True. These are equivalent to antidepressant effects.
65
False. It was derived from the daffodil.
66
True.
67
False. Supratentorial atrophy is seen.
68
False. There is an increased risk of mortality and stroke in elderly patients with dementia-related psychosis and/or behaviour disturbances. (Lily drug information leaflet 2nd March 2004.)
69
True.
70
True.
71
True.
72
False. It increases the QT interval.
73
True. An anti-arrhythmic, it may precipitate arrhythmias itself.
74
True.
75
True. They should also be used with caution in those with a history of upper gastrointestinal bleeding, those taking aspirin or another nonsteroidal. Selective serotonin re-uptake inhibitors may interfere with clotting by inhibiting storage and the uptake of serotonin by platelets. Drug Ther Bull 2004, 42(3):17–18.
76
True. Shaw J et al. Br J Psychiatry 2004, 184:183–6.
77
False. Reported perinatal complications include withdrawal symptoms, irritability, eating and sleeping difficulties and convulsions. McElhalton PR et al. Reprod Toxicol 1996, 10:285–94.
78
True.
182 Section 2 Paper 6
79
True. The criteria relate to fitness to plead.
80
True. This is benzhexol.
81
True. British National Formulary, 47th edn. Appendix 1: Interactions, anxiolytics and hypnotics. Buspirone used for anxiety (short term).
82
False. Clozapine was withdrawn in the 1960s following cases of neutropenia and agranulocytosis. Aripiprazole has recently gained a licence in the UK as an atypical neuroleptic. It is described as a dopamine stabiliser. Aripiprazole is an antipsychotic drug with high affinity for D(2) and D(3) receptors and the dopamine autoreceptor. It also has serotonin 5HT1a receptor partial agonist and 5HT2a receptor antagonist properties.
83
False. Because of adverse reactions. Kilian JG et al. Lancet 1999, 354:1641–5.
84
True. Cozza K, Armstrong S. The Cytochrome P450 System. Drug Interaction Principles for Medical Practice. Washington, DC, American Psychiatric Publishing, 2001.
85
True. Schizophrenia is associated with psychotic symptoms (hallucinations, delusions, passivity experience), disorganisation symptoms (incongruous mood, abnormalities of speech and thought), negative symptoms (apathy, self-neglect, blunted mood, loss of motivation) and cognitive impairment. Mueser KT, McGurk SR. Lancet 2004, 363:2063–72.
86
False. It occurs in 0.7–0.8 per cent of patients. Drug Ther Bull 1997, 35:81–3.
87
False. Treatment response rates are 29–65 per cent. Taylor D, Duncan-McConnell D. J Psychopharmacol 2000, 14:409–18.
88
False. They all do.
89
False. It is absolutely contraindicated in breast-feeding due to the risk of agranulocytosis in the infant.
90
False. It is thought to have little effect on prolactin at therapeutic levels.
91
True. Also olanzapine. Duff G. CEM/CMO/2004/1. Committee on Safety of Medicines, 2004.
ISIs: Answers 183
92
True. Attention deficit hyperactivity disorder first appeared in DSM-III-R (American Psychiatric Association). ICD-10 includes hyperkinetic disorder.
93
True. It has a heritability of 0.8. Taylor E et al. Eur Child Adolesc Psychiatry 1998, 7:184–200.
94
False. It is around 60 per cent. Green M et al. Diagnosis and Treatment of ADHD in Children and Adolescents. Technical Review, Number 3. Agency for Healthcare Policy and Research. AHCPR Publication Number 99-0050. Rockville, MD, American Medical Association, 1999.
95
False. ‘Advance statements’ are not legally binding, but should be honoured where possible. ‘Advance directives’ are legally binding if criteria for capacity and applicability are met at the time of completion. Williams L, Rigby J. Adv Psychiatr Treat 2004, 10(4):260–6.
96
True. Breslau N et al. Psychiatry Res 1991, 37:11–23.
97
True. Bebbington P et al. Br J Psychiatry 2004, 185:220–6.
98
True. Borderline and schizotypal personality disorders are associated with placing higher demands on mental healthcare services. Bender DS et al. Am J Psychiatry 2001, 158:295–302.
99
False. 25 seconds on EEG, 15 seconds peripherally.
100 True. One in ten have problems with mental illness, genital mutilation or suicide attempts. People who identify themselves with transsexualism are recognised as transpeople. Wylie K. BMJ 2004, 329:615–17. 101 False. The principles are: empathy using reflective listening develop discrepancy between deeply held values and existing behaviour avoid resistance by empathising and understanding rather than confrontation build the person’s confidence that change is possible. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change, 2nd edn. Portland, OR, Book News Inc., 2002. 102 True. They can occur in autistic spectrum disorders, with a similar presentation to the catatonia associated with schizophrenia. Wing L, Shah A. Br J Psychiatry 2000, 176:357–62.
184 Section 2 Paper 6
103 True. Antidepressant monotherapy can be associated with worsening of symptoms in bipolar disorder, including rapid cycling. 104 False. It describes four or more episodes. 105 False. Dialectical therapy was designed originally by M. Linehan for the treatment of borderline personality disorder. The therapist is supportive and directive. 106 True. Selective serotonin re-uptake inhibitors can cause arthralgia and myalgia as side effects. 107 True. It produces analgesia through this mechanism and also through its opioid effect. Psychiatric reactions have been reported with tramadol. 108 True. This is the main reason that clozapine-treated patients are monitored in the UK by the Clozaril Patient Monitoring Service. Other risks include pulmonary embolus, myocarditis and cardiomyopathy. 109 False. A recent Cochrane Review concludes that there is insufficient evidence to recommend vitamin E in Alzheimer’s disease. Tabet N et al. 2003, Cochrane Database Syst Rev 2000; (4):CD002854. 110 True. Sajatovic M. Int J Geriatr Psychiatry 2002, 17:865–73. 111
True. In a study of 500 elderly people in the Netherlands, impairment of attention/memory in old age preceded the development of depressive symptoms. Vinkers DJ et al. BMJ 2004, 329:881–3.
112 False. They have the highest risk, but lower absolute prevalence rates. WHO 2002 <www.who.int/mental_health/prevention/suicide> (accessed 1st September 2004). 113 False. The lifetime risk is approximately 1 per cent; 5–10 per cent with an affected first-degree relative; 45–75 per cent for a monozygotic twin. 114 True. It causes a transient rise as with epileptic seizures. Other causes include medication (risperidone, amisulpride, zotepine). Medical causes include pituitary disease (prolactinomas), chronic renal failure, hypothyroidism, sarcoid. Physiological causes include pregnancy, breast-feeding and stress.
ISIs: Answers 185
115 True. Depersonalisation disorder is characterised by prominent depersonalisation and often derealisation, without clinically notable memory or identity disturbances. Simeon D. CNS Drugs 2004, 18:343–54. 116 False. Childhood-onset dysthymic disorder has the worse outcome. It is characterised by a persistent and long-term depressed or irritable mood and is often associated with multiple problems and comorbidity. Nobile M et al. CNS Drugs 2003, 17:927–46. 117 False. Early life exposure may lead to multiple psychiatric disorders in adulthood. Donnelly CL. Child Adolesc Psychiatr Clin N Am 2003, 12(2):251–69. 118 True. Others reported include Ebstein’s anomaly, poor respiratory effort, rhythm disturbances, nephrogenic diabetes insipidus, thyroid dysfunction, hypotonia and lethargy, hyperbilirubinaemia and large for gestational age infants. 119 False. It is seen in more than 50 per cent of cases. Depression is a common presenting feature. Treatment is with penicillin and steroids. 120 False. They usually start within 12 hours of the last dose, peaking within 72 hours, and can last up to 1 week. 121 False. Lofexidine is a centrally acting alpha-2 agonist used in reducing withdrawal symptoms. 122 False. They cause delayed ejaculation. 123 True. It is a behavioural treatment described by Semans. Semans JH. South Med J 1956, 49:3–8. 124 True. 125 False. The definition described relates to erotomania (de Cleramboult’s syndrome). Pseudologia phantastica is a type of lying or story telling in which the individual believes the fantasies he tells others and acts on them. It is associated with Munchausen’s syndrome. 126 False. Generally, intoxication is associated with manic features and withdrawal with depressive mood. 127 False. Ecstasy may cause long-term brain damage. Mathins R. NIDA Notes 1996, 11(5):7.
186 Section 2 Paper 6
128 False. Ultradian rapid cycling (ultra ultra rapid cycling) relates to mood shifts of ≤ 24 hours’ duration. Ultra rapid cycling relates to cycling of mood within the course of several days to weeks. Rapid cycling bipolar disorder demands four or more mood episodes in the previous 12 months. (Rapid-Cycling Specifier DSM-IV.) 129 True. Velocardio-facial syndrome/DiGeorge syndrome associated with catechol-O-methyltransferase (COMT) deletion. 130 True. Others include old age, poor renal function, medical comorbidity and other medications (e.g. carbamazepine). Seek medical advice if the sodium falls below 125 mmol/L and consider withdrawing the antidepressant. 131 False. The lifetime prevalence is 3–13 per cent. Diagnostic and Statistical Manual. Washington, DC, American Psychiatric Association, 2000. 132 True. Whilst further studies are needed, recent research indicates that this might be true. A randomised controlled trial by Tarriot et al. showed significant improvement in physical and mental health in people with severe–moderate Alzheimer’s disease when taking both memantine and donepezil. Tarriot P et al. JAMA 2004, 291:317–24. 133 False. Research has suggested both benefits and potential harmful effects from debriefing. It uses methods including abreaction, psychoeducation and cognitive restructuring in order to decrease arousal. 134 True. Retrobulbar area: regulation of hormone secretion from the pituitary. Substantia nigra: initiation and movement execution. Ventral tegmental area: limbic and limbic-connected areas involved in motivation, mood and organisation of thought. 135 False. The description is of the Oedipus complex. The Electra complex involves a female infant with sexual feelings towards the father whilst feeling hostility towards the mother. 136 True. Toxicity occurs through its metabolites, formaldehyde and formate. Treatment is with an ethanol infusion; 10 mL of methanol can cause blindness and 30 mL can be fatal. 137 False. They are more likely to present with psychosis, depression or dementia. General paresis of the insane affects around 50 per cent of people with neurosyphilis.
ISIs: Answers 187
138 True. The reasons for this are not entirely clear; it is perhaps due to a degree of brain damage. 139 True. Pritchard C. Soc Psychiatry Psychiatr Epidemiol 1988, 23(2):85–9. 140 False. Melatonin production decreases with age. Melatonin is produced during darkness by the pineal gland. It is used widely to minimise the effects of jet-lag. The therapeutic dose has not formally been determined. 141 False. Haloperidol has greater potency than chlorpromazine, as 5 mg of haloperidol has equivalent efficacy to 100 mg of chlorpromazine. Potency is the relative dose required to achieve a specific effect. 142 False. It may even attenuate olanzapine-associated weight gain. 143 False. It is estimated at 10–30 per cent of patients. Inter-ictal psychosis is commoner than ictal psychosis. 144 False. Cataplexy is often associated with narcolepsy. Catalepsy is a motor disturbance associated with schizophrenia. Patients often adopt an odd posture, which they maintain for extended periods of time. 145 True. Internal conflicts are kept outside of their awareness. They also often have secondary gain whereby they are excused from obligations and difficult situations in their lives. 146 True. Especially in the USA and UK. It involves enhancing empathy or compassion for victims. 147 True. ‘Magic’ Psilocybe mushrooms are associated with a hallucinogenic effect. 148 False. Self-mutilation occurs most commonly in the context of borderline personality disorder. Langbehn DR, Pfehl B. Ann Clin Psychiatry 1993, 5:45–51. 149 False. Seasonal affective disorder is a subtype of affective disorder and is associated with increased weight, carbohydrate craving and hypersomnia. 150 True. The light box should be at least 1 0000 Lux. Side effects of light therapy include headache, blurred vision, insomnia and over-activity. Eagles J. Adv Psychiatr Treat 2004, 10(3):233–40.
188 Section 2 Paper 6
151 True. Tryptophan depletion produces a marked reduction in plasma tryptophan and therefore brain serotonin synthesis and release. 152 False. It has not been thoroughly evaluated. It is rarely used. 153 True. ICD-10. Rapid rate of speech with poor fluency and reduced intelligibility. ICD-10 (F98.6). 154 True. Usually the children do not speak to classmates or teachers at school. ICD-10 (F94.0), elective mutism. 155 True. For example bowel or bladder control, as part of the emotional disturbance. ICD-10 (F93.3). In most cases the disturbance is mild and of little significance. 156 True. This is rare, but has been reported. Treat as for epilepsy. 157 True. Anderluh MB et al. Am J Psychiatry 2003, 160:242–7. 158 True. The associated protein regulates feeding behaviour in the hypothalamus. Ribases M et al. Hum Molec Genet 2004, 13:1205–12. 159 False. It relates to mood disorders – to the dual effectiveness of anticonvulsants in both epilepsy and affective disorders. In epilepsy, kindling is thought to represent the repeated subthreshold neuronal stimulations in a brain area resulting in a seizure. 160 False. An obsession of doubt followed by a compulsion of checking is the second commonest. The commonest is the obsession of contamination. 161 True. It is the major excitatory amino acid. 162 False. According to Kübler-Ross, the phases are (1) denial and isolation, (2) anger, (3) bargaining, (4) depression, (5) acceptance. 163 True. Defined by Karl Jaspers, who contributed extensively to phenomenological psychopathology. Jaspers K. General Psychopathology. (Translated from the 7th German edition by Hoenig J, Hamilton MW.) Manchester, Manchester University Press, 1963.
ISIs: Answers 189
164 False. It is the inability to recognise and describe one’s own feelings or emotions. Nemiah JC, Sifneos PE. Psychother Psychosom 1970, 18(1):154–60. 165 True. It is reversible on withdrawal of lithium.
190 Section 2 Paper 6
EMIs: Answers 1 1
A
Anterior pituitary hormones are ACTH, FSH, LH, melanocyte stimulating hormone, prolactin, GH and TSH. Thyrotropin releasing factor is an anterior pituitary releasing factor, so not strictly speaking a hormone.
2
I
Substance P has been hypothesised to be involved in mood disorders and dementia.
3
E
Oxytocin and vasopressin have been proposed as being important in mood regulation.
2 1
D
2
F
3
B
3 1
B
2
F
3
E
The paraphilias are predominantly male conditions.
EMIs: Answers 191
4 1
A
Typically ‘I don’t know’ answers. Examine for depressive features.
2
C
Typical Alzheimer’s pathology.
3
I
It is important to examine frontal lobes and frontal release signs.
4
G
Often diagnosed as dementia in Parkinson’s disease. There is overlap between the two diagnoses.
5
B
5 1
C
Also there is a relative asymmetrical atrophy of anterior temporal and frontal lobes.
2
B
REM sleep behaviour disorder: motor movements occurring in REM sleep.
3
H
As is cerebral atrophy, ventricular enlargement and thinning of the corpus callosum.
4
F
6 1
J
2
G
3
F
4
A
5
I
Paykel’s classification: (1) psychotic depressives, (2) anxious depressives, (3) hostile depressives, (4) younger depressives with personality disorders.
Note. Roth and Morrisey separated groups of depressives using multiple regression analysis, and argued that the melancholic and neurotic groups were distinct.
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Index 193
INDEX Note: References are given in the form of the paper number in brackets followed by the question number. Rounded brackets indicate Individual Statements and square brackets the EMIs. ‘vs’ indicates the comparison of two items, most often the differential diagnosis of two conditions.
Abnormal Involuntary Movement Scale (1)30 Abraham, Karl (2)12 abreaction (1)44, (6)124 absence seizures [1]3 absolute risk reduction (4)131, (6)7 abstract thinking [1]6 abstraction, selective [2]2 acamprosate (4)64 acetylcholine [4]6 acetylcholinesterase inhibitors (5)138 see also cholinesterase inhibitor acetyltransferase and Alzheimer’s disease (5)100 action potential and ion transport (5)26 actus rea (6)28 adenohypophyseal hormones [6]1 adenoma sebaceum [4]5 adolescence brain injury in (5)88 childhood-onset schizophrenia in (5)121 cluttering (6)153 depression (6)50 adrenergic pathways and tramadol (6)107 see also beta-adrenoceptors advance statements and directives (6)95 affective (mood) disorders Borna disease and (4)74 Cushing’s syndrome and (3)39 dementia risk (1)37 see also specific disorders African Americans, Alzheimer’s disease and apolipoprotein D in (5)79 African Caribbeans, schizophrenia (4)161 aggression amygdala and (4)34, (4)141 child cruelty to animals and later occurrence of (4)77 children (1)15
children mimicking adult’s (3)66 cyproterone acetate (4)137 EEG in (4)150 Freud and (1)124 psychiatric ward crowding and (4)12 agnosia [2]1 object (5)56 visual, test for [1]10 see also anosognosia; astereognosis; somatopagnosia agonist, pure [1]8 agoraphobia (2)59, (5)52 AIMS (Abnormal Involuntary Movement Scale) (1)30 akathisia and violence (1)67 akinesia with neuroleptics (1)29 alcohol (and it misuse) (2)74 cerebellar degeneration (5)98 corpus callosum and (5)130 delirium tremens (2)91, (3)44, [4]4 dementia and (4)23 EEG effects (1)66 management of abstinence (4)64, (4)65 nystagmus and (5)74 seizures with (3)45 ventricular petechiae (5)99 withdrawal and dependency (2)101, (3)43 see also Korsakoff’s syndrome; methanol consumption; Wernicke’s encephalopathy alexithymia (6)164 alpha activity/rhythm (1)66, (2)105, (3)31, [3]10, (4)119 alpha-lipoic acid (4)156 altruism [2]7, [2]8 Alzheimer’s disease and dementia [6]4 in African Americans, and apolipoprotein D (5)79
194 Index
Alzheimer’s disease and dementia (contd) alpha-lipoic acid and (4)156 blood pressure elevation and (5)27 cognitive impairment (4)152, (5)86, (5)87, (5)89 dementia with Lewy bodies vs (5)110, (5)112 depression (old-age) vs (5)44 Down’s syndrome child and maternal risk of (6)44 EEG in (1)65 homocysteinaemia and (5)28 late-onset, risk to offspring (4)72 lithium (5)77 memantine (5)93, (6)132 with cholinesterase inhibitor (6)132 memory impairment (5)86, (5)87 parietal lobe symptoms (5)128 psychosis in, EMG (4)132 rural prevalence (5)125 tangles in (5)65 vitamin E and (6)109 ambitendence [2]9 amiodarone (6)70 amisulpride (1)2, (1)109 amitriptyline (1)106 amnesia see memory amoxapine (3)35, (4)14 amphetamines [1]1, (2)78 withdrawal symptoms (6)126 amygdala, aggression and placidity and (4)34, (4)141 amyloid ß/ß-amyloid (6)41 Alzheimer’s disease and (4)152 anaclitic depression (3)71 anaclitic object-choice (1)57 anal stage of development, Freud’s (2)12 analytic therapy see psychoanalysis anankastic personality [3]2 anankastic personality disorder [1]4, [1]9 anger at dying (6)162 anhedonia (2)122 animals, children and cruelty to animals (4)77 fear of animals (3)23 animism (3)22 anorexia/anorexia nervosa (1)7, (1)23, (1)68, (1)104, (1)105, (2)32, (2)83, (4)3 alcohol misuse and (2)74
cholesterol levels (6)74 enforced nasogastric feeding (4)27 family therapy (3)62 genetic factors (3)105, (6)158 leptin and (3)88 obsessive behaviour and (3)20 shoplifting and (5)101 social phobia comorbid with (1)103 suicide in (3)106 superior mesenteric artery syndrome (4)2 topiramate-induced (4)102 anosognosia (1)40 ANOVA (analysis of variance) (4)55, [4]1 Kruskal—Wallis [5]6 antichymotrypsin and Alzheimer’s disease (4)151 antidepressants [3]6, (6)61 with antipsychotic effects (4)14 in bipolar disorder, monotherapy (6)103 dental caries and (5)78 discontinuation syndrome (2)33 EEG delta activity and (4)116 erectile dysfunction and (5)4, (5)151 Hypericum perforatum as (5)1, (6)52 hyponatraemia caused by (5)39, (6)130 relapse rates (2)67 sedating (3)121 see also specific (types of) drugs antipsychotics see neuroleptic drugs antisocial/dissocial personality disorder [3]2, (6)105 borderline and, comorbid (5)143 Anton’s syndrome [2]1 anxiety age and (3)33 cannabis and (3)95 conversion reaction in (5)53 coronary artery disease and (4)9 depression comorbid with (1)9 diabetes and (1)97 eye movement desensitisation and reprocessing in (4)105 Freud on (2)52 generalised (3)37, (4)5, (6)62 mania and (2)29 offenders (4)105 pre-performance, athletes (5)141 sighing (2)98 social see social anxiety
Index 195
vicarious learning in (2)45 vitamin B12 deficiency and (2)35 see also phobic anxiety depersonalisation syndrome; separation anxious-avoidant personality disorder [1]4, [1]9 aphasia, Wernicke’s [2]1 apolipoprotein D Alzheimer’s disease in African Americans and (5)79 psychosis and (3)114 appetite cocaine withdrawal and (5)76 disorders see anorexia; bulimia; eating disorders vasopressin and (4)54 aripiprazole (6)82, (6)90 arousal reticular formation (5)24 sexual, variant/unusual methods [6]3 arrhythmias and cholinesterase inhibitors (5)138 Asperger’s syndrome (3)13, (3)26 astereognosis [4]4 asyndesis/asyndetic thinking (2)23, (2)89 atasia abasia (1)50 atherosclerosis and relapsing depression (5)43 athletes, performance anxiety (5)141 atonic seizures [1]3 atrial fibrillation and cholinesterase inhibitors (5)138 attachment see mother; separation attention in Alzheimer’s disease vs dementia with Lewy bodies (5)110 self-focused, anxiety (6)37 attention deficit hyperactivity disorder (6)92 adults (6)35 comorbid psychiatric disorders (6)94 heritability (6)93 smoking in pregnancy and (4)49 stimulants in (4)4, (5)116 tricyclics with non-response to (4)65 attorney, power of (4)71 auditory hallucinations, reducing (5)112 autism (4)98 cerebellum and (4)158
epilepsy and (4)103 infantile (3)24 Kanner’s description (4)67, (6)21 medical conditions associated with (6)32 relatives of probands with (4)20 schizophrenia and (2)53 speech and outcome in (5)114 theory of mind and (5)94 autistic spectrum disorder, catatonic symptoms (6)102 autoantibodies serotonin (4)35 thyroid (4)30 autoerotic asphyxiation (4)39 autogenic training (4)96 automatic obedience [2]9 Balint syndrome [2]1 Bandura, Alfred (2)110, (3)66 basal ganglia volume and clozapine (4)122 basal nucleus of Meynert see nucleus basalis of Meynert basic assumption theory [2]7 basilar artery (5)45 Beck, Aaron T cognitive therapy (1)92, (2)127, (5)80 cognitive triad (2)133 Depression Inventory (2)43 formulation of depression [3]1 bedwetting (2)11, (4)95 behaviour therapy (1)87 dialectical (1)96, (6)105 in nocturnal enuresis (2)11 of phobias (2)124 benzodiazepine(s) (1)55, (1)83, (2)117 cimetidine and (2)94 EEG and (5)16, (5)67 learning/memory and (2)117, (3)78 overdose [1]1 receptors (4)154 antagonist (1)31 sleep and [3]79 beta activity/waves and antidepressants (4)116 and benzodiazepines (5)16 beta-adrenoceptors blockers (3)110 post-synaptic, ECT and (4)32
196 Index
bias (4)87, (5)164, (6)16 obsequiousness [4]2 observer (5)154 publication (6)9 recall (5)95 selection (5)154, (6)17 bioavailability (3)127, [6]2 biofeedback (4)96 Bion WR [1]6, [2]7 bipolar affective disorder (4)143 age and (6)110 heritability (1)70, (3)70 lifetime risk (6)113 rapid recycling (6)104, (6)128, (6)129 suicide (4)28 treatment (4)101, (5)150, (6)103 BITE (Bulimia Investigatory Test Edinburgh) (1)22 Bleuler, Eugen [1]6, (2)53, (2)81 blood pressure, high (hypertension) dementia and Alzheimer’s disease and (5)27 venlafaxine and (5)105 blood—brain barrier permeability in hypoxia (1)14 blushing, fear (2)125 BNDF (6)158 body dysmorphic disorder [1]2, (1)46 body fat distribution (1)75 body mass index (1)75 body weight see weight BOLD effect in SPECT (4)17 bone density and recurrent depression in women (4)(4)145 borderline personality disorder (1)84, (1)85, (1)96, (1)98, (2)50, (3)55, (3)56, (3)117, (6)105 antisocial and, comorbid (5)143 omega-3 fatty acids (5)137 post-traumatic stress disorder comorbid with (6)58 self-mutilation (6)148 Borna disease (4)74 brain-derived neurotrophic peptide (6)158 brain injury, traumatic, childhood/adolescence (5)88 breast-feeding and drugs (1)72, (3)2, (6)89 Brief Psychiatric Rating Scale (5)106
Briquet’s syndrome see somatisation disorder bromide and mania (4)1 Brushfield spots [4]5 bulimia nervosa (1)22, (1)23, (2)73 serotonin and (3)104 sexual activity and (3)17 buprenorphine (5)29 buproprion (1)3, (1)4 buspirone (2)24, (6)81 caffeine (1)33, (4)46 Cameron, Norman [1]6 cancer and IL-6 and depression (6)55 cannabis (2)77, [5]5 anxiety and (3)95 schizophrenia and (3)42, (3)95 see also tetrahydrocannabinol Canon—Bard theory [2]6 carbamazepine (1)31, (2)10, (6)38 dextropropoxyphene and (3)123 haloperidol and (3)14 sodium channels and (3)107 carbon monoxide poisoning (2)60, (3)46 caries and antidepressants (5)78 case control (retrospective) studies [4]3, (5)95 castration of sex offenders (4)136 cataplexy and narcolepsy (6)144 catastrophising [2]2 catatonia (2)60, [2]9 autistic spectrum disorder and (6)102 catharsis (2)39, [2]8 Cattell RB [3]5 caudate nuclei Huntington’s disease (6)49 somatisation disorder (6)51 cell membrane, ion transport (5)8, (5)26 central nervous system stimulants see stimulants cerebellum in alcoholism (5)98 in autism (4)158 in childhood-onset schizophrenia (5)121 in Creutzveldt—Jakob disease (5)92 cerebral haemorrhage and depression (4)44 cerebral neocortex (5)9 cerebral ventricles alcoholism (5)99 Wernicke’s encephalopathy (6)66
Index 197
Charles—Bonnet syndrome (5)139 chi square (2) test (6)5 children academic underachievement (3)1 aggression see aggression of Alzheimer’s sufferer, risk to (4)72 animals and see animals brain injury in (5)88 in care, ethnicity (4)163 cluttering (6)153 conduct disorder (4)113, [5]2 consent (6)47 criminal responsibility (4)115 depression in see depression depression in later life associated with adverse parenting (4)107 developmental theory (2)12, (2)16, (2)129, (3)22, (3)67 disintegrative disorder (5)11 dysthymia (6)116 enuresis (6)23 nocturnal (2)11, (4)95 hyperactivity see attention deficit hyperactivity disorder; hyperactivity intelligence, measurement tools [3]5 Munchausen’s syndrome by proxy (5)109 mutism (selective) (6)154 of one-parent families (3)6 perfectionism, and anorexia nervosa (6)157 psychosis (incl. schizophrenia) (4)117, (5)121, (6)54 reading retardation (4)21, (4)113 school refusal see school refusal separation anxiety (1)48 sibling rivalry disorder (6)155 temperament and personality (1)119, (2)130 tics (5)70, (5)117, [5]2 trauma sensitivity and post-traumatic stress disorder (3)27, (6)117 see also adolescence; infant chloride ions and action potential (5)26 chlorpromazine (2)18, (2)58 haloperidol vs, potency (6)141 impotence and (5)18 cholesterol and anorexia nervosa (6)74 cholinesterase inhibitor (3)112, (5)122
memantine with, in Alzheimer’s disease (6)132 chronic fatigue syndrome (1)82 cimetidine (2)94 citalopram [3]6 see also escitalopram clarification (1)12, (3)51, (3)53 clearance see elimination clinical trials see trials clonidine (4)60, (4)98 Cloniger type 2 alcohol-dependent (3)43 clozapine (1)5, (1)100, (1)110, (2)108, (3)28, (3)32, (6)83, (6)86, (6)108 basal ganglia volume and (4)122 breast-feeding and (6)89 overdose [1]1 suicidal behaviour and (3)40 in treatment-resistant schizophrenia (6)83, (6)87 withdrawn in 1960s (6)82 cluttering (6)153 cocaine [3]7, (5)146, (5)147, [5]5 area of brain damage in (5)97 formication (5)129 sleep and (4)61 withdrawal (2)72, (5)76 cognitive analytic therapy (1)98, (3)63 cognitive behaviour therapy (3)49, (3)50, (3)81 cognitive dissonance [2]6 cognitive distortions [2]2 cognitive performance, stimulants improving (6)21 cognitive problems (decline/dysfunction) in Alzheimer’s disease (4)152, (5)86, (5)87, (5)89 coronary artery bypass grafting and (4)7 depression and [3]1, (6)111 irreversible vs reversible (in dementias in general) (5)90 in leukoariosis (5)127 in multiple sclerosis (4)40 in schizophrenia (4)152, (6)85 cognitive tests [1]10 cognitive therapy (Beck’s) (1)92, (2)127, (5)80 cognitive triad, Beck’s (2)133 cohesiveness [1]6 cohort (prospective) studies [4]3, (6)15, (6)17
198 Index
collaborative empiricism (3)49 concrete thinking [1]6 condensation [1]6 conditioning (1)86, (3)5 operant (3)65 conduct disorder (4)113, [5]2 confabulation (2)123, (5)136 confidence interval (6)19 95 per cent (4)128 confounders and confounding (4)80, [4]2, (6)1, (6)16, (6)17 confrontation (1)12, (3)51, (3)53 Conner’s rating scale (5)107 consent, children (6)47 construct validity (6)13 conversion disorder/symptoms (1)113, [1]2, (5)53, (6)145 conversion reaction in anxiety (5)53 coping strategies (1)92 coprolalia (4)155 coprophagia (4)155 coronary artery bypass grafting, cognitive decline following (4)7 coronary artery disease (and ischaemic heart disease) anxiety and (4)9 depression and (4)8, (4)9 corpus callosum and alcoholism (5)130 correlation coefficient [5]5 cortical myoclonus (6)78 corticosteroids see steroids cortisol and depression (3)4 counselling, post-disaster (6)133 counter-conditioning (1)86 counter-transference (3)61 couvade syndrome (2)114 Creutzveldt—Jakob disease (5)92 crime see law criminal(s) (offenders/convicts) neuroses (4)139 schizophrenia (4)138 sex offenders (4)136, (6)146 see also law; prisoners criminal responsibility, age of (4)115 cross-sectional studies (4)126, [4]3 crystallised intelligence [3]5 Cushing’s syndrome (3)39 cyclopyrolones (3)109 cyproterone acetate (4)137
cytochrome P450 (6)84 dantrolene (4)66 de Clerambault syndrome (6)125 debriefing, psychological (6)133 declarative memory (3)74 defence mechanisms [2]3 borderline personality disorder (2)50 hysteria (2)111 manic (5)38 déjà entendu and pensé (2)7, (2)8 delirium (5)72, (5)73 neuroleptic malignant syndrome (3)41 delirium tremens (2)91, (3)44, [4]4 delta activity and antidepressants (4)116 delusions (2)121, [2]4 gender and (3)19 of persecution/victimisation [2]4, (6)97, [6]3 wolf (6)163 dementia affective disorders and risk of (1)37 alcohol and (4)23 antipsychotic risks/contraindications (5)35, (6)90 blood pressure elevation and (5)27 childhood (5)11 dialysis and (4)26 homocysteinaemia and (5)28 late-onset (incl. over 90s) (5)61 pedunculopontine nuclei and (5)5 with Lewy bodies see Lewy bodies measles and (4)153 NMDA receptor antagonists (5)93 olanzapine in elderly with (6)68 outcome prediction (6)41 in Parkinson’s disease [6]4 pseudobulbar palsy and (5)19 pseudodementia and, co-existing (1)80 reversible (5)90 in Wilson’s disease (5)46 scoring (3)99 substance-induced persisting (4)50 vascular (6)45, [6]4 see also Alzheimer’s disease dementia praecox [6]4 democratisation [2]7 demyelination and alcoholism (5)130 dental caries and antidepressants (5)78
Index 199
dependence (withdrawal) with abused drugs (2)27, (2)72 alcohol (2)101, (3)43 amphetamines (6)126 opioid see opioid dependent variables (6)2 depersonalisation [1]6, (2)17, (2)132, [2]5, (3)25 derealisation and (2)119, [2]5 gender and (6)115 see also phobic anxiety depersonalisation syndrome depot antipsychotics [5]4 depression (1)26, (1)111, [6]6 anaclitic (3)71 anti-thyroid antibodies and (4)30 anxiety and (1)9 Beck’s formulation [3]1 childhood parenting and adult occurrence of (4)107 children (3)71, (4)19, (4)160, (5)119, (6)116 adolescence (6)60 ECT (6)152 classification/types [6]6 cognitive decline and [3]1, (6)111 coronary artery disease and (4)8, (4)9 cortisol and (3)4 diabetes and (1)97 double (1)25 eating disorders and (1)23 epidemiology (1)60, (1)123, (1)130, (2)3, (3)86, (4)106, (6)60 untreated depression (5)62 in epilepsy (5)149 growth hormone and see growth hormone interferon and (3)113, (5)120 interleukins and see interleukin interpersonal therapy (2)41 measurement instruments (2)43, (3)64 MRI white matter hyperdensities (5)104 multiple sclerosis and, comorbid (4)40 obsessive—compulsive disorder and (2)64 oestrogen and (1)132 offenders (4)105 older patients/old-age/late-life adverse drug reactions in hospitalised patients and (5)59 differentiation from Alzheimer’s disease (5)44
gender and (6)39 team management (5)140 in Parkinson disease (6)57 postnatal (4)146 psychosis and (1)10, (3)94 quetiapine (3)47 relapse/recurrence (2)13, (2)67, (4)29, (4)94 and atherosclerosis (5)43 and bone density and osteoporosis in women (4)(4)145 REM sleep and (1)133, (6)59 stressful life events and (1)123 stroke patients (4)44 tryptophan depletion and (6)151 winter (and seasonal affective disorder) (1)79, (6)149, (6)150 see also antidepressants depressive position (1)71, (2)109 deprivation maternal infantile autism and (3)24 speech delay and (1)99 socioeconomic, schizophrenia and (4)121 derealisation [2]5 depersonalisation and (2)119, [2]5 dereistic thinking (2)120 developmental theory (2)12, (2)16, (2)129, (3)22, (3)67, (3)70 dextromoramide (5)144 dextropropoxyphene and carbamazepine (3)123 dhat (3)98 diabetes antipsychotics and risk of (3)57 anxiety and depression in (1)97 erectile dysfunction (4)104 Diagnostic and Statistical Manual (DSM-IV) (2)118, (6)36 bipolar I disorders (4)106 erectile dysfunction (5)20 personality in (5)17 substance-induced persisting dementia (4)50 dialectical behaviour therapy (1)96, (6)105 dialysis (incl. haemodialysis) dementia and (4)26 suicide and (1)74 diamorphine see heroin
200 Index
diazepam (1)44, (2)80, [5]5 dichotomous thinking [2]2 dimethyltryptamine (5)147 Diogenes syndrome (4)70, (5)126 disclosure of information in interview (2)87 disgust (2)46 disintegrative disorder, childhood (5)11 dissocial personality see antisocial/dissocial personality dissociative disorders (4)36, (4)37 distribution (drug), volume of [6]2 distribution (frequency) (5)158 normal (5)160, (5)165 skewed (4)89, (4)90, (5)159 see also non-parametric tests; parametric test disulfiram (4)64 overdose [1]1 schizophrenia and (1)24 tricyclic antidepressants and (1)107 Divalproex sodium (sodium valproate and valproic acid) (5)150 donepezil (3)112, (6)59 DOPA analogue, alcohol abstinence (4)64 dopamine neurones cocaine and (5)96 mesencephalon (6)134 dopamine receptor antagonists (1)1, (1)2, (1)109 dopamine transport and methylphenidate (5)116 double-blind trial (6)11 Down’s syndrome [4]5, (6)25, (6)26 mothers’ risk of Alzheimer’s disease (6)44 dreams (2)62, (5)63 see also night terrors; nightmares; oneroid states drivelling [1]6 driving and mental illness (4)73 drowsiness, EEG alpha rhythm (2)104, (3)31 drugs [3]4 abused (and drugs of abuse) (1)17, (1)18, (1)19, (1)34, (1)39, (1)89, (1)90, (2)66, (5)15, [5]5 dependence/withdrawal syndrome (2)27, (2)72, (2)101 insanity plea in court and (4)102 Narcotics Anonymous 12-step approach (2)31
persisting dementia and (4)50 sex addiction (4)16 adverse reactions classification (3)83 and depression in older hospitalised patients (5)59 breast-feeding and (1)72, (3)2, (6)89 clinical trials (4)78 mania induced by (3)132, (3)133, (4)1 pharmacology see pharmacology see also specific (types of) drugs DSM-IV see Diagnostic and Statistical Manual dying, psychological adjustment to (6)162 dynamic formulation (2)28 dynamic psychotherapy/psychoanalysis, brief (3)59, (5)14 dyskinesia, orofacial (2)115 dyslexia (5)83 dyspareunia (5)22, (5)23 dysphasia (2)113 dysthymia (1)25, (1)71, (3)85, (4)29 child-onset (6)116 eating (appetite) disorders (1)4, (3)69 kindling and (6)159 SCOFF questionnaire and (3)103 see also anorexia; appetite; bulimia ECG, antipsychotic effects (4)42 ecological studies (4)93 Ecstasy (1)17, (1)18, [3]8, [5]5, (6)127 Edwards and Gross diagnostic criteria for alcohol withdrawal (2)101 EEG see electroencephalography ego (2)9, (2)81, [3]3 ego-dystonic (4)100 eicosapentaenoic acid and schizophrenia (1)42 eidetic imagery (2)128 ejaculation, premature (6)123 with SSRIs (6)122 elderly and older people bipolar disorder (6)110 dementia see dementia depression see depression drug half-lives (5)132 olanzapine and dementia in (6)68 schizophrenia/schizophrenia-like psychosis onset (5)131
Index 201
SSRIs (6)75 suicide (6)112 gender and (5)123 Electra complex (6)135 electrocardiogram, antipsychotic effects (4)42, (6)69 see also QT interval electroconvulsive therapy (ECT) childhood depression and (6)152 depersonalisation and (2)132 epilepsy precipitated by (6)156 frontal lobe effects (2)84 5HT2 receptors and (1)125 parkinsonism (4)47 post-synaptic ß-adrenergic receptors and (4)32 response prediction (1)13 seizures in (1)129, (3)36, (4)33, (6)99 side-effects (1)64 verbal memory and (3)77 electroencephalography (EEG) [3]10 aggression and (4)150 alcohol effects (1)66 Alzheimer’s disease (1)65 antidepressant effects (4)116 antipsychotic effects (4)111 attention deficit hyperactivity disorder in adults (6)35 benzodiazepine effects (5)16, (5)67 in drowsiness (2)104, (3)31 Huntington’s disease (5)48 mortality following (5)71 sleep in paradoxical sleep (5)32 sawtooth waves (4)125 Tourette’s syndrome (5)69 vascular dementia [6]4 see also specific wave patterns electromyogram, psychosis in Alzheimer’s disease (4)132 elimination (incl. clearance) (3)82, [6]2 illicit drugs [5]5 lithium (5)66 EMG, psychosis in Alzheimer’s disease (4)132 emotion(s) difficulty recognising/describing one’s own (6)164 in Klüver-Bucy syndrome (3)129
emotionally unstable-impulsive type personality disorder [1]4, [1]9 encopresis see faecal soiling enuresis (4)51, (6)23 nocturnal (2)11, (4)95 epidemiological studies (4)126, [4]3, (6)15–17 epilepsy autism and (4)103 depression in (5)149 ECT-precipitated (6)156 kindling and (6)159 partial (3)110, (6)143 prisoners (6)138 temporal lobe (5)47, (5)75 twilight state (4)124 see also seizures episodic memory (3)74, (3)78 erectile dysfunction (impotence) (4)104, (5)20, (5)151 antidepressants and (5)4, (5)151 antipsychotics and (5)18 DSM-IV and (5)20 sildenafil (1)45, (2)57, (5)151, (6)40 Erickson’s psychosocial stages of development (3)70 erotomania (6)125 error systematic (5)164 type I (6)3, (6)4 type II (4)92, (6)10, (6)18 escitalopram [3]6 ethnicity and children in care (4)163 executive function, frontal, test of [1]10 exhibitionism (4)135 sexual (5)85 experimental studies [4]3 exploring behaviour in Klüver-Bucy syndrome (3)131 exposure and outcome in ecological studies (4)93 expressive language test (3)79 extrapyramidal side-effects of antipsychotics (3)89, (3)96 eye movement desensitisation and reprocessing (4)105 face validity (5)153 facial nerve (5)37
202 Index
faecal soiling and encopresis (6)27 infant (5)81 family history of suicide (3)101 family intervention in schizophrenia (3)116 family therapy anorexia (3)62 opiate dependence (4)165 schizophrenia (5)42 fantasy thinking (2)120 farmers, suicide risk (2)65 fasting and acute intermittent porphyria (4)57 father, sexual feelings toward (6)135, (6)135 fatigue syndrome, chronic (1)82 fear see phobia fetal hypoglycaemia (6)118 fetishism [6]3 fiduciary relationship with patient, psychiatrist (1)77 Finkelhor’s sexual abuse risk factor checklist (5)142 fire-setting (pyromania) (4)51, (5)82 first-order kinetics [1]8 first-rank symptoms (4)120 fitness to plead (6)31, (6)76 ‘flashbacks’ (1)34, (5)147 fluid intelligence [3]5 flumazenil (1)31 fluoxetine suicidal behaviour (2)37 washout, for monoamine oxidase inhibitors (4)147 flupentixol [3]4, (5)55 depot preparation [5]4 fluphenazine decanoate [5]4 focal conflict theory [2]7 ‘forced thinking’ (5)75 formal thought disorder (2)23 formication, cocaine use (5)129 Foulke’s group therapeutic factors [2]7 fragile X syndrome [3]9, [4]5 freezing [2]9 frequency distribution see distribution Freud, Anna [2]3 Freud, Sigmund (1)124, (2)9, (2)12, (2)42 Friedman test [5]6 frigophobia (4)72 frontal lobe disorders [2]1
function ECT effects (2)84 tests [1]10, (2)55, (3)30, (5)50 frotteurism [6]3 funnel plots, asymmetrical (6)9 GABA drugs affecting metabolism/transport etc. (3)108–10, (3)126, [3]4 receptors (4)154 gait disorder progressive (1)115 vascular dementia (6)45 gambling addiction (6)43 gamma-hydroxybutyrate (5)133 gender reassignment, transsexual (1)62, [3]2, (6)100 general paralysis of insane (6)137 generalised anxiety disorder (3)37, (4)5, (6)62 generativity vs stagnation (3)70 genetic factors (psychiatric disorders) (3)70 Alzheimer’s disease (4)151 anorexia nervosa (3)105, (6)158 attention deficit hyperactivity disorder (6)93 bipolar disorder (ultra-rapid cycling) (3)70, (6)129 schizophrenia (1)70, (3)92 Gerstmann’s syndrome [2]1 Gestalt psychology (1)113, (3)72 GHB (gamma-hydroxybutyrate) (5)133 Gilles de la Tourette’s syndrome (2)95, (4)155, (5)25, (5)69 glabellar tapping (3)13 globus hystericus (1)58, (5)41 glucocorticoids see steroids glutamate release and nicotine (6)161 Goffman, Erving [3]1 Goldstein, Kenneth M [1]6 gout, lithium (4)43 Grahame PS [6]6 grapefruit juice and buspirone (6)81 grief reaction (1)81, (2)4 group therapeutic factors [2]7 ‘group think’ (2)20, (3)68 growth, stimulant effects (4)97 growth hormone and depression (4)60 children (4)19
Index 203
gustatory hallucinations (2)92 haemodialysis see dialysis hair-pulling (1)47, (4)99 hallucinations in Alzheimer’s disease vs dementia with Lewy bodies (5)112 auditory, reducing (5)112 flashback (1)34, (5)147 gustatory (2)92 hypnagogic (2)56, (3)29 hypnopompic (3)29 imperative (1)117 pentazocine and (2)75 reflex (2)26 tactile (2)71, (5)129 visual (2)71, (2)92, (2)112, (5)139 see also pseudohallucinations hallucinogens (1)34, (1)90, (5)147, (6)147 haloperidol [1]5 carbamazepine and (3)14 chlorpromazine vs, potency (6)141 depot preparation [5]3 Hamilton cuff method (3)36 Hawthorne effect [4]2 Hebb, Donald [3]5 hebephrenic schizophrenia [1]7, (3)12 helplessness, learned (3)64 hepatitis C (4)13 interferon use (3)113, (5)120 heritability see genetic factors heroin (diamorphine) (2)79, (5)29, [5]5 withdrawal symptoms (6)120 heterogeneity, study results [4]1, (6)14 hippocampus Korsakoff’s syndrome (5)134 suicide and 5-HT2a receptors in (6)53 histrionic personality disorder [1]4 HLA DR2 and sleep disorders (2)36, (2)76 homicide see murder homocysteinaemia (5)28 homovanillic acid levels and prodromal schizophrenia (4)6 hormones [6]1 Huntington’s disease (3)13, (6)48, (6)49, [6]5 EEG (5)48 memory (1)120 5-hydroxytryptamine (serotonin) autoantibodies (4)35
bulimia and (3)104 MDMA and [3]8 raphe nucleus and [3]8, [4]6 selective re-uptake inhibitors see selective serotonin re-uptake inhibitors see also serotonin syndrome 5-hydroxytryptamine and noradrenaline re-uptake inhibitor (3)115, [3]6 5-hydroxytryptamine receptor type 1a antagonist (3)111 type 2 ECT and (1)125 LSD action [3]8, (4)107 type 2 antagonist + and 5HT re-uptake inhibitor (3)93, [3]6 type 2a, suicide and (6)53 type 3 antagonist, obsessive—compulsive disorder (4)133 5-hydroxytryptaminergic (serotonergic) function/pathways Alzheimer’s disease and (5)89 tramadol and (6)107 hydroxyzine in generalised anxiety disorder (6)62 hyperactivity/hyperkinesis (4)98, [5]2 Conner’s rating scale (5)107 institutional rearing and (4)21 stimulants see stimulants see also attention deficit hyperactivity disorder Hypericum perforatum (5)1, (6)52 hyperkinesis see hyperactivity hyperparathyroidism [2]10 hyperprolactinaemia antipsychotics and (1)95, (6)90 ECT and (6)114 hypertension see blood pressure hypnagogic hallucinations (2)56, (3)29 hypnopompic hallucinations (3)29 hypocalcaemia and QT interval (6)72 hypoglycaemia, fetal (6)118 hypomania depression and see bipolar affective disorder in seasonal affective disorder (1)79 hyponatraemia, antidepressant-induced (5)39, (6)130 hypothalamic nuclei (5)33
204 Index
hypoxia, blood—brain barrier permeability in (1)14 hysteria (2)111 hysterical fugue (2)102 ibuprofen [3]4 ICD-10 see International Classification of Diseases ictal phenomenon, and violence (4)134 idealisation [2]3 imipramine (3)115 impotence see erectile dysfunction imprinting (2)126 incontinence see enuresis; faecal soiling incremental validity (5)152 independent variables (6)1, (6)2 infant autism (3)24 faecal soiling (5)81 infanticide (6)30 inheritance see genetic factors insanity plea in court (6)31 drug misuse and (4)75 see also general paralysis of insane intellectual functioning and psychosis (3)84 intelligence first-borne vs younger siblings (4)53 general intelligence factor [3]5 measurement tools (2)5, [3]5 see also IQ intention-to-treat analysis (4)88, (5)162 interferon and depression (3)113, (5)120 interleukin and depression IL-2 (4)118 IL-6, in cancer (6)55 International Classification of Diseases (ICD-10) (6)36 attention deficit hyperactivity disorder (6)92 body dysmorphic disorder (1)46 cluttering (6)153 elective mutism (6)188 fatigue syndrome (1)82 interpersonal therapy (2)41, (2)44 interpretation (1)12, (3)52 interview, psychiatric disclosure of information (2)87 good technique [3]1 suicide and (2)70
intimacy in analytic therapy (3)60 isolation vs (3)70 intracerebral haemorrhage and depression (4)44 ion channels, cell membrane (5)8, (5)26 see also specific ions IQ first-borne vs younger siblings (4)53 learning disability and (6)24 ischaemic heart disease see coronary artery disease isolation [2]3 intimacy vs (3)70 Japan, suicide rate (3)87 Jasper, Karl (6)163 jealousy (morbid) (2)69, (3)10 psychotropics with (5)102 retrospective ruminative (4)24 Jung, Karl (1)102 Kanner’s description of autism (4)67, (6)21 kappa (statistics) (5)161 Kendall’s correlation coefficient [5]5 Kendell RE [6]6 Kennedy’s syndrome [5]1 khat (1)39 kidney problems see entries under renal kindling theory (6)159 Kleinian theory (1)111, (2)9, (2)109 kleptomania (4)100 Klinefelter’s syndrome (4)68, [4]5 Klüver-Bucy syndrome (2)90, (3)128–31 Korsakoff’s syndrome (3)75, (5)136 CO poisoning and (3)46 hippocampus in (5)134 supratentorial atrophy (6)67 Kraeplin, Emil [6]6 Kruskal—Wallis test [5]6 Kübler-Ross’ stages of dying (6)162 kurtosis (5)165 LAAM (4)18 lactate, sodium, and panic symptoms (1)121 lambda waves [3]10 lamotrigine [4]6, (5)149, (6)50
Index 205
language development see speech expressive, test (3)79 law crimes (6)28-31 fitness to plead (6)31, (6)76 insanity plea see insanity plea Diogenes syndrome (4)70 driving and mental illness (4)73 forced feeding of anorexic patients (4)27 power of attorney (4)71 see also criminal learning benzodiazepine and (3)78 social (3)66 vicarious (2)45 learning disability IQ ranges (6)24 neuroleptics and (5)68 legal issues see law leptin anorexia and (3)88 antipsychotics and (2)19 olanzapine and (4)48 leukoariosis, cognitive decline (5)127 levodopa-induced mania (3)132 Lewy bodies, dementia with (5)91, [6]4, [6]5 Alzheimer’s disease vs (5)110, (5)112 Liddle’s classification of schizophrenia (1)108 light therapy, winter depression (6)150 likelihood ratio (4)129, (5)163 ␣-lipoic acid (4)156 Liquid Ecstasy (5)133 lithium (1)6, (1)72, (3)16, [3]4, (5)97, (6)38 Alzheimer’s disease and (5)77 in gout (4)43 myasthenia gravis and (3)9 overdose [1]1 Parkinson’s disease and (3)15 pharmacology (6)63 drug interactions (3)118, (4)33 elimination (5)66 in pregnancy (6)118 tau phosphorylation and (5)77 thyroid enlargement (6)165 toxicity in chronic renal failure (3)119 locus ceruleus [4]6
lofexidine (6)121 logistic regression analysis (4)80 loosening of associations [1]6 LSD (1)90, [3]8, (4)107, (5)147 lycanthropy (6)163 lysergic acid diethylamide (LSD) [3]8, (4)107, (5)147 McNaughten Rules (6)29 macro-orchidism [4]5 magnetic resonance imaging in depression (5)104 in psychosis (6)35 Mahler, Margaret (2)16 malingering [1]1 mania (1)26, (1)111, (1)131 anxiety and (2)29 depression and see bipolar affective disorder drug-induced (3)132, (3)133, (4)1 lithium response (5)97 social rhythm and (4)15 see also hypomania manic defence (5)38 Marchiafava—Bignami disease (4)23, (5)130 Martin—Bell syndrome [3]9, [4]5 masochism, sexual [6]3 maternal see mother MDMA (ecstasy) (1)17, (1)18, [3]8, [5]5, (6)127 mean of normal distribution (5)160 measles (4)153 MECP2 gene (4)162 median of normal distribution (5)160 medicolegal issues see law melatonin (1)91, (6)46, (6)140 memantine (1)41, (5)93, (6)132 in Alzheimer’s dementia see Alzheimer’s disease membrane, cell, ion transport (5)8, (5)26 memory (2)47 declarative (3)74 episodic (3)74, (3)78 falsifications (2)6, (5)136 impairment and loss (amnesia) (4)36 Alzheimer’s disease and (5)86, (5)87 anterograde and retrograde (3)76 benzodiazepines and (2)117, (3)78
206 Index
memory (contd) impairment and loss (amnesia) (contd) Huntington’s disease and (1)120 Klüver-Bucy syndrome and (3)128 multiple sclerosis and (4)40 schizophrenia and (3)64 verbal, ECT-related (3)77 long-term/secondary (1)8 semantic (3)74 short-term/temporary (3)73 test of [1]10 menantetranone (2)32 mens rea (6)28 mesencephalon see midbrain mesenteric artery syndrome, superior (4)2 meta-analyses (4)130, (6)64 methadone (4)165 methanol consumption (6)136 methylenedioxymethamphetamine (MDMA; ecstasy) (1)17, (1)18, [3]8, [5]5, (6)127 methylphenidate (Ritalin) (4)97, (5)116 Meynert’s nucleus basalis see nucleus basalis of Meynert mianserin (3)122 midbrain (mesencephalon) dopaminergic neurones (6)134 structures (5)36 migraine and suicide (6)96 millennium effect (6)56 milnacipram (3)115, [3]6 mind basic operations (1)102 primitive states of [1]6 theory of, and autism (5)94 Mini-Mental State Examination (MMSE) (3)99 mirror gazing (3)12 mirror phenomenon [2]7 mirtazapine [3]6 misidentification, delusional [2]4 moclobemide (2)21, [3]6 mode of normal distribution (5)160 modelling and social facilitation (2)110 monoamine oxidase A inhibitors (2)21, [3]6 fluoxetine washout (4)147 tricyclic antidepressants and (5)111 mood disorders see affective disorders; and specific disorders morphine (2)79
Morrisey JD [6]6 mother absence/deprivation see deprivation attachment to (2)40, (2)126 separation from see separation deaths in psychiatric illness (4)145 suicide (4)82 of Down’s syndrome child, Alzheimer’s disease risk (6)44 sexual feelings toward [3]3, (6)135 smoking in pregnancy, and ADHD (4)49 see also parent; parenting motivation theory (2)34 motivational interviewing (6)101 multiple personality disorder (4)37, (4)38 multiple sclerosis (4)40, [5]1 depression comorbid with (4)40 Munchausen’s syndrome [3]2, (6)125 Munchausen’s syndrome by proxy (5)109 murder/homicide infant (6)30 of mentally-ill people (3)100 by schizophrenics (3)100 muscarinic receptors and schizophrenia (3)18 muscle relaxants (neuromuscular blockers) (4)33 mutism, selective (6)154 myasthenia gravis and lithium (3)9 myoclonus, cortical (6)78 nalbuphine, athletes (5)141 naltrexone (4)81 narcolepsy (2)56, (2)76, (3)29, (5)51 cataplexy and (6)144 Narcotics Anonymous (2)31 nasogastric feeding of anorexic patients, enforced (4)27 nefazodone (3)93, [3]6 pathological gambling (6)43 negative predictive value (5)5 negative reinforcement (2)49 negative symptoms prognostic value (2)107 as risk factor for tardive dyskinesia (1)59 neocortex (5)9 nerve conduction, saltatory (5)7 neurofibrillary tangles in (5)65 neurofibromatosis types I and II [5]3
Index 207
neuroleptic drugs (antipsychotics) (3)102, [3]4 akathisia with (1)67 akinesia with (1)29 with antidepressant effects (4)14 atypical (1)27, (3)35 contraindicated in dementia (5)35 seizure threshold and (6)88 basal ganglia volume and (4)122 depot [5]4 diabetes risk (3)57 ECG and (4)42, (6)69 extrapyramidal side-effects (3)89, (3)96 hyperprolactinaemia and (1)95, (6)90 impotence and (5)18 leptin and (2)19 parkinsonism induced by (6)80 relative potency (6)141 resistance/non-response to (3)124, (6)83, (6)87 learning disability and (5)68 tardive dyskinesia with (1)59 typical/conventional, non-response (1)5 weight gain (2)19, (5)55 see also specific drugs neuroleptic malignant syndrome (1)78, (1)110, [1]5, (3)41 dantrolene in (4)66 risk factors (4)52 neuromuscular blockers (4)33 neuronal cell membrane, ion transport (5)8, (5)26 neuroses, offenders (4)139 neurosyphilis (4)25, [5]1, (6)119, (6)137 nicotine and glutamate release (6)161 nicotinic receptor antagonists (1)3 night terrors (3)80, (5)31 nightmares (3)80, (4)62, (5)31 benzodiazepines and [3]8 night-time, enuresis (2)11, (4)95 NMDA receptor antagonists (5)93 nocturnal problems see sleep and entries under night non-parametric tests [5]6 noradrenaline (4)31, [4]6 see also 5-hydroxytryptamine and noradrenaline re-uptake inhibitor noradrenergic re-uptake inhibitor, selective [3]6
nucleus basalis of Meynert [4]6 Alzheimer’s disease and (5)100 null hypothesis (6)2, (6)3, (6)10 number-needed-to-treat (4)131, (6)77 nutmeg abuse (2)66 nystagmus (5)74 obedience, automatic [2]9 object agnosia (5)56 object-choice (1)57 object constancy (2)16 obsequiousness bias [4]2 observational studies [4]3 observer vs selection bias (5)154 obsessive behaviour/disorders (3)38, [3]2 anorexia nervosa and (3)20 obsessive—compulsive disorder (1)53, (2)64, (2)86, (2)96, (6)160 drug treatment (1)54, (4)133 gender and (4)148 late-onset in men, prognosis (5)10 Tourette’s syndrome and (2)95 obstructive sleep apnoea and schizophrenia (4)10 occipital lobe of cerebral, lesions/disorders [2]1, (5)57 odds ratio (6)15 Oedipal complex [3]3, (6)135 oestrogen and depression (1)132 olanzapine (1)101, (3)57 elderly with dementia and (6)68 hyperlipidaemia and (3)102 impotence and (5)18 leptin and (4)48 stroke risk in elderly with dementia (6)91 older patients see elderly omega-3 fatty acids in borderline personality disorder (5)137 ondansetron (4)133 oneroid states (2)71 operant conditioning (3)65 opioid (5)141, (5)144, (6)121 antagonist (4)81 dependence (4)18, (4)165 relapse prevention (4)81 withdrawal symptoms (6)120 oral stage of development, Freud’s (2)12 orofacial dyskinesia (2)115
208 Index
osteoporosis and recurrent depression in women (4)(4)145 over-inclusive thinking [1]6 oxazepam (1)83, (2)80 oxytocin [6]1 P300 latency in schizophrenia (4)11 pain culture and (2)93 phantom limb (5)54 substance P and [6]1 see also dyspareunia pairing [2]7 panic disorders (1)36, [3]6, (4)5 treatment (4)105 panic symptoms and sodium lactate (1)121 paracetamol overdose, suicide (1)20 parametric tests (4)79, (4)112 paramnesias (2)6 see also memory, falsifications paranoid personality disorder [1]4, (3)54 paranoid-schizoid position [3]3 paranoid schizophrenia [1]7 paraphilia [6]1 paraphrenia [6]6 late-onset, sex distribution (5)124 parent, sexual feelings towards [3]3, (6)135 parenting of child and later-life depression (4)107 parietal lobe lesions (2)82, [2]1 non-dominant [4]4 symptoms, in Alzheimer’s disease (5)128 Parkinson disease (3)13 dementia in [6]4 depression in (6)57 lithium and (3)15 parkinsonism [3]80 antipsychotic drug-induced (6)80 drug-resistant, ECT (4)47 paroxetine (6)57 Parson’s sick role (1)116 Paykel ES [6]6 pedunculopontine nuclei and late-onset dementia (5)5 pentazocine (2)75 perfectionism and eating disorders (1)7, (6)157
persecution or victimisation, delusions [2]4, (6)97, [6]3 personality anankastic [3]2 child temperament and (1)119, (2)130 dissocial see antisocial/dissocial personality disorder in DSM-IV (5)17 personality disorders [1]4, [1]9, [3]2, (4)106 borderline see borderline personality disorder end-stage, Diogenes syndrome associated with (5)126 multiple (4)37, (4)38 paranoid [1]4, (3)54 schizoid [1]4, [1]9, (4)157 schizotypal (6)98 petit mal [1]3 phaeochromocytoma [2]10 phantom limb pain (5)54 pharmacology [1]8, (3)82, (3)127, (6)84, [6]2 depot antipsychotics [5]4 elderly (5)132 illicit drugs [5]5 see also specific drugs and pharmacological parameters phase IV trials (4)78 phencyclidine (5)148 phenothiazines and rabbit syndrome (3)125 phenylketonuria [4]5 phobias/fears agoraphobia (2)59, (2)99, (5)52 animals, children (3)23 behaviour therapy (2)124 frigophobia (4)72 social see social anxiety and phobia phobic anxiety depersonalisation syndrome (2)63 phosphate ions and action potential (5)26 Piaget, Jean [1]6, (2)129, (3)22 Pick’s disease [6]4, [6]5 pimozide (2)54, (3)120, (5)70 pindolol (3)111 pipothiazine palmitate [5]3 piracetam (6)78 pituitary hormones, anterior [6]1 pleasure-sensing area, cocaine-related damage (5)97
Index 209
porphyrias (4)56, (4)57 positive outcome modelling (2)110 positive predictive value (6)8 Post F [6]6 post-marketing surveillance (4)78 postnatal/postpartum/puerperal psychiatric disorders counselling in treatment/prevention of (6)133 depression (4)146 psychosis, recurrence (1)73, (4)59 post-traumatic stress disorder (2), (6)117 borderline personality disorder comorbid with (6)58 children (3)27, (6)117 potassium ions and action potential (5)26 power of attorney (4)71 power of study (4)92, (4)112, (5)155, (6)6, (6)18 Prader—(Labhart—)Willi syndrome [4]5 predictive validity (6)13 predictive value negative (5)5 positive (6)8 prefrontal lobe/cortex lesions [4]4 suicide and 5-HT2a receptors in (6)53 pregnancy lithium in (6)118 male partner complaints of obstetric symptoms in (2)114 psychiatric illness immediately after see postnatal disorders smoking in, and ADHD (4)49 tricyclic antidepressants (6)77 Premack principle (1)87, (3)69 pre-operational stage of development (2)129, (3)22 preparedness theory (2)61 primitive states of mind [1]6 primitive thinking in depression [3]1 prisoners epilepsy (6)138 remand (4)140 suicide rate (5)12, (6)76 Pritchard criteria (6)31, (6)79 probability (p) (4)85, (4)92, (6)4, (6)18, (6)19 prolactin [6]1 elevated see hyperprolactinaemia
propranolol (2)116 prospective (cohort) studies [4]3, (6)15, (6)17 pseudobulbar palsy and dementia (5)19 pseudocyesis (2)114 pseudodementia [6]4 co-existing with dementia (1)80 pseudohallucinations (2)22, (2)25 pseudologia phantastica (6)125 psilocybin (6)147 psychiatric interview see interview psychiatric ward crowding and aggression (4)12 psychiatrist, fiduciary relationship with patient (1)77 psychic determinism (4)108 psychoanalysis (analytic therapy; analysis) (3)58, (3)60, (3)61 brief dynamic (3)59, (5)59 cognitive (1)98, (3)63 psychological debriefing (6)133 psychosis (and psychotic symptoms) (6)54 in Alzheimer’s disease, EMG (4)132 apolipoprotein D and (3)114 childhood-onset (4)117, (5)121, (6)54 Cushing’s syndrome and (3)39 depression and see depression epilepsy and (5)13, (6)143 intellectual functioning and (3)84 khat and (1)39 MRI (6)35 neurosis and, borderline between (1)85 nutmeg abuse and (2)66 postpartum/puerperal, recurrence (1)73, (4)59 schizophrenia-like, onset in elderly (5)131 victimising experiences (6)97 vitamin B12 deficiency and (2)35 psychostimulants see stimulants psychotherapy (1)12, (3)51, (3)52, (3)53 in borderline personality disorder (3)117 brief dynamic (3)59, (5)59 see also specific methods publication bias (6)9 puerperal disorders see postnatal disorders punch drunk syndrome [6]5 pyromania (4)51, (5)82
210 Index
QT interval, antipsychotics and (4)42, (6)69 quadrantanopia [2]1 quetiapine for depressive symptoms in psychosis (3)47 rabbit syndrome (1)28, (3)125 randomisation and random sampling (4)86, (5)158 Rapaport’s therapeutic community [2]7 raphe nucleus and serotonin [3]8, [4]6 Raven’s progressive matrices [3]5 Rawlins and Thompson classification of adverse drug reactions (3)83 reaction formation [2]3 reactive mode [2]7 reading retardation (4)21, (4)113 reboxetine [3]6 erectile dysfunction and (5)4 weight change (6)142 recall bias (5)95 recapitulations [3]1 receiver operator curve [4]1 reference, delusions of [2]4 reflex epilepsy [1]3 reflex hallucination (2)26 reinforcement (2)49 relative risk (4)127, (5)156 reliability (test) (5)6, (5)161 REM sleep (5)108 benzodiazepines and [3]8 cocaine and (4)61 dementia with Lewy bodies and [6]5 depression and (1)133, (6)59 dreams and (5)63 lithium and (1)56 risperidone and (2)68 remand prisoners (4)140 renal elimination, lithium (5)66 renal failure chronic, lithium toxicity in (3)119 in neuroleptic malignant syndrome [1]5 renal patients on dialysis see dialysis Renfrew scheme (3)79 reticular formation (5)24 retrospective (case control) studies [4]3, (5)95 Rett’s syndrome (4)162, (6)33 risk absolute, reduction (4)131, (6)6
relative (4)127, (5)157 risk ratio (6)15 risperidone (1)110, (2)68, (3)57, (3)85 dementia and (5)35, (6)91 Ritalin (methylphenidate) (4)97, (5)116 rivastigmine (5)122 Rorschach test (1)88 Roth M (2)63, [6]6 St John’s wort (5)1, (6)51 St Louis hysteria see somatisation disorder saltatory nerve conduction (5)7 sampling random (4)86 size of sample (6)19 schizoid personality disorder [1]4, [1]9, (4)157 schizophrenia (1)118, [1]7, [6]6 Afro-Caribbeans (4)161 asyndetic thinking and (2)89 autism and (2)53 cannabis and (3)42, (3)95 childhood-onset psychosis and (4)117, (5)121, (6)54 cognitive impairment (4)152, (6)85 disulfiram and (1)24 drug treatment and treatment-resistance see neuroleptic drugs eicosapentaenoic acid and (1)42 family intervention (3)116 family therapy (5)42 first-rank symptoms and (4)120 gender and age of onset (3)21 genetic factors (1)70, (3)92 grey matter and (3)97, (5)49 hallucinations (2)112 hebephrenic (3)12 incidence (5)57 in learning-disabled (5)68 Liddle’s classification (1)108 memory impairment (3)64 muscarinic receptors and (3)18 negative symptoms see negative symptoms neurocognitive subtype (3)64 obstructive sleep apnoea and (4)10 P300 latency in (4)11 paternal age and (1)63 prevalence (2)2
Index 211
prodromal, pHVA levels (4)6 prognosis/outcome in developing countries (3)8 indicators (2)106, (2)107 recurrence rate after first episode (3)91 skin-conductance-orientating response to novel stimuli (4)123 smoking and (1)43 social causation (4)121 social drift hypothesis (4)121 steroids in (5)60 suicide and (1)112, (3)40 Veraguth’s fold (1)35 very-late onset (5)131 violent crime (4)138 schizotypal personality disorder (6)98 Schneider, Kurt [1]6 school refusal [5]2 and academic underachievement (3)1 SCOFF questionnaire (3)103 seasonal affective disorder (incl. winter depression) (1)79, (6)149, (6)150 seizures (and ictal phenomenon) [1]3 alcohol misuse and (3)45 antipsychotics (atypical) and (6)88 in ECT (1)129, (3)36, (4)33, (6)99 partial (3)110, (6)143 psychosis and (5)13, (6)143 violence and (4)134 see also epilepsy selection bias (5)154, (6)17 selective abstraction [2]2 selective noradrenergic re-uptake inhibitor [3]6 selective serotonin re-uptake inhibitors [3]6, (4)45 arthralgia with (6)106 elderly (6)75 erectile dysfunction and (5)4, (5)151 hyponatraemia and (5)39 in obsessive—compulsive disorder (1)54 Parkinson’s disease patients (6)57 premature ejaculation with (6)122 with serotonin receptor antagonist activity (3)93, [3]6 in social phobia (4)164 selegiline in depression, transdermal (6)61 self-focused attention, anxiety (6)37 self-injurious behaviour (1)52, (3)34
borderline personality disorder (6)148 see also trichotillomania semantic memory (3)74 senile squalor (Diogenes) syndrome (4)70 separation (from mother) (2)40, (3)71 anxiety on (1)48 septohippocampal formation (5)34 serotonin syndrome (4)58 see also 5-hydroxytryptamine sertraline (3)2 sex addiction and substance misuse (4)16 sex offenders (4)136, (6)146 sexual abuse (5)142 sexual activity and bulimia (3)17 sexual behaviour, variant/unusual [6]3 sexual characteristics, undeveloped secondary [4]5 sexual dysfunction men see ejaculation, premature; erectile dysfunction women (4)109, (5)22, (5)23 sexual exhibitionism (5)85 sexual feelings towards parents [3]3, (6)135 sexual pleasure and fire-setting (5)82 Shapiro, Francine (4)105 shoplifting (4)100, (4)110, (4)114 anorexia nervosa and (5)101 sibling rivalry disorder (6)155 sick role, Parson’s (1)116 significance (statistical) (4)84, (4)91, (6)5, (6)6 sildenafil (1)45, (2)57, (5)151, (6)40 single photon emission computed tomography (4)17 skewed distributions (4)89, (4)90, (5)159 Skinner BF (3)65 sleep cocaine and (4)61 disorders (2)36, (2)56, (2)76, (3)29, (3)80, (5)51, (6)144 melatonin and (1)91 paradoxical (5)32 reticular formation and (5)24 sawtooth waves (4)125 tics and (5)118 various drugs in (1)55, (1)56, [3]8 see also dreams; night terrors; nightmares; REM sleep
212 Index
sleep apnoea, obstructive, schizophrenia and (4)10 sleep/wake cycle and delirium (5)73 sleep walking (5)31, (5)64 smoking clozapine and (3)28 in pregnancy, and ADHD (4)49 schizophrenia and (1)43 social anxiety and phobia (2)125, (6)37, (6)131 comorbid with anorexia nervosa (1)103 drug therapy (4)164 social drift hypothesis, schizophrenia (4)121 social facilitation (2)110 social learning (3)66 social rhythm in mania episodes (4)15 socioeconomic factors schizophrenia (4)121 suicide (6)139 Socratic questioning (2)42, (5)80 sodium ion channels (5)8 action potential and (5)26 and carbamazepine (3)107 sodium lactate and panic symptoms (1)121 sodium valproate (1)31, (1)51, (6)38 GABA hydroxylase and (3)108 see also Divalproex somatisation disorder (Briquet’s syndrome; St Louis hysteria) (1)61, (2)97 caudate nuclei (6)51 somatopagnosia (1)40 somnambulism (sleep walking) (5)31, (5)64 Spearman’s g [3]5 SPECT (4)17 spectinomycin and lithium (3)118 speech (and language) development (3)67 in autism, prognostic value (5)114 delay (1)99, (5)114, (5)115 disorders (2)113, [2]1, [3]9, (6)153 speedballs (1)89 spinal artery, anterior (5)45 sport, performance anxiety (5)141 ‘stages of change’ model (1)68 stagnation vs generativity (3)70 standard deviation (4)83, (6)6 statistics (4)79, (4)83–92, (4)112, [4]1, (5)58, (5)152–65, [5]6, (6)1–20
Sternbach’s diagnostic criteria (4)58 steroids mania induced by (3)132 in schizophrenia (5)60 stimulants (CNS) (4)97, (5)116, (5)146 abuse (5)15 cognitive performance and (6)21 in hyperactivity (6)21 in attention deficit hyperactivity disorder see attention deficit hyperactivity disorder striatonigral pathway [6]1 stroke depression and (4)44 risperidone-related risk, in elderly with dementia (6)91 Stroop test (3)30, (5)50 subacute sclerosing panencephalitis (4)153 sublimation [2]3 substance P [6]1 substance use see drugs, abused substantia nigra (5)36 suicide (1)93 anorexia nervosa and (3)106 attempted (1)94, (2)30 bipolar patients (4)28 in comorbid anxiety and depression (1)9 elderly see elderly family history of (3)101 farmers (2)65 fluoxetine and (2)37 gender and (2)88 haemodialysis patients (1)74 5-HT2a receptors and (6)53 Japan, rate (3)87 marital status and (1)121 maternal (4)82 migraine and (6)96 obsessive—compulsive disorder and (2)86 paracetamol overdose (1)20 prisoners (5)12, (6)76 psychiatric interviewing and (2)70 schizophrenia and (1)112, (3)40 unemployment and (6)139 wartime (1)11 sulpiride [3]4 superego (2)9, [3]2, [3]3 superior mesenteric artery syndrome (4)2 susto (1)21
Index 213
suxamethonium (4)33 syphilis, neurological (4)25, [5]1, (6)119, (6)137 systematic error (5)164 systematic review (4)130 tactile hallucinations (2)71, (5)129 tardive dyskinesia (2)51, (2)85, (3)89, (3)90 negative symptoms as risk factor for (1)59 tau protein (5)44, (6)41 lithium and (5)77 temazepam [5]5 temporal lobe epilepsy (5)47, (5)75 temporal lobe lesions [2]1 Klüver-Bucy syndrome and (3)130 testamentary capacity (4)142 testes, abnormally large (macroorchidism) [4]5 tetrachloroethylene (1)19 tetrahydrocannabinol (5)145 tics and (5)3 Thematic Apperception Test (1)88 theory of mind and autism (5)94 therapeutic communities [2]7 leaving in 1st month (2)38 therapeutic factors Foulke’s group therapeutic factors [2]7 Yaloms’ [2]7 theta activity [3]10 antidepressants and (4)116 thioridazine (6)69 thioxanthene [3]3 Thurstone LL (2)14, (2)47, [2]6 thyroid antibodies (4)30 lithium effects (6)165 tiagabine (3)126 tics (5)3, (5)118, [5]2 children (5)70, (5)117, [5]2 tooth caries and antidepressants (5)78 topiramate (2)48, (4)101, (4)102 Tourette’s syndrome (2)95, (4)155, (5)25, (5)69 Tower of London Test (2)55 tramadol (6)107 transcranial magnetic stimulation (5)112 transference (3)58, (3)59 transitional object (2)131
transpeople (6)100 transsexualism (1)62, [3]2, (6)100 tranylcypromine and tricyclic antidepressants (5)111 traumatic event, sensitivity to/psychiatric pathology following see post-traumatic stress disorder trazodone (3)121 trials, clinical (4)78 double-blind (6)11 dropouts, in intention-to-treat analysis (4)88 trichotillomania (1)47, (4)99 tricyclic antidepressants (1)38, (2)100, (3)35 attention deficit hyperactivity disorder (4)65 childhood depression and (5)119 disulfiram and (1)107 obsessive—compulsive disorder and (1)54 in pregnancy (6)77 QT interval and (6)71 tranylcypromine and (5)111 trihexyphenidyl (6)80 trinucleotide repeat, Huntington’s disease (6)48 trisomy 21 see Down’s syndrome tryptophan depletion in depression (6)151 L-tryptophan use [3]6, (4)31 tuberous sclerosis [4]5, [5]3 twilight states (5)30 epileptic (4)124 type I error (6)3, (6)4 type II error (4)92, (6)10, (6)18 ultra- and ultra-ultra-rapid cycling bipolar disorder (6)128 unemployment and suicide (6)139 universality [2]8 urinary incontinence see enuresis vaginismus (4)109 validity (5)6, (6)12 construct (6)13 face (5)153 incremental (5)152 valproate and valproic acid see Divalproex; sodium valproate variables (6)1, (6)2
214 Index
variance (4)83 analysis of see ANOVA vascular dementia (6)45, [6]4 vasopressin [6]1 appetite and (4)54 venlafaxine [3]6 adverse effects (5)39, (5)103, (5)105 ventricles see cerebral ventricles verbal memory and ECT (3)77 Viagra (sildenafil) (1)45, (2)57, (5)151, (6)40 vicarious learning (2)45 victim empathy, sex offenders (6)146 victimisation/persecution, experiences of [2]4, (6)97, [6]3 vigabatrin (3)110, [3]4 violence akathisia and (1)67 ictal phenomenon and (4)134 schizophrenia and (4)138 twilight states and (5)30 visual agnosia, test for [1]10 visual hallucinations (2)71, (2)92, (2)112, (5)139 vitamin B12 deficiency (2)35 vitamin E and Alzheimer’s disease (6)109 vitamin K2 (2)32 volume of distribution [6]2 von Recklinghausen’s disease [5]3 weight (body) change antipsychotics (2)19, (5)55 cocaine intoxication [3]7
reboxetine (6)142 topiramate (2)48, (4)102 low, as risk factor for antidepressant-induced hyponatraemia (6)130 Wernicke’s aphasia [2]1 Wernicke’s encephalopathy (2)103, (5)136, (6)66 Weschler Adult Intelligence Scale (2)5 Weschler Preschool and Primary Scale of Intelligence [3]5 Whitaker, Dorothy Stock [2]7 WHO ‘5 well-being index’ (3)7 Wilcoxon test (5)58, [5]6 Wilson’s disease [2]10, (5)46 Winnicott, Donald W (2)15, (2)131 winter depression (and seasonal affective disorder) (1)79, (6)149, (6)150 withdrawal syndrome see dependence wolf delusion (6)163 World Health Organization ‘5 well-being index’ (3)7 XXY syndrome (4)68, [4]5 Yalom, Irvin [1]6, [2]7 Yerkes—Dodson’s theories of motivation (2)34 Z test and Z statistic (5)157 zero-order kinetics [1]8, [6]2 zopiclone (1)55 zotepine (6)88 zuclopenthixol acetate and decanoate [5]3
