A1.1.3 Sociocultural Psychiatry Flashcards
Insanity sometimes is the sane response to an insane society. This was proposed by
Select one: R.D. Laing Anthony Cleare Thomas Szasz Foucault Phillip Pinel
RD Laing was a prominent anti-psychiatrist who wrote ‘The Divided Self’.
The correct answer is: R.D. Laing
Which of the following is NOT true concerning research ethics?
Select one:
Subjects can be recruited by contacting medical colleagues
Written approval must be obtained from ethics committees
Advertisements can be used to recruit subjects
Financial incentives can be offered for subjects to participate in research
A subject is ethically bound to complete a study after giving written informed consent
Subjects, both healthy controls and patients, are reimbursed for their participation in research.
But signing a consent form does not mean that they cannot discontinue the study during its course.
The correct answer is: A subject is ethically bound to complete a study after giving written informed consent
What is the number of women that have been reported being amputated in the genital area?
Select one: 10 millions 1 million 100 millions 10000 100, 000
WHO has estimated that 100 to 140 million girls and women worldwide are currently living with the consequences of FGM.
The correct answer is: 100 millions
In prematurely born infants, after which week of pregnancy are we legally able to resuscitate an infant irrespective of parental wishes?
Select one: 22 wks 16 wks 20 wks 21 wks 24 wks
In United Kingdom women have access to termination of pregnancy for maternal reasons until 24 weeks completed gestation; so it is rational children born at or beyond 25 weeks gestation are treated according to the child’s perceived best interests even if this is not in accordance with parental wishes. There is no legislation imposing an age limit in UK for resuscitating premature babies as of now.
The correct answer is: 24 wks
In clinical psychiatric population which of the following disorders is more common in higher social classes?
Select one: Autism Anorexia Nervosa Bulimia Nervosa ADHD Schizophrenia
For a long time now it is debated whether the social class differences in anorexia reflects help seeking or referral patterns only or the actual disease prevalence. Reappraisal of socioeconomic status from clinical data in anorexia shows that the social class distribution is consistently weighted toward social classes 1/2. Community studies have shown that the social class, professional status, and education were not associated with an increased risk of reporting an eating disorder in such community samples.
The correct answer is: Anorexia Nervosa
Partial adaptation of a new culture without giving up one’s culture of origin completely is called
Select one: Acculturation Sojourning Enculturation Accommodation Assimilation
Enculturation: This refers to culture being learnt through contact with family, friends, classmates, teachers and the media. This happens in everyone irrespective of migration, etc. Assimilation refers to the partial adaptation of a new culture (seen in immigrants or refugees) without giving up one’s culture of origin completely.
The correct answer is: Assimilation
The term refrigerator mother is associated with which of the following mental illness?
Select one: Autism Panic disorder Schizophrenia ADHD Depression
Mothers with autistic children were blamed to be ‘refrigerator mothers’ who ‘defrosted just enough to produce a baby’ but remained emotionally cold, inflexible and lacking warmth in the parental relationship. This theory has been widely discussed and refuted as no proof exists to support this claim.
The correct answer is: Autism
Institutional neurosis was described by
Select one: Pavlov Goffman Barton Parsons Pilowsky
Russell Barton (1976) described ‘institutional neurosis’, characterized by symptoms such as apathy, lack of initiative, loss of interest and submissiveness. Factors attributed to this state include loss of contact with the outside world, enforced idleness, brutality and bossiness of staff, loss of friends and personal possessions, poor ward atmosphere and loss of prospects outside the institution.
The correct answer is: Barton
The four prima facie ethical principles were promulgated by
Select one: Charaka Beauchamp and Childress Hippocrates Galen Aristotle
The prima facie principles were promulgated by Beauchamp and Childress.
The correct answer is: Beauchamp and Childress
Which of the following risk factor is likely to be causative in a young man diagnosed with schizophrenia?
Select one: Having lost his mother before the age of 14 Being a migrant Living alone Alcohol use HLADR2 gene
Immigration is one of the strongest known risk factors for schizophrenia.
The correct answer is: Being a migrant
Which class of psychotropic medication are the most likely ones to impair driving performance?
Select one: Antipsychotics Psychostimulants Mood stabilizers Benzodiazepines Antidepressants
All drugs acting on the central nervous system can impair alertness, concentration and driving performance. This is particularly so at the initiation of treatment or soon after and when the dosage is being increased. Driving must cease if adversely affected.
The correct answer is: Benzodiazepines
Which one among the following is classified under higher-level principle?
Select one: Maleficence Justice Beneficience Respect for autonomy Best interests
Higher level principles include Deontology (Rights and duties or Rules) and Teleology (practice based on best interests / outcomes). The prima-facie principles (constituting the ethical principlism) are lower level principles.
The correct answer is: Best interests
When a psychiatric patient is unwell, family and friends report their actions to mental health professionals in an attempt to get them admitted to an institution. What was the term used by Goffman to describe it?
Select one: Role stripping Batch living Institutional neurosis Mortification Betrayal funnel
Goffman also described the social/moral career of a mental patient. i.e., the process whereby a person with social ties, friends, and family in the community is institutionalized and converted into an inmate whose world is limited to his immediate hospital ambience. (Peele et al. 1977). The first step is process by which patients pass through a ‘betrayal funnel’, as the people they trust most family and friends conspire against them, reporting their actions to doctors and mental health professionals (called the ‘circuit of agents’) who run the decision-making process.
The correct answer is: Betrayal funnel
An Asian immigrant in England is observed to practice his religion and cultural traditions at home but adapts well especially at work with a good degree of fluency in both English and his native language. This type of enculturation is called
Select one: Accommodation Assimiliation Melting Pot Biculturalism Bisection
The acculturative process involves acquisition and retention as well as relinquishing attitudes/values and practices in both majority and minority populations that continue over several generations. The rate of change and the circumstances that influence it vary greatly, both between and within groups. For these reasons, studies of groups experiencing acculturative change often divide the groups by temporal experience into first-, second-, and third-generation immigrants. Families within such groups have been categorized as traditional, transitional, or bicultural. Traditional families are characterized as using their native tongues rather than English, living in ethnic enclaves, avoiding interaction with majority cultural institutions, and maintaining preimmigration values and behaviors. Transitional families are characterized by greater fluency in the language of the host culture and by children who are becoming familiar with the values and social behaviors of the dominant majority population through attendance at school and school-related activities. Bicultural families are defined as those with a high degree of language fluency in their native languages as well as English, economic stability, and residence in multiethnic settings. Biculturalism appears to be more adaptive and associated with minimal acculturation stress.
The correct answer is: Biculturalism
In which of the following disorder an overrepresentation of higher social class is seen in brothers and children of the patients?
Select one: Anorexia nervosa Bipolar disorder Alcoholism Depressive disorder Antisocial personality
An overrepresentation is found in the higher occupational class in bipolar probands’ brothers and children. It is consistently noted that the family of origin in bipolar probands belong to a higher social class thought the patients themselves might be at a lower social class. A study (Tsuchiya et al. 2004) that examined the above phenomenon in two merged Danish registers had nearly 950 probands and 50 matched control for each case. The results of this study clearly showed that higher social class of parents together with longer paternal education history and larger possession of wealth increased the risk of bipolar disorder in the offspring. It is speculated that bipolar genes may offer some survival benefits such as excessive creativity or productivity which uplifts the families to higher social status
The correct answer is: Bipolar disorder
Which of the following is a semi-structured interview that can be used to gather information regarding expressed emotions from family members of a patient with psychosis?
Select one: Camberwell Family Interview LEDS Inventory Brown & Harris Family Interview Cambridge Family Interview Holmes & Rahe Inventory
Camberwell Family Interview is a semi-structured interview carried out with relatives of patients with Schizophrenia.
The correct answer is: Camberwell Family Interview
Torts are wrongs for which a person is liable in
Select one: Court of Protection Civil law Both Civil and criminal Law Criminal Law Military Law
Torts are errors for which a person is liable in civil as opposed to criminal law. They include negligence, libel, slander, trespass and nuisance. If a person of unsound mind commits a wrong, then any damages awarded in a court of law are usually only nominal.
The correct answer is: Civil law
Major recurring themes behind the stigma against mental illness includes all except
Select one: Blaming Cost of treatment required Poor prognosis Disruption of social interaction Dangerousness
Hayward and Bright described four major recurring themes or beliefs behind the stigma against mental illness. These include 1.Dangerousness 2.Attribution of responsibility 3.Poor prognosis 4. Disruption of social interaction
The correct answer is: Cost of treatment required
Melting pot model refers to which of the following types of countries?
Select one:
Countries with increasing immigration trend
Countries with no immigration
Countries with zero population growth
Countries with high population attrition due to emigration
Countries with negative population growth
The United States is often quoted as a Melting Pot of various immigrant societies.
The correct answer is: Countries with increasing immigration trend
A 12-year-old girl is called by names at her school after her dad’s admission at the local psychiatric hospital. This is called
Select one: NIMBY opposition Self stigma Nosophobia Courtesy stigma Stereotyping
Family and friends may endure a stigma by association, the so-called courtesy stigma (Goffman, 1963). Courtesy stigma refers to the stigmatization an unaffected person experiences due to his or her relationship with a person who bears a stigma. Parents of children with psychiatric conditions are particularly vulnerable to courtesy stigma.
The correct answer is: Courtesy stigma
A boy whose mother has depression has a high likelihood to develop one of the following conditions before age 20?
Select one: Schizophreniform illness OCD Borderline personality disorder Alcohol use disorder Depression
The strongest risk factor for depression is a personal or family history of depression.
The correct answer is: Depression
Which of the following increases the likelihood that a patient with a particular disease gets stigmatized?
Select one:
Disease is well concealable
Disease is thought to be inflicted by an external agent
Disease leads to disruption in social interactions
Disease elicits pity but no disgust in others
Disease is reversible
Disruptiveness indicates the extent to which a disease strains or obstructs interpersonal interactions. The degree of stigmatisation is directly proportional to the degree of disruption in social interaction produced by the condition.
The correct answer is: Disease leads to disruption in social interactions
According to Holmes and Rahe social readjustment scale, which of the following has the highest life change value?
Select one: Birth of a child Personal injury Marriage Road traffic offence Divorce
The Holmes-Rahe scale rates 43 life events by units. After the death of one’s spouse (100 units worth), divorce tops the rest of the stressors list and generates about 73 units.
The correct answer is: Divorce
A patient refuses to have a nasogastric intubation after an overdose, and the AandE consultant feels this procedure is potentially lifesaving and complies with expected standard of care. The best course of action is
Select one:
Refer the patient to a psychiatrist
Do not perform the procedure if the patient is determined to have the capacity to make this decision
Assume that the patient does not have the capacity to decide whether to have the procedure or not
Try repeatedly and convince the patient that the procedure is necessary until they eventually consent
Sedate the patient first and then carry out the procedure
Patients have the right to refuse medical care, even when it seems medically necessary to save their life. The risks and benefits of accepting or refusing the procedure must be explained to and understood by the patient in order for them to make an informed decision about such a refusal. If they show good under- standing of the risks and benefits, then they have the capacity to decide. Bullying them into changing their mind is inappropriate, although they should be made aware that the procedure will likely still be made available to them at a later date should they voluntarily change their mind about having it done. A psychiatry consult may be helpful in this case if there is concern that an underlying mental illness is affecting the patient’s judgment but is not necessary for determining the patient’s capacity to make this decision.
The correct answer is: Do not perform the procedure if the patient is determined to have the capacity to make this decision
Which of the following is regarded as ‘Father of Sociology’?
Select one: Talcott Parsons Jean-Paul Sartre Soren Kierkegaard William Tuke Emil Durkheim
Emile Durkheim, a French journalist, formally established the study of sociology. He is often thought of as the ‘Father of Sociology’. Auguste Comte, who devised a system of societal reform and advanced the study of sociology, is also claimed as the Father of Sociology by some.
The correct answer is: Emil Durkheim
One year after losing her job of 15 years, a depressed woman gets another job but unfortunately within two weeks she loses the new job. She feels ‘stuck in her life’. Which of the following category does this event belong?
Select one: Loss Entrapment Threat Danger Humiliation
Entrapment includes long-term sustained entrapment includes serious difficulties that can only get worse or persist according to the subject; or a failed positive event where a potential fresh start went disastrously wrong within 1-2 wk, leaving the person stuck in square one.
The correct answer is: Entrapment
A West African student presents with lethargy, insomnia, palpitation and anxiety. Choose one culture-bound syndrome:
Select one: Windigo Dhat Latah Piblokto Fag
The ‘brain fag’ syndrome, which was first reported from West Africa in 1960 among students, has been shown to occur very widely in African students in western educational systems south of the Sahara. Seen predominantly in male students, it generally manifests as vague somatic symptoms, depression, and difficulty concentrating.
The correct answer is: Fag
A patient admitted at an inpatient unit is making steady progress. But his symptoms worsen whenever he comes back from home leave. His mother criticises him of being very reluctant and lazy to get involved in ‘normal life’. The next step in management must consider
Select one: Behavioural therapy Increase antipsychotic dose Family therapy Detention Antidepressant drugs
Classical studies by Brown et al., and Vaughn and Leff indicated four times higher relapse rates for patients with schizophrenia who were discharged to parents who were hostile, critical, or overly involved (high Expressed emotions - EE), compared to patients whose parents who did not behave this way. A greater degree of patient adjustment and decreased relapse are associated with higher levels of family tolerance (Spiegel and Wissle, 1986). Family therapy can help reduce the EE.
The correct answer is: Family therapy
The concept of schizophrenogenic-mother was proposed by
Select one: Lidz Fromm-Reichmann Rutter Bateson Wynne
The concept of schizophrenogenic-mother was coined by Freida Fromm-Reichmann. These mothers were described to be ‘rejecting, impervious to the feelings of others, rigid in moralism concerning sex and had a significant fear of intimacy’.
The correct answer is: Fromm-Reichmann
The term total institution is associated with
Select one: Szasz Foucault Thomas Hardy Jacques Lacan Goffmann
A total institution is a place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life. The term was coined and defined by American sociologist Erving Goffman in his 1961 work Asylums.
The correct answer is: Goffmann
Which of the following aspects best describes one’s ethnicity?
Select one: social activities genetic factors group identification their appearance values and beliefs
Race is perceived as a permanent entity determined by genetic ancestry and characterized by physical appearance. Culture is perceived as a changeable entity determined by upbringing and choice and characterized by behaviours and attitudes. Ethnicity is perceived as partially changeable entity determined by social pressure and psychological need characterized by a sense of group identity and belonging.
The correct answer is: group identification
Which of the following is NOT a vulnerability factor for depression in Brown and Harris study?
Select one:
Having a long standing physical illness
Lack of employment outside home
Absence of a close confiding relationship
Loss of mother before age of 11
Having 3 or more children under 15 living at home
Social and economic circumstances associated with the onset of depression in women living in inner urban London were studied by Brown and Harris in 1978. They identified four vulnerability factors: 1. absence of a close confiding relationship; 2. loss of the mother before the age of 11; 3. lack of employment outside the home; 4. Having 3 or more children under 15 living at home.
The correct answer is: Having a long standing physical illness
Which of the following describes the code of ethical recommendations used currently to guide clinical research worldwide?
Select one: Tuskegee code GMC guidance Mt Sinai declaration Nuremburg Code Helsinki declaration
Helsinki declaration contains the current research ethics code in practice. The Helsinki Declaration adopted by the 18th World Medical Association General Assembly in 1964 and has been amended five times since, most recently in 2000. Notes of clarification were added in 2002 and 2004. The current (2004) version is the only official one. Currently since 2007 another revision has been initiated and consultation is open as of April 2008.
The correct answer is: Helsinki declaration
A depressed 55-year-old man reports a high amount of adverse life events, but no positive events preceding his first episode of depression. Which of the following explanation is NOT correct?
Select one:
His depression is probably due to absence of positive life events
Social adversity experienced from an event depends on contextual rating by the patient
Recurrent episodes have less preceding life events than the first episode
Stressful life events have established association with depressive disorder
He is recalling more stressful life events due to cognitive bias
Depressed patients may recall more stressful life events due to cognitive bias. It is shown that the frequency of desirable (or entrance life events) was comparable in controls and the depressed population; so the absence of positive events cannot be the simple explanation for depression. It is demonstrated that those with a recurrent episode of depression have less preceding life events than those with a first episode of depression. This may be related to kindling phenomenon.
The correct answer is: His depression is probably due to absence of positive life events
Which of the following type of life events predicts the onset of pure depressive illness?
Select one: Humiliation Threat Danger Entrapment Loss
Combined loss and humiliation events are more depressogenic than a threat or other individual types of events. Humiliation events induce defeat and submission responses that may be directly related to depression. In a study by Kendler et al. (2003), humiliation predicted onsets of pure major depression but not pure generalised anxiety episodes, and danger predicted pure generalised anxiety but not pure major depression episodes. But the results had only moderate strength in prediction.
The correct answer is: Humiliation
A 40-year-old man has chest pain and dizziness but his blood tests and ECG are normal. He is advised to take medications, fat-restricted diet, exercise. This is called
Select one: Sick role Illness Depression Worried well Illness behaviour
The concept of illness behaviour was largely defined and adopted during the second half of the twentieth century. Broadly speaking, it is any behavior undertaken by an individual who feels ill to relieve that experience or to better define the meaning of the illness experience.
The correct answer is: Illness behaviour
