A1.1.3 Sociocultural Psychiatry

Question 1

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

Answer 1

RD Laing was a prominent anti-psychiatrist who wrote ‘The Divided Self’.

The correct answer is: R.D. Laing

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

Partial adaptation of a new culture without giving up one’s culture of origin completely is called

Select one:
Acculturation
Sojourning
Enculturation
Accommodation
Assimilation

Answer 6

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

Question 7

The term refrigerator mother is associated with which of the following mental illness?

Select one:
Autism
Panic disorder
Schizophrenia
ADHD
Depression

Answer 7

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

Question 8

Institutional neurosis was described by

Select one:
Pavlov
Goffman
Barton
Parsons
Pilowsky

Answer 8

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

Question 9

The four prima facie ethical principles were promulgated by

Select one:
Charaka
Beauchamp and Childress
Hippocrates
Galen
Aristotle

Answer 9

The prima facie principles were promulgated by Beauchamp and Childress.

The correct answer is: Beauchamp and Childress

Question 10

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

Answer 10

Immigration is one of the strongest known risk factors for schizophrenia.

The correct answer is: Being a migrant

Question 11

Which class of psychotropic medication are the most likely ones to impair driving performance?

Select one:
Antipsychotics
Psychostimulants
Mood stabilizers
Benzodiazepines
Antidepressants

Answer 11

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

Question 12

Which one among the following is classified under higher-level principle?

Select one:
Maleficence
Justice
Beneficience
Respect for autonomy
Best interests

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Camberwell Family Interview is a semi-structured interview carried out with relatives of patients with Schizophrenia.

The correct answer is: Camberwell Family Interview

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

The United States is often quoted as a Melting Pot of various immigrant societies.

The correct answer is: Countries with increasing immigration trend

Question 20

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

Answer 20

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

Question 21

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

Answer 21

The strongest risk factor for depression is a personal or family history of depression.

The correct answer is: Depression

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

Which of the following is regarded as 'Father of Sociology'? ``` Select one: Talcott Parsons Jean-Paul Sartre Soren Kierkegaard William Tuke Emil Durkheim ```

Answer 25

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

Question 26

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 ```

Answer 26

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

Question 27

A West African student presents with lethargy, insomnia, palpitation and anxiety. Choose one culture-bound syndrome: ``` Select one: Windigo Dhat Latah Piblokto Fag ```

Answer 27

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

Question 28

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 ```

Answer 28

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

Question 29

The concept of schizophrenogenic-mother was proposed by ``` Select one: Lidz Fromm-Reichmann Rutter Bateson Wynne ```

Answer 29

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

Question 30

The term total institution is associated with ``` Select one: Szasz Foucault Thomas Hardy Jacques Lacan Goffmann ```

Answer 30

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

Question 31

Which of the following aspects best describes one's ethnicity? ``` Select one: social activities genetic factors group identification their appearance values and beliefs ```

Answer 31

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

Question 32

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

Answer 32

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

Question 33

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 ```

Answer 33

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

Question 34

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

Answer 34

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

Question 35

Which of the following type of life events predicts the onset of pure depressive illness? ``` Select one: Humiliation Threat Danger Entrapment Loss ```

Answer 35

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

Question 36

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 ```

Answer 36

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

Question 37

Best evidence base to decrease alcohol harm is ``` Select one: Education of public about harm of alcohol Interventions in drinking environments Increasing the price of alcohol Extending the times of sales Media-advocacy ```

Answer 37

When other factors are held constant, such as income and the price of other goods, a rise in alcohol prices leads to less alcohol consumption and vice versa. Price increases reduce the harms caused by alcohol and can also indicate that heavier drinking has been reduced. Policies that increase alcohol prices delay the initiation of drinking, slow young people's progression towards drinking larger amounts and reduce heavy drinking among them. Setting a minimum price per gram of alcohol can be as effective as an across- the-board increase in tax, with both options costing heavy consumers far in excess of the cost to light consumers. Natural experiments in Europe consequent to economic treaties have shown that as alcohol taxes and prices have gone down, so sales and alcohol consumption have usually increased. (From Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm, WHO 2009). The correct answer is: Increasing the price of alcohol

Question 38

Which of the following statements about Camberwell family interview is not true? Select one: It includes positive comments The rating is based on content and vocal tone It is carried out with patient It is a semi-structured standard interview It assess expressed emotions

Answer 38

It is a semi-structured interview carried out with relatives of patients with Schizophrenia. The correct answer is: It is carried out with patient

Question 39

Which of the following is true with regards to Changing Minds campaign? Select one: It is not a part of Care Programme Approach It provides a legal clause against stigma It is an initiative from World Health Organisation It is focussed on geriatric mental health issues It is an ongoing programme against stigma

Answer 39

Concern about the stigma of mental illness culminated in the Royal College of Psychiatrists' 5-year 'Changing Minds' campaign (1998-2003) whose aim was to promote positive images of mental illness, challenge misrepresentations and discrimination, encourage patient advocacy and educate the public about the real nature and treatability of mental disorder (Crisp et al, 2000) The correct answer is: It is not a part of Care Programme Approach

Question 40

The following are true in relation to the biopsychosocial model except Select one: It is based on the fact that each system is at the same time a component of higher system The hierarchy and continuum of natural systems were discussed to explain biopsychosocial model It is based on systems theory It is similar to biomedical model It was proposed by George Engel

Answer 40

The biopsychosocial model is a systems theory-based explanation of disease models. It is not similar to the biomedical model. Engel GL. The clinical application of the biopsychosocial model. Am J Psych May 1980; 137(5):535-44. The correct answer is: It is similar to biomedical model

Question 41

The phenomenon of relative deprivation is explained by ``` Select one: Barthel index Jarmen index Brian Index Jasper Index Haschinski index ```

Answer 41

A scoring system developed by the British general practitioner Brian Jarman for the level of social deprivation in a community, using census data on percentages of old people living alone, single-parent families, children younger than 5 years of age, unskilled and unemployed persons, ethnic minorities, overcrowded dwellings, changes of address in previous year, etc. Although a valid indicator, it is not generally accepted outside the United Kingdom. The correct answer is: Jarmen index

Question 42

Which of the following describes an extreme anxiety symptom where a person thinks that his penis is shrinking into his abdomen, and he may die as a result? ``` Select one: Fag Koro Dhat Amok Latah ```

Answer 42

Koro is known as genital retraction syndrome. When affected, patients believe that their genitals will be completely sucked into the body, causing death. While this condition occasionally occurs in women, it is much more common in men. Koro is a considered a culture-bound syndrome, meaning that it only occurs in certain cultures and does not directly correspond with diseases or conditions recognised by Western medicine. It is most common in China, Southeast Asia, and Malaysia, although outbreaks have occurred in Africa as well. The condition tends to have a different name in every region. For example, the Chinese term of 'suo yang' translates as 'shrinking penis'. The correct answer is: Koro

Question 43

Understanding the impact of a life event in light of one's current social context and self-perspective is called contextual rating of social adversity. Which of the following employs the above method? ``` Select one: Holmes and Rahe social adjustment scale Life cycle chart Impact of Events scale Life events and difficulties schedule Sociogram ```

Answer 43

Life events can be measured using standard scores for each type of life event (e.g. Marriage 100, divorce 90 etc). Brown and Harris popularized a different method whereby life events are graded according to the inherent meaning of the events to the individual concerned i.e. contextual rating of the social adversity. Accordingly the effect and impact of a life event is understood in light of one's current social context and self-perspective. LEDS=Life Events and Difficulties Schedule was devised by Brown and Harris. The correct answer is: Life events and difficulties schedule

Question 44

Which of the following ethical principles is not associated with Charaka? ``` Select one: Compassion towards patients Updating medical knowledge Sympathy towards the sick Maintaining medical records Confidentiality ```

Answer 44

Charaka promoted 4 Cs - confidentiality, caring practice, continuous professional development and compassion. The correct answer is: Maintaining medical records

Question 45

A 40-year-old man received inpatient detoxification two weeks ago and since then has been staying away from alcohol use. According to Prochaska's model, which stage is he in? ``` Select one: Maintenance Action Relapse Contemplation Precontemplation stage ```

Answer 45

The maintenance stage is the phase wherein the person strives to maintain gains made and while attempting to improve those areas of life harmed by drug use. The correct answer is: Maintenance

Question 46

A clinician refuses to prescribe clozapine to an elderly lady with resistant schizophrenia as she had developed neutropenia 13 years ago when it was first prescribed to her. Which of the following ethical principle is maintained here? ``` Select one: Non maleficience Autonomy Beneficience Justice Teleology ```

Answer 46

American philosophers Tom Beauchamp and James Childress and British doctor and philosopher Raanon Gillon pioneered the following prima facie principles: Non-maleficence refers to avoiding harm (primum non nocere). The correct answer is: Non maleficience

Question 47

Which of the following syndromes refer to the fear of cold seen in Chinese men? ``` Select one: Pa-Leng Koro Piblokto Shenkui Amok ```

Answer 47

Pa-Leng is a form of frigophobia seen in China. It is more common in men. The correct answer is: Pa-Leng

Question 48

A doctor carries out what is best for the patient, regardless of patient's own wishes. This approach can be termed as ``` Select one: utilitarianism maternalism paternalism deontology consequentialism ```

Answer 48

Paternalism is the interference with people's liberties or autonomy with an argument that this is done "for their own good." The correct answer is: paternalism

Question 49

Which of the following statements is correct about abuse of children? Select one: Children with disabilities were less likely to be maltreated than children without disabilities Boys are more likely to be the subject of sexual abuse Girls are more likely to be the subject of physical abuse and are at a greater risk of physical injury Abuse is inversely proportional to family size People who were subjected to physical abuse in childhood are more likely to abuse their own children

Answer 49

About one-third of all individuals who were maltreated would subject their children to maltreatment. Children with disabilities are 1.7 times more likely to be maltreated than children without disabilities. Girls are sexually abused three times more often than boys. Boys are at a greater risk of serious injury and of emotional neglect than are girls. The correct answer is: People who were subjected to physical abuse in childhood are more likely to abuse their own children

Question 50

A 31-year-old woman of Inuit origin started becoming too excited for no apparent reason, taking her clothes off and throwing her naked body into cold icy water. Which of the following is the most likely diagnosis? ``` Select one: Amok Tstsumu Koro Latah Piblokto ```

Answer 50

Piblokto is seen in Arctic Eskimo communities. It is characterised by a dissociative episode with excitement often followed by seizures and coma lasting up to 12 hours. Patients may be withdrawn before the attack and usually has amnesia for the episode; they may tear off clothing, shout obscenities, eat faeces, and jump naked into ice cold water. The correct answer is: Piblokto

Question 51

A man doesn't think drinking alcohol is a problem and doesn't want to quit. According to Prochaska's model, which stage is he in? ``` Select one: Relapse Precontemplation stage Contemplation Action Maintenance ```

Answer 51

In pre-contemplation stage, the user does not recognize that problem use exists, although this may be increasingly obvious to those around them The correct answer is: Precontemplation stage

Question 52

The notion that there are inherent distinctions among ethnic groups and that some ethnicities are biologically superior to others can be described as ``` Select one: Xenophobia Scientology Racism Determinism Right-centeredness ```

Answer 52

Racism refers to attitudes, beliefs, or behaviors that favour one group over another. The minority group might be seen as biologically (innately) inferior and, therefore, practices involving their domination and exploitation are justified. The correct answer is: Racism

Question 53

A 40-year-old man with schizophrenia is treatment resistant. He lives with his family who apparently has high EE. Which of the following statements about EE is true? Select one: High EE may be the cause for his schizophrenia Reducing the duration of face to face time spent with family may reduce the relapse High EE can cause poor insight EE can be measured using Camberwell Assessment of Needs (CANE) High EE has no effect on relapse rates in female patients

Answer 53

In the majority of the studies, high expressed emotion was predictive of relapse in symptoms of schizophrenia nine months later for both genders. A large amount of face-to-face contact (more than 35 hours per week) with a relative with a high expressed emotion score increased the risk of relapse, but in households with a low expressed emotion score, high levels of contact appeared to be protective. The correct answer is: Reducing the duration of face to face time spent with family may reduce the relapse

Question 54

A medical student is undertaking a clinical research project and is keen to know the ethical principles that are widely implemented in medical practice. Choose the correct option: Select one: Duty of care and good will Respect for autonomy, justice and confidentiality Consent, confidentiality and capacity assessment. Respect, justice and consent Respect for autonomy, beneficence and justice

Answer 54

American philosophers Tom Beauchamp and James Childress and British doctor & philosopher Raanon Gillon pioneered the following prima facie principles: a) autonomy-respecting patients' wishes and freedom of choice b) beneficence-acting in patients' best interests c) Non-maleficence-avoiding harm d) Justice-treating problems equally, with equitable distribution of resources to the needy. These four principles are the main guiding aspects of current medical practice, and most other related ethical discussions relevant to clinical practice can be brought under these four aspects. The correct answer is: Respect for autonomy, beneficence and justice

Question 55

In UK which of the following disorders are most stigmatized? ``` Select one: Learning difficulties and personality disorders Schizophrenia and addictions Schizophrenia and eating disorders Schizophrenia and dementia Schizophrenia and depression ```

Answer 55

Public opinion: These 4 themes formed the basis of Office of National Statistics survey in the UK where 1790 adults were interviewed to measure subjective perception of 7 different mental disorders including schizophrenia, depression, alcoholism, drug use, dementia, panic disorder and eating disorders. Schizophrenia and addictions were regarded most negatively; approximately 60% respondents thought addicted individuals have only themselves to blame for their problems. Most individuals knew the difference between various disorders and most felt that depression and anxiety are treatable. The correct answer is: Schizophrenia and addictions

Question 56

Before being diagnosed as having schizophrenia, Mark was regarded as a suspicious young man by his colleagues. After an acute admission, his colleagues avoided him and so he became more suspicious if any one ever approached him. Which of the following aspect of social labeling applies to Mark's suspiciousness following diagnostic labeling? ``` Select one: Partial deviance Formal deviance Primary deviance Secondary deviance Spiral deviance ```

Answer 56

Edwin Lemert developed the idea of primary and secondary deviance to explain the social process of labeling. Primary deviance is any general deviance before the person is labeled as deviant. Secondary deviance is any action that takes place after primary deviance as a reaction to the institutions and the labeling. The correct answer is: Secondary deviance

Question 57

Which of the following genetic changes have been shown to influence an individual's response to stressful life events in terms of later depression? ``` Select one: Prion protein polymorphisms Serotonin transporter polymorphisms CYP450 polymorphisms COMT polymorphism GABA B receptor polymorphisms ```

Answer 57

Caspi demonstrated a link between 5HT polymorphisms and life events in depressive response. The correct answer is: Serotonin transporter polymorphisms

Question 58

Immigrants carry a higher risk of schizophrenia than the native population in UK. Which of the following is correct in this regard? Select one: Significant social disadvantage in the immigrants may explain the association Pre-psychotic segregation explains the higher risk Incidence rates of schizophrenia in Caribbean countries are higher than UK Psychiatric hospital admission rates are lesser among ethnic minorities Excess risk is specific for African and Caribbean immigrants

Answer 58

The correct answer is: Significant social disadvantage in the immigrants may explain the association. Though the frequency of most mental illnesses are found to be higher in migrants that the natives, schizophrenia has been studied the most. Conflicting explanations have been offered to explain why migrants have more schizophrenia. Acc to Copper: a. The excess risk is not specific for African-Caribbean immigrants. It is also present among African-born Black immigrants to the UK, and to a lesser extent among immigrants from Asian countries. Hence, any explanation cannot be purely biological and not simply race specific. b. Incidence rates of schizophrenia in Caribbean countries are similar to those found in the indigenous UK population; this excludes country of origin theory which proposes that the immigrants carry such higher incidence rates from where they come from. The rate for schizophrenia in second generation African-Caribbean people born in the UK appears to be higher than in the first generation, which is strongly suggestive of an environmental rather than a genetic effect. c. There is no evidence for selective immigration from the Caribbean as part of a pre-psychotic segregation. According to this theory individuals who are psychosis prone find it hard to survive in the countries of birth and so immigrate to other regions. d. A significant social disadvantage is evident in the immigrant population with a higher risk of schizophrenia. e. The immigrants' pathways to psychiatric care are characterized by long delays in seeking professional help, a lower probability of medical referral, frequent involvement of the police and emergency services and high proportions of compulsory and secure-unit admissions. The long-term outcome tends to be correspondingly unfavorable for immigrants. Hospital admission rates are consistently noted to be higher among ethnic minority population as a whole but variations between groups. In UK, highest rates of hospital admissions were noted among Irish migrants followed by people born in Caribbean. Rate of mental illness among South Asian population is notably lower than UK-born white population. It is unclear if these are effects of migration or social disadvantage or organizational differences in pathways of care. Census of inpatients, 2005 showed that 9% of in-patients were black or mixed black white ethnicity while black patients were 44% more likely to have been sectioned and 50% more likely to have been put in seclusion. Black Caribbean men were 29% more likely to have been subject to control and restraint. It is speculated that an association with the use of substances may be a confounder

Question 59

Which of the following is NOT a measure of expressed emotions? ``` Select one: Critical comments Positive comments and warmth Emotional over involvement Hostility Social isolation ```

Answer 59

Expressed emotions concept was developed by Brown and Rutter in 1966 as a part of the Camberwell Family Interview (audiotaped interview with a carer), and later modified by Vaughn and Leff in 1976. The ratings were based on content and prosodic aspects and emphasis of speech. Five measures are considered (including positive regard and emotional warmth); The final scores of emotional over-involvement, critical comments and hostility were the most predictive measures for relapse. The correct answer is: Social isolation

Question 60

A doctor wants to establish a long-term therapeutic relationship with her patient. Focusing on which of the following provides the best likelihood for achieving this? ``` Select one: Strengths and interests of the patient Adherence to medication Patient's childhood experiences Wishes of the patient's carers Insight of the patient ```

Answer 60

The major functions of medical interviews include gathering information, developing and maintaining a therapeutic relationship and communicating information. The establishment of long-term therapeutic relationship hinges on understanding the strengths and interests of a patient. The correct answer is: Strengths and interests of the patient

Question 61

A patient with acute relapse of schizophrenia was given time off the ward. He came back next day with his mother who was blaming him for his illness, and 'what he has put himself through'. Which of the following actions is likely to be most helpful? Select one: Suggest Cognitive Behavioural Therapy for schizophrenia Stop all home leave immediately Suggest family therapy Provide psychodynamic support to the mother Use Mental Health Act to detain the patient to the ward

Answer 61

High EE can be reduced by family therapy focussed on addressing communication patterns within the family unit. The correct answer is: Suggest family therapy

Question 62

A Chinese man is afraid of going out of his house. He believes that the cold wind will destroy his soul. What is the cultural bound syndrome described here? ``` Select one: Koro Piblokto Pa-Leng Susto Windigo ```

Answer 62

Susto (also called as espanto) is known as a "fright sickness". Susto comes from the Spanish word for "fright" (i.e. Sudden intense fear, as of something immediately threatening). A more severe and potentially fatal form of susto is called espanto (also from Spanish, meaning terror or intense fright). People believe that if a person is suffering from susto, his or her soul is separated from the body The correct answer is: Susto

Question 63

The Myth of Mental Illness' was written by ``` Select one: Szasz Cleare Cooper Laing Foucalt ```

Answer 63

Antipsychiatry refers to a confederation of psychiatrists, psychologists, nurses, social and welfare workers, lay people and patients who oppose the traditional mental health practice and treatment. Three major pioneers are: 1. R.D. Laing, 2. Thomas Szasz and 3. Foucault. R.D. Laing wrote 'The Divided Self' (1959), Sanity, Madness and the Family (1964). Thomas Szasz wrote 'The Myth of Mental Illness' 1961) and 'The Manufacture of Madness' (1971). Foucault wrote Madness and Civilization (1965). The correct answer is: Szasz

Question 64

A Japanese man is afraid of going out with his friends as he is embarrassed about his bad body odour. Despite repeated reassurances that he does not smell badly, he insists on being left alone. The most likely diagnosis is ``` Select one: Taijin-jikoshu-kyofu Piblokto Pa-Leng Koro Susto ```

Answer 64

Taijin refers to a fear of losing good will of others due to imagined shortcomings of oneself. Social anxiety, tremulousness, self-consciousness and a sense of physical defect or deformity are seen; these can develop into anthropophobia (fear of people) - a severe form of social phobia. The correct answer is: Taijin-jikoshu-kyofu

Question 65

Mr. Brown is not feeling well and calls off sick at work. Which of the following behaviours, if expressed by Mr.Brown under these circumstances would be regarded as abnormal? Select one: Extending absence from work when the illness continues Taking self-blame for the illness Complying with treatment as prescribed by the doctor Not carrying out normal social roles Seeking help from an internet doctor

Answer 65

The correct answer is: Taking self-blame for the illness. The sick role is a concept described by the American sociologist Talcott Parsons.He defined the sick role as having four chief characteristics. 1. The sick person is freed or exempted from carrying out normal social roles. 2. People who are sick are not directly responsible for their disease. 3. It is necessary that a sick person tries to get well. 4. The sick person must seek competent help and cooperate with medical care to get well.

Question 66

A young male doctor from India gets married and moves to the UK with his wife and his two kids. The children are attending a primary school. His retired parents also join him soon after. Which of the following is true? (October 2008) Select one: No one can adjust to the change for next 5 years The young couple will have the maximum difficulty in adjusting to change The children will have the maximum difficulty in adjusting to change The grandparents will have the maximum difficulty in adjusting to change Everyone will adjusts with same degree of ease

Answer 66

The elderly find it more challenging to acculturate when compared to the younger immigrants. The correct answer is: The grandparents will have the maximum difficulty in adjusting to change

Question 67

Which of the following is least likely to be consistent with an individual assuming the Sick Role? Select one: The individual takes time off work to aid recovery The individual refuses medical help and does not accept his/her diagnosis The individual is considered not responsible for his/her sickness The individual is relieved of his social and vocational responsibilities The individual wants to get better

Answer 67

A patient assumes the sick role when ill, seeks to get well and relinquishes the sick role once better. The correct answer is: The individual refuses medical help and does not accept his/her diagnosis

Question 68

A 20 years old immigrant Jamaican man develops schizophrenia. Which of the following is most likely to be true? Select one: His immigration is likely to be due to psychotic experiences His parents are likely to be from a lower socioeconomic class compared to parents of native patients He is likely to be poorly educated compared to native patients He is likely to seek professional help early in the course of his illness The risk of schizophrenia in his parents is likely to be similar to the risk in the parents of native patients

Answer 68

The correct answer is: The risk of schizophrenia in his parents is likely to be similar to the risk in the parents of native patients. Theories such as prepsychotic segregation have failed to explain the high rates of schizophrenia seen in immigrants. The most acceptable notion at present is that this risk is mediated by social adversity faced by immigrants.

Question 69

Which of the following is false with respect to Nuremburg code? Select one: Nuremburg is a place in Germany Voluntary consent was upheld as a vital aspect of research The code pertains to human research ethics Tried Japanese doctors for unfair treatment of patients It is related to World War 2

Answer 69

The correct answer is: Tried Japanese doctors for unfair treatment of patients. Nuremburg code is related to the trial received by Nazi doctors after WWII.

Question 70

The right action is the one that has the best foreseeable consequences. This is called; ``` Select one: Engel's model Utilitarian moral theory Paternalistic model Hammurabi code Oath of Hippocrates ```

Answer 70

The correct answer is: Utilitarian moral theory. Consequentialist moral theories are teleological: they aim at some goal state and evaluate the morality of actions in terms of progress toward that state. The best-known version of consequentialism is utilitarianism. As most clearly stated by Mill a proponent of the utilitarianism (teleology), the basic principle of utilitarianism is: Actions are right to the degree that they tend to promote the greatest good for the greatest number. In contrast, deontological principles are duty based. Kant's theory is an example of a deontological or duty-based ethics: it judges morality by examining the nature of actions and the will of agents rather than goals achieved. A deontological theory looks at inputs rather than outcomes.

Question 71

A patient with paranoid schizophrenia was enraged at a shop and killed the shopkeeper. A forensic psychiatrist who examined him feels that he needs psychiatric treatment. The court decides that he must be sentenced to prison. Which of the following ethical principle is closely related to the above scenario? ``` Select one: Non-Maleficience Distributive justice Confidentiality Utilitarianism Paternalism ```

Answer 71

The correct answer is: Utilitarianism. The strengths of utilitarianism lie in its practicality and clarity. It approximates the principle of 'beneficence' and fits well with approaches to public policy. Legislated responsibilities of psychiatrists, particularly in relation to issues of public safety, are invariably utilitarian in nature and have usually emerged in the context of social and political responses to issues such as public safety especially in relation to forensic patients.

Question 72

According to Nuremburg code formulated after the Second World War, human experimentation can be carried out only if which of the following conditions is satisfied? Select one: Written consent is given for infliction of more than necessary pain Voluntary consent is given A study causing harm can be completed only if carers agree with patients Research is economical Subjects are well compensated for any suffering underwent

Answer 72

The correct answer is: Voluntary consent is given. According to Nuremburg Code human experimentation, can be carried out only if 1. voluntary consent is given 2. Research is intended for common good of the society 3. avoidance of unnecessary pain and suffering is guaranteed for the subjects 4. subject has liberty to withdraw at any point 5. qualified researchers undertake research 6. scientist must terminate a study if more harm is being caused than expected to the subjects

Question 73

Identify the study that is related to deliberately infected individuals with hepatitis ``` Select one: ECA study Willowbrook study Isle of wight study Belmont study Tuskesse study ```

Answer 73

The correct answer is: Willowbrook study. From 1963 through 1966, studies were carried out at the Willowbrook State School, a New York State institution for "mentally defective persons." These studies were designed to gain an understanding of the natural history of infectious hepatitis and subsequently to test the effects of gamma globulin in preventing or ameliorating the disease. The subjects, all children, were deliberately infected with the hepatitis virus; early subjects were fed extracts of stools from infected individuals, and later subjects received injections of more purified virus preparations. Investigators defended the deliberate injection of these children by pointing out that the vast majority of them acquired the infection anyway while at Willowbrook, and perhaps it would be better for them to be infected under carefully controlled research conditions. During the course of these studies, Willowbrook closed its doors to new inmates, claiming overcrowded conditions. However, the hepatitis program, because it occupied its own space at the institution, was able to continue to admit new patients. Thus, in some cases, parents found that they were unable to admit their child to Willowbrook unless they agreed to his or her participation in the studies. This case caused a public outcry because of the perception that parents and their children were given little choice about whether or not to participate in research.

Question 74

Amok | F68 disorder of personality and behaviour

Answer 74

Amok Mostly dissociative not psychotic in nature. Starts with sullen period, followed by outburst of violent, sometimes homicidal behaviour; A return to premorbid state occurs after the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or an exacerbation of a chronic psychotic process. Seen in Malaysia, Laos, Philippines, Papua New Guinea, and Puerto Rico.

Question 75

Ataque de nervios | F45 somatoform

Answer 75

Ataque de nervios An attack of distress wherein sudden shouting, crying, beating oneself on chest with dissociation and panic attacks can occur with a sense of being out of control. May have loss of consciousness or amnesia afterwards. Related to acute stress (trauma or family conflict) A sense of heat arising from chest into head may be present Mechanism: dissociative trance South America

Question 76

Berdache

Answer 76

Berdache North America Term for a male who has assumed female gender role

Question 77

Bouffee delirante

Answer 77

Bouffee delirante Seen in French-speaking nations a a sudden outburst of agitated and aggressive behaviour, confusion resembling an episode of brief psychotic disorder. West Africa and Haiti commonly

Question 78

Brain fag

Answer 78

Brain fag West Africa students with difficulties in concentrating, remembering, and thinking. A type of somatoform illness.

Question 79

Dhat | F48 / F45: neurotic disorder / somatoform autonomic

Answer 79

Dhat India/SE Asia Refers to severe anxiety and hypochondriacal concerns associated with the seminal discharge accompanied by feeling weak and exhausted. Called shenkui in China (fear of loss of yang from men: see below)

Question 80

Frigophobia Pa-Leng : fear of cold; Pa-Feng: fear of wind (F40 specific phobias)

Answer 80

Frigophobia (Pa-Leng : fear of cold; Pa-Feng: fear of wind) (F40 specific phobias) China A morbid fear of feeling cold / wind due to presumed yin-yang imbalance. Yin-yang refers to Oriental psychological notion of two opposing forces; yin is dark, female and negative force. Yang is bright, male and positive force. Excessive yin in males leads to pa-leng or pa-feng Affected men typically bundle themselves in warm clothing, avoid wind or drafts, and eat foods that are symbolically and calorically "hot' while avoiding foods that are "cold"

Question 81

Koro (Turtle Head) | F48 / F45: neurotic disorder / somatoform autonomic

Answer 81

Koro (Turtle Head) (F48 / F45: neurotic disorder / somatoform autonomic) Malaysia, SE Asia Refers to an episode of sudden and intense anxiety that the penis (or, in women, the vulva and nipples) will recede into the body and possibly cause death. Can occur as epidemics!

Question 82

Latah | F48 / F44: neurotic disorder / dissociative

Answer 82

Latah Hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behaviour seen in middle-aged women. Malaysia and south East Asia

Question 83

Mal de ojo

Answer 83

Mal de ojo Mediterranean concept of evil eye affecting children with physical symptoms mostly.

Question 84

Nerfiza or Nevra

Answer 84

Nerfiza or Nevra Egypt, Greece and Central America Common, often chronic, episodes of extreme sorrow or anxiety, inducing a complex of somatic complaints such as head and muscle pain, diminished reactivity, nausea, appetite loss, insomnia, fatigue and agitation. The syndrome is more common in women than in men. Often treated with traditional herbal teas

Question 85

Piblokto | F44 dissociative

Answer 85

Piblokto Dissociative episode with excitement often followed by seizures and coma lasting up to 12 hours. May be withdrawn before the attack and usually has amnesia for the episode; they may tear off clothing, shout obscenities, eat faeces, jump into ice cold water naked etc. Seen in Arctic Eskimo communities (Inuits)

Question 86

Shinkeishitsu

Answer 86

Shinkeishitsu “Nervous traits’ in Japanese A syndrome of obsessions, compulsive perfectionism, social withdrawal, extreme sensitivity and neurasthenia.

Question 87

Susto | F48 / F45: neurotic disorder / somatoform autonomic

Answer 87

Susto Attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness.

Question 88

Tajin-kyofu-shou | F40.1 / 40.8 social phobia

Answer 88

Tajin-kyofu-shou (F40.1 / 40.8 social phobia) Japanese psychiatric syndrome Fear of losing good will of others due to imagined shortcomings of oneself Social anxiety, tremulousness, self-consciousness and a sense of physical defect or deformity Can develop into anthropophobia (fear of people) – a severe form of social phobia four subtypes: sekimen-kyofu (the phobia of blushing – closer to social phobia), shubo-kyofu (the phobia of a deformed body- closer to body dysmorphic disorder), jikoshisen-kyofu (the phobia of eye-to-eye contact), and jikoshu-kyofu (the phobia of one’s own foul body odor).

Question 89

Ufufuyane, (singular), Amafufunyane, (plural)

Answer 89

Ufufuyane, (singular), Amafufunyane, (plural), Seen in Kenya, Southern Africa; Bantu, Zulu; and affiliated groups Anxiety state attributed to the effects of magical potions (given to them by rejected lovers) or spirit possession Characteristic sobbing, repeated neologisms, paralysis, trance-like states, or loss of consciousness in young, unmarried women, who may also experience nightmares with sexual themes, and rarely episodes of temporary blindness.

Question 90

Windigo

Answer 90

Windigo (F68 personality and behaviour) Involves an intense craving for human flesh and the fear that one will turn into a cannibal. Seen among Algonquian Indian cultures