Descriptive Psychopathology

Question 1

A 78-year-old man hospitalized after a fall, repeatedly sees small angels flying around his head. Which of the following is least likely to be true in this case?

Select one:
1. This phenomenon can occur due to anticholinergic toxicity
2. This phenomenon is reported in delirium tremens
3. The perception has occurred without appropriate stimulus
4. This phenomenon is associated with organic disorders of the brain
5. Presence of intact consciousness suggests a functional disorder than an organic mental
illness

Answer 1

Presence of intact consciousness suggests a functional disorder than an organic mental illness

Auditory hallucinations are more characteristic of schizophrenic illnesses while visual hallucinations are characteristic of organic illnesses. Visual hallucinations are rarely seen as an isolated feature in psychotic illness. They are associated with organic disorders of the brain, cortical tumours, dementias, drug and alcohol intoxication and withdrawal, stimulant and hallucinogen ingestion and most commonly in delirium tremens

Question 2

A patient on an adult psychiatric ward says that Dr. Smith has been his consultant for the past 15 years. Even though he recognises his face, he knows he is not Dr. Smith anymore but an imposter. What is this phenomenon called?

Select one:
1. Capgras syndrome
2. Fregoli’s syndrome
3. Borognosia
4. Prosopognosia
5. Illusion of doubles

Answer 2

Capgras syndrome

Capgras syndrome is an uncommon syndrome in which the patient believes that a person to whom they are close, usually a family member (a doctor in this question), has been replaced by an exact double. The
underlying psychopathology is delusional misidentification.

Question 3

A psychiatrist attempts to move a patient’s arm. Before doing so, he instructs the patient to resist moving and not to let him manipulate his arm. But the patient continues to move his arm in the direction of the force. Once the psychiatrist removes the application of force, the patient’s arm comes back to the original position. This phenomenon is called

Select one:
1. Grimacing
2. Posturing
3. Negativism
4. Mitgehen
5. Automatic obedience

Answer 3

Mitgehen

Mitgehen refers to a form of extreme cooperation in which the patient moves their body in the direction of the slightest pressure on the part of the examiner. For example, the doctor puts his forefinger under the patient’s arm and presses gently, after that the arm moves upwards in the direction of the pressure. Once the pressure stops, the arm returns to its former position. Light pressure on the occiput of the patient, who is standing, leads to bending of the neck, flexing of the trunk and, if the pressure continues, the patient may fall forward.

Question 4

A male patient with a diagnosis of schizophrenia says ‘I had a hysterectomy at age 3 and since then I became a man’. This can be described as which of the following symptom?

Select one:
1. Delusional misinterpretation
2. Delusional memory
3. Pseudologia fantastica
4. Delusional perception
5. Confabulation

Answer 4

Delusional memory

Delusional memories are variously defined, some authors taking the view that they are delusional interpretations of real memories (Pawar and Spence, 2003), while others, such as the authors of the Present State Examination (PSE), suggesting that delusional memories are memories of past events that never occurred but which the subject clearly ‘recollects’

Question 5

Delusions of motor control are thought to be related to

Select one:
1. Loss of proprioceptive reflexes
2. A form of motor neglect
3. Paroxysmal spike activity in premotor area
4. Failure to predict sensory feedback of one’s own movements
5. Inability to control execution of motor maps

Answer 5

Failure to predict sensory feedback of one’s own movements

According to this sensory-feedback model if something seems to be going wrong with the action, it is quite possible to correct for it on the basis of concurrent self-awareness. Delusions of motor control are thought to be caused by a failure to predict sensory feedback of own movements (One of the models used to explain delusions of control in patients with schizophrenia) [Ref: Gallagher, S. Psychopathology 2004; 37:8-
19]

Question 6

In logoclonia, the subject keeps repeating which of the following?

Select one:
1. Last syllable
2. Last word
3. Examiner’s question
4. Recently hear word
5. Last sentence

Answer 6

Last syllable

Logoclonia: Spastic repetition of a terminal syllable. It occurs in Parkinsonism.
Verbigeration: repetition of senseless sounds, syllables or words. It occurs in expressive aphasia and catatonic schizophrenia.

Question 7

A 33-year-old patient with psychotic depression spilt all the contents of a boiling sauce pan by inverting it upside down. When asked about this event, she said ‘ It came to me from the Polish Embassy. It was nothing to do with me; they wanted it so I picked up the pan and poured it.’ She is describing

Select one:
1. Made act
2. Made affect
3. Delusional perception
4. Perseveration
5. Made impulse

Answer 7

Made impulse

She owns up the action, but not the impulse behind it. Hence, this is made impulse, not made act.

Question 8

Regarding pure word deafness, which one of the following statements is false?

Select one:
1. Here a patient can speak fluently.
2. The patient cannot understand speech, even though hearing is unimpaired for other sounds
3. It is also called as sub cortical auditory dysphasia.
4. The patient can recognize the meaning of words.
5. The patient can read and write correctly.

Answer 8

The patient can recognize the meaning of words

Also called as subcortical auditory dysphasia, pure word deafness is characterized by the patient being able
to speak, read and write fluently. But he cannot understand speech, even though hearing is unimpaired for other sounds; he hears words as sounds, but cannot recognize the meaning even though he knows that they are words.

Question 9

Which of the following is a term used to describe the phenomenon of hearing one’s own thoughts aloud?

Select one:
1. Mitmachen
2. Mitgehen
3. Gegenhalten
4. Gedankenlautwerden
5. Word salad

Answer 9

Gedankenlautwerden

One type of auditory hallucination is hearing one’s own thoughts spoken aloud and is also one of Schneider’s first-rank symptoms. Known in German as Gedankenlautwerden, it describes hearing one’s thoughts spoken just before or at the same time as they are occurring. Echo de la pensee (French) is a slightly different phenomenon of hearing the voice speaking back after the thoughts have occurred.

Question 10

A 48-year-old man who exhibits decreased speech stated that his thoughts were ‘taken from me years ago by a parish council’. The most appropriate psychopathology described here is

Select one:
1. Crowding of thoughts
2. Retrospective falsification
3. Thought diffusion
4. Delusional memory
5. Thought withdrawal

Answer 10

Though withdrawal

Schneider gave the description of a man who was experiencing thought withdrawal in the above format.

Question 11

A 64-year-old patient admitted in a stroke ward bursts out into laughter or tears within minutes with no control over these emotions. What is the psychopathology seen in this case?

Select one:
1. Depression
2. Mania
3. Mixed affective state
4. Grief reaction
5. Emotional incontinence

Answer 11

Emotional incontinence

In emotional lability patients have difficulty controlling their emotions, but in affective incontinence there is total loss of control and this is particularly common in cerebral atherosclerosis and in multiple sclerosis, where spontaneous outbursts of laughter or crying occur. In its most severe form, the terms ‘forced laughing’ and ‘forced weeping’ are used to describe this phenomenon.

Question 12

Common characteristics of schizophrenic auditory hallucinations include all except
Select one:

1. Speaking in one’s mother tongue
2. Being multiple
3. Having different accent
4. Often present throughout the day incessantly
5. Male voice

Answer 12

Often present throughout the day incessantly

Signs pointing to a genuine hallucinatory experience include: Increase in background noise reduces the severity and gives more control to the sufferer; The voices are perceived in the same space as the other
normal perceptions, and perceived simultaneously with other environmental objects; The voices have different accent but use plain language (non-technical) and often affect-laden (angry or sad, etc); The
voices are never continuous, almost always episodic; The voices almost never speak in other languages that the patients do not know.

Question 13

A middle-aged gentleman was noticed to be giggling inappropriately on hearing the news of his father’s death. What is the term used to denote this type of pathological change in affect?

Select one:
1. Affective blunting
2. Apathy
3. Affective flattening
4. Anhedonia
5. Incongruity of affect

Answer 13

Incongruity of affect

Incongruity of affect: It refers to the objective impression that the displayed affect is not consistent with the current thoughts or actions. It commonly occurs in schizophrenia although mild forms could exist in non-schizophrenic patients. (Smiling when bewildered)

Question 14

The organic states associated with autoscopic hallucinations of seeing oneself in external space include all except

Select one:
1. Parietal tumours
2. Toxic infective states
3. Temporoparietal lesion
4. Epilepsy
5. Frontal lobe dementia

Answer 14

Frontal lobe dementia

The organic states commonly associated with autoscopy are epilepsy, focal lesions affecting the parieto-occipital region and toxic infective states affecting the basal regions of the brain. Occasionally patients with schizophrenia have autoscopic hallucinations but they are more common in acute and sub-acute delirious states.

Question 15

A woman states that she is often woken up when drifting to sleep by a voice saying a sentence or phrase that has no discoverable meaning. Which one of the following statements about her experience is true?

1. It does not occur in organic states
2. It can occur in the absence of a diagnosable mental illness
3. EEG is likely to show beta rhythm
4. Such experiences can occur only in the auditory modality
5. It is a sign of nocturnal epilepsy

Answer 15

It can occur in the absence of a diagnosable mental illness

Hypnagogic hallucination is a transient false perception experienced while on the verge of falling asleep. The same phenomenon experienced while waking up is called as hypnopompic hallucinations(in which
case it persists on awakening). It is frequently experienced by normal healthy people and so, not a symptom of mental illness. It can also occur in organic states such as narcolepsy and occur in any modality. Subjects describing hypnagogic hallucinations often assert that they are fully awake. This is not so and electroencephalogram (EEG) records show that there is a flow of alpha rhythm at the time of the hallucination.

Question 16

Circumstantial speech is seen in all EXCEPT

Select one:
1. Learning disability
2. Mania
3. Anankastic personality disorder
4. Dementia
5. Broca’s Aphasia

Answer 16

Broca’s Aphasia

In Broca’s aphasia, fluency is often reduced.

Question 17

A 42 yr old man is at a haste to catch the last train for the day to London. In his rush, he reads ‘Swindon’ as London and boards the wrong train. Which of the following has taken place?

Select one:
1. Hallucination
2. Pareidolic illusion
3. Imagery
4. Completion illusion
5. Affect illusion

Answer 17

Affect illusion

Affect illusions arise in the context of a particular mood state as described in this example.

Question 18

A patient can hear voices whenever the noise of water running through a tap is heard. This is called

Select one:
1. Reverse hallucination
2. Synesthesia
3. Reflex hallucination
4. Functional hallucination
5. Extracampine hallucination

Answer 18

Functional hallucination

In functional hallucination, “an auditory stimulus causes a hallucination but the stimulus is experienced as well as the hallucination. In other words, the hallucination requires the presence of another real sensation. For example, a patient with schizophrenia first heard the voice of God as her clock ticked; later she heard voices coming from the running tap and voices coming from the chirruping of the birds” (From Fish’s Psychopathology, 3rd ed).

Question 19

Which of the following can differentiate depersonalisation seen in normal persons and those with a depersonalisation-related psychiatric problem?

Select one:
1. No difference is notable between the two groups
2. Shorter duration in the latter
3. Intense affective change is seen in the latter
4. Feelings of detachment is not seen in the former
5. Sense of time is not altered in the former

Answer 19

Intense affective change is seen in the latter

According to Sims, pathological depersonalisation is associated with intense affective change.

Question 20

Which one of the following is not a core feature of Ganser’s syndrome?

Select one:
1. Visual hallucinations
2. Somatic conversion features
3. Clouding of consciousness
4. Approximate answers or VORBEIGEHEN (to pass by)
5. Pseudohallucinations

Answer 20

Visual hallucinations

Ganser syndrome refers to the production of approximate answers. e.g. Question: “What is the capital of France?” - Answer: “London”. It is occasionally associated with organic brain illness but is much more
commonly seen as a form of malingering in those attempting to feign mental illness e.g. in prisoners awaiting trial.

Question 21

A 66 yr old patient diagnosed with schizophrenia is observed to have rigidity at rest but carries out voluntary
movements normally. Which of the following is true?

Select one:
1. He has extrapyramidal rigidity from antipsychotics
2. He is a malingerer
3. He has spasticity due to cerebrovascular pathology
4. He does not have catatonia
5. He is exhibiting catatonia

Answer 21

He is exhibiting catatonia

Increased resting muscle tone that comes down during voluntary action is characteristic of catatonia.

Question 22

What does the term paranoia literally mean?

Select one:
1. Grandiosity’
2. Self reference’
3. On suspicion’
4. Besides mind’
5. Inside mind’

Answer 22

Besides mind’

Paranoia means ‘besides one’s mind’.

Question 23

Changes in the shape of objects especially with a loss of symmetry is called

Select one:
1. Eidetic imagery
2. Macropsia
3. Micropsia
4. Dysmegalopsia
5. Asterognosis

Answer 23

Dysmegalopsia

Dysmegalopsia refers to a change in the perceived shape of an object. Some authors reserve the term dysmegalopsia to describe objects that are perceived to be larger (or smaller) on one side than the other (Sims, 2003), while others use the term generically to describe any change in perceived size (Hamilton, 1974). Others use the term metamorphosia rather than dysmegalopsia to describe objects that are irregular in shape.

Question 24

Phantom mirror image is a synonymous term for which one of the following hallucinations?

Select one:
1. Reflex hallucination
2. Autoscopic hallucination
3. Haptic hallucination
4. Hypnagogic hallucination
5. Teichoscopic hallucination

Answer 24

Autoscopic hallucination

Autoscopy, also called phantom mirror-image, is the experience of seeing oneself and knowing that it is oneself. It is not just a visual hallucination because kinaestethic and somatic sensation must also be present to give the subject the impression that the hallucinated percept is one’s own self.

Question 25

Auditory hallucinations with clear consciousness are least likely to be due to

Select one:
1. Temporal lobe epilepsy
2. Alzheimer’s disease.
3. Cocaine abuse
4. Alcohol abuse
5. Schizophrenia

Answer 25

Temporal lobe epilepsy

Alcoholic hallucinosis, any functional psychiatric disorder, and early dementia can cause auditory hallucinations with clear consciousness.

Question 26

The Doppleganger phenomenon is best described as a/an

Select one:
1. Somatoform disorder
2. Ideational disturbance
3. Perceptual disturbance
4. Malingering phenomenon
5. Body image disturbance

Answer 26

Ideational disturbance

It refers to the awareness of another human being accompanying the self. Reported in psychosis and in severe sleep deprivation.

Question 27

A chronic schizophrenia patient snouts his lips and maintains this posture for a long time even when he is active doing other work. Which of the following best describes the above sign?

Select one:
1. Catalepsy
2. Snout spasm
3. Cataplexy
4. Posturing
5. Mannerism

Answer 27

Snout spasm

In catatonia the lips may be thrust forward in a tubular manner known as ‘snout spasm’ (or schnauzkrampf) and although this is obviously a disorder of expression it is best regarded as a stereotyped posture.

Question 28

Which of the following best describes paraschemazia?

Select one:
1. Mixture of meaningless words
2. Distortion of body image
3. Inappropriate familiarity in a new place
4. Distorted awareness of time
5. Loss of emotional control following brain injury

Answer 28

Distortion of body image

Paraschemazia or distortion of body image is described as a feeling that parts of the body are distorted or twisted or separated from the rest of the body and can occur in association with hallucinogenic use, with an
epileptic aura and with migraine on rare occasions.

Question 29

In which of the following conditions is the stimulus perceived as a corresponding object but the quality of the percept is altered?

Select one:
1. Negative hallucinations
2. Perceptual distortions
3. Illusions
4. Hallucinations
5. Imagery

Answer 29

Perceptual distortions

Distortions are changes in perception resulting from a change in the intensity and quality of the stimulus or the spatial form of the perception.

Question 30

A 7-year-old girl speaks very clearly and fluently with her friends at school but becomes mute when at home. This is called

Select one:
1. Akinetic mutism
2. Poverty of content of speech
3. Elective mutism
4. Poverty of speech
5. Hysterical mutism

Answer 30

Elective mutism

Elective mutism may occur in children who refuse to speak to certain people; for example, the child may be mute at school but speak at home.

Question 31

Echolalia is characterised by

Select one:
1. Automatic repetition of one’s own speech
2. Automatic repetition of the actions of others
3. Automatic repetition of one’s own actions
4. Virtual absence of movement and speech but preserved consciousness
5. Automatic repetition of other person’s speech

Answer 31

Automatic repetition of other person’s speech

Echolalia refers to the automatic repetition of other person’s speech. Echopraxia refers to the automatic repetition of visually perceived actions of others. Akinetic mutism is the virtual absence of movement and speech in the presence of full consciousness.

Question 32

Automatism is a recognised phenomenon seen most commonly in patients with

Select one:
1. Borderline personality disorder
2. Hysterical dissociation
3. Bipolar disorder
4. Schizophrenia
6. Temporal lobe epilepsy

Answer 32

Temporal lobe epilepsy

Automatism: Clouding of consciousness occurring around an epileptic seizure accompanied by complex actions without the subject’s awareness. It lasts less than 5 minutes but rarely even up to an hour. Violence is rare.

Question 33

A 70-year-old patient with a diagnosis of chronic schizophrenia keeps touching her head as if she is saluting someone, even when no one is around. She denies ‘hearing voices or seeing things’. Which of the following is the most likely cause?

Select one:
1. Stereotypy
2. Mannerism
3. Echopraxia
4. Chorea
5. Hallucinatory behaviour

Answer 33

Mannerism

Unusual repeated performances of a goal-directed motor action or the maintenance of an unusual modification of an adaptive posture are known as ‘mannerisms’. Examples of this sign are unusual hand
movements while shaking hands, when greeting others, and during writing. Other examples may include peculiarities of dress, hairstyle and writing.

Question 34

According to Jaspers which of the following is true about primary delusions?

Select one:
1. They occur before other symptoms
2. They are un-understandable in terms of other mental experiences
3. They are specific for schizophrenia
4. They have prognostic significance in schizophrenia
5. They are resistant to treatment

Answer 34

They are un-understandable in terms of other mental experiences

Jaspers emphasized the importance of un-understandability. Primary delusional experiences tend to be reported in acute schizophrenia but are less common in chronic schizophrenia, where they may be buried under a mass of secondary delusions arising from primary delusional experiences, hallucinations, formal
thought disorder and mood disorders.

Question 35

Flashback phenomenon is commonly reported after ingesting which of the following substances?

Select one:
1. Cocaine
2. Psychotropic medication
3. Nicotine
4. Hallucinogen
5. Psychostimulant

Answer 35

Hallucinogen

Long after ingesting a hallucinogen like LSD; a person can experience a flashback of hallucinogenic symptoms. This syndrome is diagnosed as hallucinogen persisting perception disorder in DSM-5. This reexperiencing of perceptual symptoms following cessation of hallucinogen use is characterised by seeing
geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes or intensified colours, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia. This is also called flashback phenomenon. The following can trigger a flashback: Emotional
stress, Sensory deprivation, Use of another psychoactive substance, such as alcohol or marijuana. (Excerpts from Kaplan & Sadock Synopsis of Psychiatry 10th ed)

Question 36

Coenaesthesia is a type of

Select one:
1. Visual hallucination
2. Olfactory hallucination
3. Eidetic imagery
4. Visceral hallucination
5. Delusional belief

Answer 36

Visceral hallucination

Coenaesthetia refers to unfounded bodily sensations related to visceral, somatic hallucinations seen in schizophrenia. Examples of coenaesthetic hallucinations are a burning sensation in the brain, a pushing sensation in the blood vessels, a cutting sensation in the bone, etc.

Question 37

A patient complains of odd sensations such as ‘electric heating’ emanating from her knees. This can be described as

Select one:
1. First rank symptom
2. Somatic delusion
3. Overvalued idea
4. Somatic passivity
5. Somatic hallucination

Answer 37

Somatic hallucination

Fish describes a patient who felt a frictional rub along her ribs that had no physical explanation and was unreal. This is also a somatic hallucination.

Question 38

The commonest psychiatric diagnosis reported in patients with autoscopic hallucinations is

Select one:
1. Depression
2. Hysterical Dissociative states
3. Schizophrenia
4. Dementia
6. Bipolar disorder

Answer 38

Depression

It is also seen in normal people when they have extreme fatigue, where it is usually accompanied by impaired consciousness. Sims states that depression is the commonest psychiatric cause of autoscopy.

Question 39

Concrete thinking is usually tested by means of

Select one:
1. Verbal fluency test
2. Proverb testing
3. Cognitive estimates test
4. Luria test
5. Sorting test

Answer 39

Proverb testing

Concretism is considered an important aspect of schizophrenic thought disorder. Traditionally it is measured using the method of proverb interpretation, in which metaphoric proverbs are presented with the request that the subject tell its meaning. Interpretations are recorded and scored on concretistic tendencies. Its
reliability is doubtful, and it is rather complicated to perform

Question 40

A 9-year-old girl can see the colour white associated with the number 7 and see the colour purple whenever she comes across the number 9. This is called

Select one:
1. Functional hallucination
2. Reflex hallucination
3. Reverse hallucination
4. Synaesthesia
5. Extracampine hallucination

Answer 40

Synaesthesia

Synaesthesia is the experience of a stimulus in one sense modality producing a sensory experience in another. Colour-Number synaesthesia (reading or hearing numbers is associated with seeing colours) is the most common type.

Question 41

Which of the following is true regarding pseudohallucinations?

Select one:
1. Cannot be seen in normal people
2. Seen in Ganser’s syndrome
3. Insight is not retained
4. Associated with amnesia for the object
5. Occurs in external outer space

Answer 41

Seen in Ganser’s syndrome

Ganser’s syndrome is associated with pseudohallucinations, as described originally by Ganser.

Question 42

Which of the following is not a type of perceptual distortion?

Select one:
1. Hyperacusis
2. Hyperaesthesia
3. Macropsia
4. Dysmegalopsia
5. Pseudohallucinations

Answer 42

Pseudohallucinations

Micropsia, Macropsia, dysmegalopsia, altered sensory perceptions such as hypoacusis/hyperacusis are classified as sensory distortions.

Question 43

A patient with OCD has intrusive thoughts about the safety of his family. He fights these thoughts by often tapping his desk 5 times and also by praying mentally 5 times as fast as he could. The acts of praying are
best termed as

Select one:
1, Spiritual obsessions
2. Delusions
3. Normal behaviour
4. Coping skill
5. Compulsions

Answer 43

Compulsions

Compulsions are, in fact, merely obsessional motor acts. They may result from an obsessional impulse that leads directly to the action, or they may be mediated by an obsessional mental image or thought, as, for example, when the obsessional fear of contamination leads to compulsive washing.

Question 44

Which of the following is true concerning the psychopathology of morbid jealousy?

Select one:
1. It is not seen as an isolated phenomenon
2. The belief can be held with delusional fixity
3. It is more common in women than men
4. It is an obsessional state
5. It intensifies on geographical separation of partners

Answer 44

The belief can be held with delusional fixity

Morbid jealousy can occur as an isolated state but can also occur in association with alcohol or cocaine misuse, impotence, schizophrenia, mania, depression, organic conditions like dementia, and terminal
stages of alcoholism and punch-drunk syndrome. Male to female ratio is 3:1.

Question 45

Vorbereiden is seen in

Select one:
1. Couvade syndrome
2. Tourette’s syndrome
3. Ganser syndrome
4. Cotard syndrome
5. Asperger’s syndrome

Answer 45

Ganser syndrome

Vorbereiden is approximate answering seen in those with a variant of hysterical pseudodementia described by Ganser. It is different from the flight of ideas. It is often used interchangeably with vorbeigehen and is often described as a part of the rare Ganser syndrome.

Question 46

When the word ‘pink’ is considered, linked words such as ‘Barbie’ and ‘girls’ get activated in brain. This is called

Select one:
1. Syntax
2. Indirect priming
3. Secondary priming
4. Direct priming
5. Cohesion

Answer 46

Direct priming

Reaction times are decreased in response to words preceded by semantically related words (‘cat’-‘dog’) in comparison with words preceded by semantically unrelated words (‘bus’-‘dog’), this is known as semantic priming effect. “When a concept node is activated by corresponding word stimulus, this activation then spreads through the network to connected nodes, falling off with decreasing relatedness. The degree to which one concept activates another is thus presumably proportional to their relatedness in the semantic network”. Large priming effects for indirectly related words (those related only through at least one other concept, such as ‘cat’ and ‘cheese,’ mediated by ‘mouse’) have been observed in schizophrenia patients with thought disorder. This is called indirect priming.

Question 47

Which one of the following statements about delusional perception is false?

Select one:
1. It refers to a type of secondary delusion
2. A normal perception is interpreted with delusional meaning and has immense personal significance.
3. It may be preceded by delusional mood.
4. It refers to a delusion that follows a normal perception.
4. It is one of the first rank symptoms of schizophrenia

Answer 47

It refers to a type of secondary delusion

Delusional perception is a primary delusion and a Schneiderian First Rank Symptom.

Question 48

In most cases of dysmorphophobia, the affected mental state is associated with

Select one:
1. Anxiety disorder
2. Major mood disorder
3. Personality disorder
4. Psychotic disorder
5. Eating disorder

Answer 48

Major mood disorder

Most cases of dysmorphophobia are associated with a major mood disorder. Most patients with Dysmorphophobia have other associated conditions like mood disorder, anxiety disorder and psychosis.

Question 49

The ratio between number of different words used during a discourse and total number of spoken words is reduced in a patient with schizophrenia. What is the above called?

Select one:
1. Word count
2. Cloze ratio
3. Cohesion ratio
4. Type token ratio
5. None of the above

Answer 49

Type token ratio

The type-token ratio (TTR) is a measure of vocabulary variation within a written text or a person’s speech. It is reduced in schizophrenic speech.

Question 50

Which one of the following is NOT an elementary hallucination?

Select one:
1. Seeing flashes of light
2. Hearing multiple buzzing sounds
3. Unstructured flakes of images in a delirious patient
4. Voices repeating the word ‘go’
5. Single tone of unclear sound

Answer 50

Voices repeating the word ‘go’

Auditory hallucination may be elementary and unformed, and experienced as simple noises, bells, etc. Elementary auditory hallucinations can occur in organic states and prodromal psychosis.

Question 51

Which one of the following phenomena can be described as ego-syntonic?

Select one:
1. Delusions
2. Depersonalisation
3. Derealization
4. Both depersonalisation and derealization
5. Obsessions

Answer 51

Delusions

Delusions are ego-syntonic. The subject who experiences them does not feel uncomfortable by the mere presence of the phenomenon. The rest all described above are ego-dystonic, where the phenomena per se, not merely the consequences, are distressing and unacceptable.

Question 52

Illusions that are created out of vague sensory percepts by an admixture of imagination and emotional states are called

Select one:
1. Pseudohallucinations
2. Imagery
3. Pareidolia
4. Fantasy
5. True hallucinations

Answer 52

Pareidolia

Pareidolic Illusions are meaningful percepts produced when experiencing a poorly defined stimulus. It occurs more commonly in children than in adults. These illusions are created out of sensory percepts by an admixture with imagination, and typically images are seen from shapes. On closer attention, the intensity of pareidolic illusions becomes more intricate and detailed.

Question 53

Which of the following is true about first rank symptoms of schizophrenia?

Select one:
1. They are essential for diagnosing schizophrenia
2. They represent disturbance of ego-boundary
3. They are not seen in other psychiatric disorders
4. They are specific for schizophrenia
5. They emphasize on content rather than form

Answer 53

They represent disturbance of ego-boundary

The original psychoanalytic interpretation of FRS is that the boundary between the ego and the surrounding world breaks down, leading to thought and volition being alienated.

Question 54

Which one of the following is not a characteristic feature of transsexualism?

Select one:
1. It is characterized by normal anatomical sex.
2. The diagnosis is usually made after puberty.
3. It is a delusional belief of mistaken sexual identity
4. Distress is due to the inappropriateness of one’s anatomical sex to perceived gender
5. Subjects show a marked preoccupation with the wish to undergo surgical correction

Answer 54

It is a delusional belief of mistaken sexual identity

Transsexualism occurs as an overvalued idea - not a delusion.

Question 55

A patient says ‘X-rays sent by my neighbour enter the back of my neck, where the skin tingles and feels warm, they pass down the back in a hot wavy current about six inches to the sides of my hip bone.’ This is best described as

Select one:
1. Made volition
2. Made impulse
3. Synaesthesia
4. Somatic passivity
5. Kinaesthetic hallucination

Answer 55

Somatic passivity

As the sensation is ascribed to the neighbour, an external agent, this is best described as a somatic passivity rather than a somatic hallucination.

Question 56

Which of the following correctly describes a hypnagogic hallucination?

Select one:
1. Hallucinations on waking up from sleep
2. Hallucinations when falling asleep
3. Hallucinations that occur only in day time sleep
4. Hallucinations that form a part of dreaming
5. Hallucinations that induce a sleep-like state

Answer 56

Hallucinations when falling asleep

Hallucinations on waking up from sleep are called hypnopompic hallucinations

Question 57

Erotomania has been reported in association with all EXCEPT

Select one:
1. Paranoid schizophrenia
2. Mania
3. Delusional disorder.
4. Alcoholism
5. Depersonalisation syndrome

Answer 57

Depersonalisation syndrome

DeClerambault’s syndrome is a form of delusion of love (erotomania). The patient is usually a woman who believes that a celebrity / someone at a higher social status is in love with her.

Question 58

A man shouts ‘Biance’ every time he sees a pretty woman. Which of the following best describes this phenomenon?

Select one:
1. Compulsive act
2. Obsessive image
3. Obsessive impulse
4. Mental compulsion
5. Rumination

Answer 58

Compulsive act

Compulsions occur as motor acts. They may not be preceded by an identifiable obsession especially in disorders other than OCD such as autism, dementia, Tourette’s etc. where compulsive acts can be seen without preceding obsessions.

Question 59

‘It is not me who is unhappy, but they are projecting unhappiness into my brain. They project upon me laughter for no reason.’ This is called

Select one:
1. Made impulse
2. Made act
3. Blunted affect
4. Somatic passivity
5. Made affect

Answer 59

Made affect

This a passivity symptom described along with other FRS.

Question 60

Which one of the following is a type of catatonic phenomenon?

Select one:
1. Aphonia
2. Waxy flexibility
3. Dyskinesia
4. Oculogyric crisis
5. Akathisia

Answer 60

Waxy flexibility

Except waxy flexibility, the other terms described in the question are neurological conditions.

Question 61

A patient gets recurrent intrusive thoughts about death. This sometimes involves her own death or death of her loved ones. She does not believe they are true, but she is afraid she might yield to them. The form of
psychopathology exhibited here is

Select one:
1. Obsessions
2. Suicidal ideas
3. Loss of control
4. Delusions
5. Homicidal ideas

Answer 61

Obsessions

The form of experience is obsession; the content is related to death.

Question 62

Choose one of the following statements that is true about autochthonous delusions.

Select one:
1. Autochthonous delusion is a type of secondary delusion
2. Autochthonous delusions and wahneinfall are equivalent terms.
3. Autochthonous delusions may give rise to secondary delusions
4. Retrospective delusions are the same as autochthonous delusions
5. Autochthonous delusions arise as a result of auditory hallucinations

Answer 62

Autochthonous delusions may give rise to secondary delusions

Primary delusions such as autochthonous delusions may give rise to many secondary delusions that may get tightly systematized later. For example, a patient who suddenly gets an autochthonous idea that Martians are invading his office, may then start connecting normal behaviours of his colleagues to Martians and may form a systematized belief complex involving cameras, alien sign languages, UFOs etc.

Question 63

A hospital manager is presenting data to a trust board. He says ‘murder of 2 hospitals’ instead of ‘merger of 2 hospitals’. This is an example of

Select one:
1. stock word
2. logoclonia
3. paragrammatism
4. neologism
5. parapraxis

Answer 63

Parapraxis

A Freudian slip, also called parapraxis, is often an error in speech that is interpreted as occurring due to the interference of some unconscious wish, conflict, or train of thought. The concept is thus a part of the psychodynamic theory.

Question 64

Overvalued ideas are NOT noted in the core symptoms of which one of the following disorder?

Select one:
1. Transsexualism
2. Anorexia nervosa
3. Body dysmorphic disorder
4. PTSD
5. Morbid jealousy

Answer 64

PTSD

PTSD is an anxiety disorder; overvalued ideas are not described in the diagnostic criteria of PTSD

Question 65

Refraining from speech and making no attempt at spoken communication despite being fully conscious is called

Select one:
1. Mutism
2. Stuttering
3. Stammering
4. Neologisms
5. Vorbereiden

Answer 65

Mutism

Refraining from speech and making no attempt at spoken communication despite adequate level of consciousness is called as mutism. The cause of mutism includes affective disorder, schizophrenia, personality disorders, organic cerebral disorders, Dissociative disorders, neurosis and learning disability.

Question 66

Which of the following is true with regard to primary delusions?

Select one:
1. They are more common in chronic rather than in acute schizophrenia
2. They are usually well elaborated
3. The content is usually aligned to cultural and social norms
4. Their origin can be traced back to a person’s premorbid mental state
5. By definition, they are not understandable

Answer 66

By definition, they are not understandable

Jaspers defined primary delusions as un-understandable. Their ‘primary’ nature also means that no observable abnormalities in mental state precede these delusions. In contrast, secondary delusions arise out of other mental phenomenon such as hallucinations or euphoric mood etc.

Question 67

Alexithymia is common in those with

Select one:
1. Psychosomatic disorders
2. Dementia
3. Psychotic disorder
4. Mood disorder
5. Personality disorder

Answer 67

Psychosomatic disorders

It occurs in psychosomatic disorders, substance abuse, masked depression, PTSD and in some cases of sexual deviance.

Question 68

‘My thoughts leave my head in a type of mental ticker-tape. Everyone around me has only to pass the tape through their mind, and they know my thoughts.’ This patient is describing

Select one:
1. Thought broadcast
2. Thought withdrawal
3. Thought echo
4. Thought blocking
5. Thought insertion

Answer 68

Thought broadcast

This is the classical feature of thought broadcast: everyone comes to know what we think, as and when we think.

Question 69

Which of the following is NOT a first rank symptom of schizophrenia?

Select one:
1. Voices giving repeated feedback as and when the patient does an act
2. Voices commanding the patient
3. Voices discussing among themselves
4. Voices echoing patient’s own thoughts
5. Voices giving commentary on the patient

Answer 69

Voices commanding the patient

Voices sometimes give instructions to a patient, who may or may not act upon them; these are termed ‘imperative’ or ‘command hallucinations’ and are not a FRS.

Question 70

Psychomotor retardation is a characteristic feature of

Select one:
1. Dementia
2. Schizophrenia
3. Borderline personality disorder
4. Depression
5. Bulimia

Answer 70

Depression

Melancholia is a form of depression that is defined as a quality of mood, which is distinct from grief, occurring in association with significant psychomotor retardation often with somatic symptoms of depression (as described in ICD-10).

Question 71

Which one of the following is not true about Folie a Deux?

Select one:
1. The person with the primary psychosis is usually the active member.
2. In Folie a Deux the associate usually experiences a primary delusion
3. The associate is usually in some way disadvantaged and dependent
4. The commonest relationship among sufferers is that of twin sisters.
5. The delusions are usually persecutory in nature.

Answer 71

In Folie a Deux the associate usually experiences a primary delusion

Folie a deux is a term derived from French words meaning ‘madness shared by two’. An individual develops a delusion similar to another individual who already has an established delusion; usually the two individuals have a close relationship (often sisters). In DSM-5, this is termed as Shared Psychotic Disorder. Note: Folie a trios - madness shared by three. Folie a quatre - madness shared by four. Folie a famille -
madness shared by the family. Folie a plusieurs - madness shared by many.

Question 72

Which of the following statements about alcoholic hallucinosis is incorrect?

Select one:
1. Patients with alcoholic hallucinosis have a clear sensorium.
2. These usually appear in persons abusing alcohol for a long time.
3. The hallucinations respond poorly to antipsychotics.
4. The hallucinations usually last less than a week, when patients believe in the
hallucinations though afterwards they may realise the untrue nature.
5. The most common hallucinations are unstructured sounds or voices that may be
characteristically malign and threatening.

Answer 72

The hallucinations respond poorly to antipsychotics.

Alcoholic hallucinosis: The most common hallucinations are unstructured sounds or voices that may be characteristically malign and threatening. The hallucinations usually last only for few days, during which the patients lack insight and believe in an external source for hallucinations though afterwards they often realise their untrue nature. These usually appear in persons abusing alcohol for a long time. Delusions are usually secondary interpretations of the hallucinations. The patient is usually distressed, anxious, and restless. Unlike those experiencing delirium tremens, those with alcoholic hallucinosis have a clear sensorium. As an empirical timescale, hallucinations lasting for more than six months should initiate suspicion of other psychoses including schizophrenia. The hallucinations respond well and rapidly to antipsychotics. The prognosis is good provided that the person remains abstinent. But the evidence base for treating alcoholic hallucinosis is very poor.

Question 73

A woman wakes up at 6am every morning, does 1 hour of vacuuming, prepares her list for the day and arrives at work 30 minutes before the start time. At work, she is always ahead of her schedule and always plans things well in advance. She expects her junior colleagues to be at her standard. What is the correct term to describe this scenario?

Select one:
1. Compulsion
2. Obsessive thinking
3. Obsessional traits
4. OCD
5. Normal phenomena

Answer 73

Normal phenomena

Unless there is some evidence of psychosocial dysfunction, this must be considered as normal.

Question 74

A sense of perplexity and uncertainty that exists during a prodrome of psychosis may be linked most appropriately to which of the following experiences?

Select one:
1. Negative symptoms
2. Delusional memory
3. Autochthonous delusions
4. Depression
5. Delusional mood

Answer 74

Delusional mood

With the delusional mood, a patient has the knowledge that there is something going on around him/her that concerns him/her, but cannot point out what it is. Usually the meaning of the delusional mood becomes
obvious when a sudden delusional idea or a delusional perception occurs.

Question 75

A 35-year-old lady in your inpatient unit covers her head with a veil. She claims that
other people can cometo know what she thinks.

The most likely description is
Select one:
1. Thought insertion
2. Thought broadcast
3. Thought withdrawal
4. Thought blocking
5. Obsessions

Answer 75

Thought broadcast

Patients may complain that their thoughts are no longer private but are accessible to others. This is associated with thought broadcasting or thought diffusion (also a first-rank symptom) and is best classified
as a disorder of thought rather than a hallucinatory experience, since there is no necessary implication that thoughts must first be heard.

Question 76

A patient who is on antipsychotic drugs is seen pacing around the ward but when questioned he described no subjective discomfort or restlessness in legs. Which of the following best describes his condition?

Select one:
1. Chorea
2. Agitation
3. Akathisia
4. Passivity
5. Dyskinesia

Answer 76

Agitation

Akathisia is a drug induced movement disorder that is associated with subjective restlessness, tension and general unease.

Question 77

Which of the following syndromes and delusional types are not correctly associated?

Select one:
1. Morbid jealousy-delusions of marital infidelity
2. De Clerembault syndrome-Delusions of love
3. Cotard’s syndrome-nihilistic delusions
4. Ekbom’s syndrome-delusions of infestation
5. Couvade syndrome-delusion of pregnancy in postpartum mothers

Answer 77

Couvade syndrome-delusion of pregnancy in postpartum mothers

Couvade syndrome is a conversion symptom seen in partners of expectant mothers during their pregnancy. The symptoms vary but mimic pregnancy symptoms, and so include nausea, vomiting, and abdominal pain and food cravings.

Question 78

Which one of the following is a type of abnormally induced movement?

Select one:
1. Tics
2. Chorea
3. Stereotypy
4. Perseveration
5. Tremors

Answer 78

Perseveration

Signs characterized by abnormal induced movement include perseveration, automatic obedience and other catatonic signs.

Question 79

Depersonalisation is also described as a/an

Select one:
1. ‘what if’ phenomenon
2. ‘why me’ phenomenon
3. ‘if not’ phenomenon
4. ‘what next’ phenomenon
5. ‘as if’ phenomenon

Answer 79

‘as if’ phenomenon

Patients with depersonalisation will frequently use the descriptor ‘as if’ when attempting to explain their experiences - ‘as if I were an automaton’, ‘as if I did not really exist’, ‘as if the world is not real’. These
experiences are hard to capture in words, so it is not surprising that patients rely heavily on similes or metaphors when attempting to communicate them.

Question 80

Which of the following is NOT a delusional misidentification syndrome?

Select one:
1. Fregoli syndrome
2. Cotard’s syndrome
3. Capgras syndrome
4. Reduplicative paramnesia
5. Syndrome of subjective doubles

Answer 80

Cotard’s syndrome

Fregoli syndrome: The patient believes that strangers have been replaced by familiar people. So, an unfamiliar person is credited with the identity of a familiar person. Delusions of misidentification to persons
include Capgras, Fregoli, Intermetamorphosis and syndrome of subjective doubles. Delusions of
misidentification to places include reduplicative paramnesia.

Question 81

Which of the following is associated with Ganser’s syndrome?

Select one:
1. Automatisms
2. Amnesia for behaviour
3. Confabulation
4. Anhedonia
5. Accurate answers

Answer 81

Amnesia for behaviour

Ganser, in 1898 described a constellation of symptoms clouding of consciousness with disorientation, auditory and visual hallucinations (or pseudo-hallucinations), amnesia for the period during which the
symptoms were manifest, conversion symptoms following recent emotional stress in prisoners. This syndrome is dissociative in origin and goes by his name.

Question 82

Apathy is characterised by
Select one:
1. Lack of eye contact
2. Lack of movements
3. Lack of insight
4. Lack of feeling
5. Lack of speech

Answer 82

Lack of feeling

Apathy is characterised by an absence of feelings, in extreme states presenting as a lack of motivation, desire and will. It is associated with anergia and lack of volition.

Question 83

Which of the following is most likely to be seen in an 18-year-old girl with hysterical aphonia?

Select one:
1. Vocal cord movements are restricted
2. Patient loses ability to speak aloud but whispers
3. Speech is absent
4. There is difficulty in articulation
5. Patient loses ability to cough

Answer 83

Patient loses ability to speak aloud but whispers

Dysarthria: There is difficulty in articulation, which occurs in lesions of the brain stem, schizophrenia and cerebellar disorder.
Dysphonia: Impairment of ability to vocalize with some hoarseness of voice, which occurs in the paralysis of the 9th cranial nerve and disease of vocal cords. Aphonia: Patient loses ability to vocalise and whispers, occurs in conversion disorders. Aphonia is defined as the absence of vocalization or phonation and differs from mutism, which is the absence of speech.
Hysterical aphonia is characterized by a normal whisper and cough. Examination with a laryngoscope reveals normal vocal cord movement with respiration.

Question 84

Which one of the following statements about illusions is false?

Select one:
1. Illusions can be brought on by sensory deprivation
2. Visual illusions may be influenced by the prevailing emotional tone.
3. Both affect and complete illusions resolve on closer attention.
4. Illusions occur when the perception threshold is increased
5. Illusions can be normal experiences

Answer 84

Illusions occur when the perception threshold is increased

Illusions occur when the sensory perceptual threshold is reduced, as in delirium, leading to inappropriate perceptions from ambiguous or incorrect stimuli.

Question 85

Which one of the following statements regarding deja vu and jamais vu is false?

Select one:
1. Deja vu is associated with inappropriate familiarity
2. Deja vu may occur in normal individuals
3. Deja vu is unusual in schizophrenia
4. Jamais vu is the sense that events being experienced for the first time have been
experienced before.
5. Deja vu occurs more often in TLE with a right-sided focus

Answer 85

Jamais vu is the sense that events being experienced for the first time have been experienced before.

Jamais vu is described as the loss of sense of familiarity when an event that has been attended before is experienced once again.

Question 86

The commonest psychiatric diagnosis reported in patients with Capgras syndrome is

Select one:
1. Psychotic depression
2. Schizophrenia
3. Alzheimer’s dementia
4. Depression
5. Bipolar disorder

Answer 86

Schizophrenia

Here the patient believes that a familiar person has been replaced by an impostor whose external appearances are identical to the real person. It was first described by Rebout-Lachaux. Most patients with
Capgras syndrome are females and the commonest reported psychiatric diagnosis is schizophrenia.

Question 87

Dereistic thinking is a term used to describe which one of the following?

Select one:
1. Lateral thinking
2. Abstract thinking
3. Logical thinking
4. Unrealistic thinking
5. Goal directed thinking

Answer 87

Unrealistic thinking

Undirected fantasy thinking in the past, has also been termed autistic or dereistic thinking.

Question 88

Which of the following is not a mixed affective state?

Select one:
1. Depressive mania
2. Inhibited mania
3. Depression with poverty of thought
4. Excited/agitated depression
5. Manic stupor

Answer 88

Depression with poverty of thought

In mixed states incongruity between motor features and mood state is found: mania with inhibition, depression with excitation etc.

Question 89

A 45-year-old man in a psychiatric inpatient unit is noted to move his right arm inwards while throwing his left arm outwards repeatedly while walking on the corridor. These are not noted when he is sitting in the lounge. He is exhibiting

Select one:
1. Parkinsonism
2. Akathisia
3. Dystonia
4. Mannerism
5. Stereotypy

Answer 89

Mannerism

This is an unusual repeated performance and maintenance of a modification of an adaptive posture during walking - this is best termed as a mannerism.

Question 90

A constellation of unchanging facial expression, decreased spontaneous movements, poverty of expressive
gestures, poor eye contact and affective non responsivity is termed as

Select one:
1. Lability of affect
2. Incongruity of affect
3. Flattening of affect
4. Reactive affect
5. Blunting of affect

Answer 90

Flattening of affect

Flattening of affect occurs in schizophrenia, depression and brain lesions.

Question 91

Eidetic imagery is best classified as a

Select one:
1. Vivid visual memory
2. Pseudohallucinations
3. Affect illusion
4. Hallucination
5. Complete illusion

Answer 91

Vivid visual memory

Eidetic imagery is a particular type of exceptionally vivid visual memory, more common in children than adults.

Question 92

A patient, who lost his right arm amputated following a crush injury, suffers from recurrent sensations arising out of the lost limb. This experience is a

Select one:
1. Delusion
2. Body image disturbance
3. Hallucination
4. Pseudohallucination
5. Somatisation

Answer 92

Body image disturbance

In most phantom limbs the phenomenon is produced by peripheral and central disorders. Hence it is improper to term this as a hallucination (which in strict sense must occur in the absence of a stimulus). The phantom limb does not necessarily correspond to the previous image of the limb in that it may be shorter or consist only of the distal portion so that the phantom hand arises from the shoulder. It is best described as a body image disturbance.

Question 93

Dysmorphophobia is typically a/an

Select one:
1. Delusional idea
2. Cognitive distortion
3. Cultural idea
4. Obsessional idea
5. Overvalued idea

Answer 93

Overvalued idea

Dysmorphophobia: It is a type of overvalued idea where the patient believes one aspect of his body is abnormal or conspicuously deformed. It is the expressed opinion of others that result in the belief. The degree of conviction is the main discriminating factor between delusion and overvalued idea. Though dysmorphophobia is usually considered as an overvalued idea, it can reach delusional intensity. Dysmorphophobia can remit following surgery in some patients.

Question 94

Epileptic automatism is associated with

Select one:
1. Preserved consciousness
2. Loss of postural control
3. Presence of aura
4. Loss of muscle tone
5. Duration lasting few seconds to few minutes

Answer 94

Duration lasting few seconds to few minutes

In the presence of disturbed consciousness, but preserved muscle tone and postural ability, patients with temporal lobe epilepsy may sometimes carry out complex motor acts termed as epileptic automatisms.
These are usually short-lived.

Question 95

Which of the following are the two stages in a delusional perception?

Select one:
1. Normal perception and misinterpretation
2. Delusional mood and delusional significance
3. Normal perception and delusional significance
4. Recall of abnormal memory and delusional significance
5. Abnormal perception and delusional significance

Answer 95

Normal perception and delusional significance

A delusional perception is the attribution of a new meaning, usually in the sense of self-reference, to a normally perceived object.

Question 96

In pure word blindness which of the following is true?

Select one:
1. Speech fluency is diminished
2. Speech comprehension is lost
3. Cannot write spontaneously
4. Reading comprehension is impaired
5. Writing comprehension is impaired

Answer 96

Reading comprehension is impaired

Also called subcortical visual aphasia, pure word blindness is associated with reduced reading comprehension but the patient can normally speak and understand the spoken word; he/she can write spontaneously and to dictation.

Question 97

Which of the following is a thought disorder that predicts relapse in schizophrenia?

Select one:
1. Circumstantiality
2. Tangentiality
3. None of the listed
4. Vorbeireden
5. Concrete thinking

Answer 97

None of the listed

FTDs seen in acute state have no prognostic value in predicting relapses.

Question 98

Which of the following is NOT a feature associated with alexithymia?

Select one:
1. Increase in abstract thinking ability
2. Reduced symbolic thinking
3. Difficulties in differentiating body sensations and emotional states.
4. Diminution of fantasy
5. Difficulties in recognizing one’s own feelings

Answer 98

Increase in abstract thinking ability

Alexithymia is a condition where a person is unable to describe his or her emotions in words. Frequently, alexithymic individuals are unaware of what their feelings are, and may have diminished abstract and fantasizing abilities.

Question 99

Which of the following statements is not true with regard to depersonalisation?

Select one:
1. Depersonalisation is rare in psychiatric practice
2. Depersonalisation is often a difficult experience to describe
3. Depersonalisation is a frequent experience of normal healthy people
4. Depersonalisation is often accompanied by the symptom of derealization
5. Affect is invariably involved in depersonalisation

Answer 99

Depersonalisation is rare in psychiatric practice

Depersonalisation is a common occurrence in normal population (around 10-30% reported prevalence) and in psychiatric clinics (more than 25% in some series).

Question 100

Suggestibility is a prominent feature of

Select one:
1. Perseveration
2. Circumstantial thinking
3. Tangentiality
4. Over inclusive thinking
5. Confabulation

Answer 100

Confabulation

The role of suggestibility is important in those who present with confabulation, pseudologia, retrospective falsification or false memory. Suggestible subjects accept statements from others, act upon their commands and deny evidence from the senses or from rational understanding that would contradict these statements.

Question 101

HiY Descriptive Psychopathology 118
One-way amnesia is associated with

Select one:
1. Histrionic personality disorder
2. Schizotypal personality disorder
3. Multiple personality disorder
4. Borderline personality disorder
5. Anankastic personality disorder

Answer 101

Multiple personality disorder

In multiple personality disorder, one-way amnesia is reported. One-way amnesia refers to the phenomenon
where in the personality A knows B’s existence, while B is not aware of A’s life.

Question 102

Which one of the following statements about delusional mood is incorrect?

Select one:
1. Delusional mood is same as delusional atmosphere.
2. The patient feels profoundly apprehensive and uncomfortable
3. Delusional mood is often followed by a fully formed delusion
4. Delusional mood is characteristically associated with perplexity
5. Delusional mood is a first rank symptom of schizophrenia

Answer 102

Delusional mood is a first rank symptom of schizophrenia

Delusional mood is a primary delusional state, but not a FRS.

Question 103

Elderly women who develop Ekbom’s delusion most commonly visit which of the following medical department before being referred?

Select one:
1. Psychiatric
2. Rheumatology
3. Neurology
4. Ophthalmology
5. Dermatology

Answer 103

Dermatology

While the term Ekbom syndrome is used in Parkinson’s to describe Restless Legs Syndrome, Ekbom’s delusion refers to delusional parasitosis.

Question 104

Retardation of thinking seen in depressive disorder is appropriately classified as which one of the following?

Select one:
1. Disturbed form of thought
2. Disturbed content of thought
3. Disturbed control of speech
4. Disturbed thought agency
5. Disturbed stream of thought

Answer 104

Disturbed stream of thought

Severe depression with psychomotor retardation may be associated with mutism, but more often there is
poverty of speech and the patient replies to questions in a slow and drawn-out fashion: this is a disturbance
in thought stream.

Question 105

Which of the following is not a catatonic sign?

Select one:
1. Catalepsy
2. Posturing
3. Negativism
4. Ambivalence
5. Ambitendence

Answer 105

Ambivalence

Ambivalence is an inability to make decisions; it is not a catatonic sign on its own unless it manifests as ambitendence.

Question 106

La belle indifference is typically seen in

Select one:
1. Multiple sclerosis
2. Schizophrenia
3. Conversion disorder
4. Dissociative amnesia
5. Dissociative fugue

Answer 106

Conversion disorder

La belle indifference is the inappropriate lack of concern about a deficit or disability that typically appears in conversion disorders. It is also seen in medical illnesses such as stroke . It is rare and non-specific symptom, and of no diagnostic value. La belle indifference is more commonly observed in adults, and is rare in children and adolescents (as few as 8%). Children and adolescents may typically express fear and hopelessness regarding their lack of voluntary control over their neurological symptoms.

Question 107

A patient repeats the last word that she uttered without any apparent purpose. This is called

Select one:
1. Echolalia
2. Logoclonia
3. Perseveration
4. Palilalia
5. Stammering

Answer 107

Palilalia

Palilalia is a compulsive involuntary repetition of a semantically acceptable phrase or word spoken by the patient herself.

Question 108

All of the following are accepted as neologisms except

Select one:
1. Personal jargon invented to describe the schizophrenic experience
2. A phrase constructed with incorrect grammar
3. A new word incorrectly built up with origins clearly understandable
4. An accepted word used in an unusual way acquiring a new meaning
5. Completely new word, the derivation of which cannot be understood

Answer 108

A phrase constructed with incorrect grammar

There are multiple definitions for neologisms such as; 1. Completely new word that its derivation cannot be
understood 2. A new word incorrectly built up with origins clearly understandable also known as word
approximation E.g handshoe for glove. 3. An accepted word used in an unusual way acquiring a new meaning 4. Technical neologisms: Personal jargon invented to describe the schizophrenic experience For example a patient using the neologism ‘aerotelegony’ to describe the process by which his thoughts were influenced from the outside.

Question 109

Emotional lability is least likely to be due to

Select one:
1. Frontal lobe damage
2. Pseudo bulbar palsy
3. Bipolar disorder
4. Temporal lobe atrophy
5. Delirium

Answer 109

Temporal lobe atrophy

Emotional lability is characterized by rapid exaggerated affective changes, which occurs commonly in elderly and frontal lobe injury.

Question 110

Teichopsic hallucinations are typical of

Select one:
1. Migraine
2. Temporal Lobe epilepsy
3. Lacunar infarcts
4. Sleep deprivation
5. Parietal lobe lesions

Answer 110

Migraine

Teichopsia is also known as scintillating scotoma; it is the sensation of a luminous appearance before the eyes, with a zigzag, wall-like outline seen in migraine.

Question 111

Crowding of thoughts occurs mainly in

Select one:
1. Schizophrenia
2. Dementia
3. Mania
4. Learning disability
5. Depression

Answer 111

Schizophrenia

Crowding of thought occurs in schizophrenia. Here the patient describes his thoughts as being passively concentrated and compressed in his head. The associations are experienced as being excessive in
amount, too fast, inexplicable and outside the person’s control. Experientially, this is different from a manic flight of ideas.

Question 112

Patients with chronic schizophrenia may lose the track of their age and may state an age different from their actual age. To be called as age disorientation, the difference in stated age and actual age must be at least

Select one:
1. 1 year
2. 10 years
3. 5 years
4. 20 years
5. 3 years

Answer 112

5 years

Age disorientation is defined as misstating one’s age by 5 or more years. It is observed in a substantial number of chronically ill, institutionalized schizophrenic patients. Prevalence estimates have been limited to data from surveys of hospitalized mental patients in chronic care facilities, where approximately 25% of patients are age disoriented.

Question 113

Which of the following cannot be considered as a component of descriptive psychopathology?

Select one:
1. Defence mechanisms
2. Understanding patient’s experience
3. Using terms to describe behaviour
4. Establishing rapport with patient
5. Empathetic approach

Answer 113

Defence mechanisms

Defence mechanisms are best described under psychodynamic (explanatory) psychopathology.

Question 114

Kinaesthetic hallucination is reported in cases with

Select one:
1. Amphetamine withdrawal
2. Benzodiazepine withdrawal
3. Cocaine withdrawal
4. Alcohol withdrawal
5. Cannabis withdrawal

Answer 114

Benzodiazepine withdrawal

Symptoms of benzodiazepine withdrawal include autonomic hyperactivity, increased tremor, insomnia, nausea or vomiting, transient visual, tactile, or auditory hallucinations or illusions, psychomotor agitation.
anxiety (most prominent), with grand mal seizures and kinaesthetic hallucinations reported in a few patients.

Question 115

Choose one incorrect statement about fugue states:

Select one:
1. Consciousness is unimpaired.
2. It is a dissociative reaction to unbearable stress.
3. Fugue state generally has an insidious onset
4. It is associated with amnesia
5. Spontaneous resolution is a common outcome

Answer 115

Fugue state generally has an insidious onset

Fugue states are rare syndromes with an abrupt onset and a duration of few hours/days. There will be loss of episodic memory and sense of personal identity. It is associated with a period of wandering, leaving residual amnesic gaps for the period of the fugue. The factors predisposing would include stress, depressed mood, head injury, alcohol abuse and epilepsy (Kopelman).

Question 116

Which of the following is not a type of formal thought disorder described by Carl Schneider?

Select one:
1. Derailment
2. Fusion
3. Substitution
4. Omission
5. Overinclusion

Answer 116

Overinclusion

Some of the terms described by Carl Schneider include fusion, omission, substitution, derailment and
drivelling.

Question 117

You are interviewing a newly admitted patient in your ward. When asked what he had for breakfast, he says ‘cereals’. Then when you asked ‘what is your name?’ he says ‘cereals’. When you asked ‘what is his date of birth?’ he continues to say ‘cereals’. The most likely symptom exhibited here is

Select one:
1. Stuttering
2. Stereotypy
3. Automatism
4. Perseveration
5. Mannerism

Answer 117

Perseveration

Perseveration occurs when mental operations persist beyond the point at which they are relevant and thus
prevent progress of thinking. Perseveration may be mainly verbal or ideational.Verbal perseveration can be
a perseveration of theme rather than the actual words and this can be regarded as impairment of switching.
In other cases the set or attitude is perseverated, and the patient cannot solve a new problem because they
cannot break free from their previous set. Verbal perseveration can occur in schizophrenia and organic states.

Question 118

A patient comes to the clinic and in a formal manner addresses you and the nurse as ‘Hello sir, how are you? How is madam?’ This is called

Select one:
1. Stock word
2. Neologism
3. Scanning speech
4. Stereotypy
5. Stilted speech

Answer 118

Stilted speech

Stilted speech - Speech excessively stilted and formal. e.g. ‘The attorney comported himself indecorously’.

Question 119

Pseudologia fantastica is most commonly associated with

Select one:
1. Pick’s dementia
2. Frontal lobe damage
3. Obsessional personality
4. Dissocial personality
5. Borderline personality/Narcissistic personality

Answer 119

Dissocial personality

Pseudologia fantastica or fluent plausible lying (pathological lying) is seen in personality disorders of
antisocial or hysterical type. It often carries a grandiose tinge and can be triggered by a personal crisis, such as facing legal proceedings. A person with pseudologia may believe their own stories and often there is a blur between fantasy and reality. When confronted, these individuals may admit to lying.

Question 120

Who first considered the distinction between ‘understanding’ and ‘explaining’ as a core skill in psychiatric
practice?

Select one:
1. Jaspers
2. Durkheim
3. Kraepelin
4. Kretschmer
5. Schneider

Answer 120

Jaspers

Jaspers is often regarded as the father of phenomenology in psychiatry. He distinguished ‘understanding’ as a component that is different from ‘explaining’ an observed phenomenon.

Question 121

Which one of the following is not a type of primary delusion?

Select one:
1. Delusional atmosphere
2. Delusional memory
3. Delusional misidentification
4. Delusional perception
5. Autochthonous delusions

Answer 121

Delusional misidentification

The 4 types of primary delusions include delusional mood, delusional perception, delusional memory and autochthonous delusions.

Question 122

Which of the following is not included in the classification of Delusional Disorders in ICD 10?

Select one:
1. Delusions of infestations
2. Delusions of grandiosity
3. Delusions of control
4. Delusions of love
5. Delusions of jealousy

Answer 122

Delusions of control

Delusions of control are bizarre delusions seen often in schizophrenia-like disorders, and not in a persistent
delusional disorder.

Question 123

A patient answers ‘five’ when asked how many days a week has. Which of the following is true about the
psychopathology exhibited by the patient?

Select one:
1. It is done intentionally
2. It is seen only in prison population
3. It is not seen in schizophrenia
4. It is a disturbance of thought control
5. It is a disturbance of thought form

Answer 123

It is a disturbance of thought form

Approximate answers suggest that the patient understands the questions but appears to be deliberately avoiding the correct answer. It is described under formal thought disturbances though it is often thought to be dissociative in origin.

Question 124

Which one among the following is not a motor symptom of schizophrenia?

Select one:
1. Cataplexy
2. Psychological pillow
3. Negativism
4. Ambitendency
5. Catalepsy

Answer 124

Cataplexy

Recognised motor symptoms of schizophrenia include catatonia, catalepsy, negativism, ambitendency,
psychological pillow, mannerism, stereotypy, echopraxia, mitmachen, mitgehen and automatic obedience.

Question 125

A patient experiences some disturbing thoughts. He feels these thoughts originate elsewhere and reach him fully formed. He does not feel he owns these thoughts. Which of the following terms best describes the above?

Select one:
1. Thought withdrawal
2. Thought insertion
3. Obsessions
4. Thought broadcasting
5. Thought blocking

Answer 125

Thought insertion

In thought insertion the patient knows that thoughts are being inserted into their mind, and they recognise them as being foreign and coming from without; this symptom, although commonly associated with schizophrenia, is not unique to schizophrenia.

Question 126

Musical hallucinations has been reported in all of the following except

Select one:
1. Temporal lobe lesions
2. Cochlear defects
3. Schizophrenia
4. Dominant parietal lobe lesions
5. Sensory deprivation

Answer 126

Dominant parietal lobe lesions

Hearing loss or deafness is a very important factor associated with musical hallucinations. The hallucinatory
experiences are more intense when the surrounding noise is low. Brain imaging studies of patients with musical hallucinations reveal a dysfunctional temporal cortex, especially on the left more than the right hemisphere.

Question 127

A special ability of memory in which visual images are drawn from memory accurately at will and described as if being perceived currently is noted in some people. Which of the following is true about this?

Select one:
1. It is common in depression
2. Common in the elderly
3. It is a type of hallucination
4. Seen in some religious practices
5. Always part of pathological experience

Answer 127

Seen in some religious practices

Eidetic images represent visual memories of almost hallucinatory vividness that are found in disorders due to substance misuse, especially hallucinogenic agents such as LSD and mescaline. It is seen more commonly in children and those involved in group religious practices.

Question 128

The patient would think ‘I must put the kettle on’, and after a pause of not more than one second would hear a voice say ‘I must put the kettle on’. This is best described as

Select one:
1. Thought insertion
2. Thought diffusion
3. Thought provocation
4. Audible thoughts
5. Thought broadcast

Answer 128

Audible thoughts

This classical symptom is also known as thought echo.

Question 129

While assessing the psychopathology of a psychotic patient, you notice that a major thought gets replaced by a minor thought in his thinking process. This is called

Select one:
1. substitution
2. derailment
3. drivelling
4. fusion
5. omission

Answer 129

Substitution

In derailment the thought slides on to a subsidiary thought while in substitution a major thought is substituted by a subsidiary one. Omission consists of the senseless omission of a thought or part of it. In fusion, heterogeneous elements of thought are interwoven with each other while in drivelling there is
disordered intermixture of constituent parts of one complex thought.

Question 130

Reduced symbolic thinking is a feature of

Select one:
1. Ambivalence
2. Avolition
3. Apathy
4. Alexithymia
5. Anhedonia

Answer 130

Alexithymia

Reduced symbolic thinking is a feature of alexithymia. Patients have difficulty in distinguishing between somatic and psychological feelings.

Question 131

Which of the following neurological disturbances closely mimic schizophrenic speech disturbance?

Select one:
1. Anomia
2. Motor aphasia
3. Jargon aphasia
4. Non fluent aphasia
5. Conduction aphasia

Answer 131

Jargon aphasia

There is more overlap between formal thought disorder and Wernicke’s aphasia than any other form of
aphasia But compared to Wernicke’s aphasia (jargon aphasia), schizophrenic discourse often has a preferred theme or preoccupation; aphasic discourse rarely does. Speakers with schizophrenia often jump from one subject to another based on the sounds or associations of words they have uttered (association chaining or glossomania). This is seldom observed in jargon aphasia. Schizophrenic discourse often includes rare words, evidence of a large, intact vocabulary; jargon aphasia, even when very fluent, shows a restricted vocabulary. More importantly, verbal comprehension remains intact in schizophrenia while it is impaired in Wernicke’s aphasia.

Question 132

Overinclusive thinking is tested by using a

Select one:
1. Verbal fluency test
2. Proverb testing
3. Similarities test
4. Sorting test
5. Cognitive estimates test

Answer 132

Sorting test

Overinclusion was first described by Cameron in 1944. Goldstein’s card sorting test can be used to test
overinclusion. According to Goldstein sorting tasks mainly are designed to assess conceptual thinking, and he emphasized that the test primarily evaluates the categorical or abstract attitude.

Question 133

On seeing a cat crossing the road, a cab driver starts thinking that the MI5 are about to arrest him soon. This is an example of

Select one:
1. Delusional perception
2. Somatic passivity
3. Delusional misinterpretation
4. Thought insertion
5. Delusional memory

Answer 133

Delusional perception

A delusional perception is a two staged process of primary delusion: a normal perception followed by delusional judgement.

Question 134

The term anhedonia was coined by

Select one:
1. Bleuler
2. Ribot
3. Kraeplin
4. Sifneos
5. Kretschmer

Answer 134

Ribot

An inability to enjoy anything in life or even get pleasure from everyday occurrences is called as anhedonia
(for example being hugged by one’s children).The term was coined in 1896 by Ribot, a French psychologist.

Question 135

Deja vu and jamais vu are disorders of

Select one:
1. Familiarity
2. Volition
3. Perception
4. Behaviour
5. Mood

Answer 135

Familiarity

These are best described as pathological states involving familiarity.

Question 136

Inability to verbalize one’s strong emotions is termed as

Select one:
1. Ambivalence
2. Apathy
3. Anhedonia
4. Alexithymia
5. Avolition

Answer 136

Alexithymia

Alexithymia: First described by Sifnoes in 1973. It is characterized by inability to verbalize affect and elaborate fantasies.

Question 137

Obsessional slowness is common in which of the following type of obsessions?

Select one:
1. Washing obsessions
2. Obsession of symmetry
3. Obsessions of contamination
4. Cleaning obsessions
5. Religious obsessions

Answer 137

Obsession of symmetry

An obsessive need for symmetry and exactness and a compulsion to order and arrange often results in slowness

Question 138

A woman reports that she can see her recently deceased husband though she does not believe he could be alive. This is best described as a

Select one:
1. Perceptual distortion
2. Visual hallucination
3. Affect illusion
4. Pseudohallucination
5. Pareidolia

Answer 138

Pseudohallucination

So called hallucinations of widowhood are indeed pseudohallucinations in phenomenological terms.

Question 139

Which of the following is false with regard to pseudohallucinations?

Select one:
1. Patient may have insight about the absence of reality
2. May occur in a subjective space e.g. within the head
3. They may accompany true hallucinations
4. Pathognomonic of borderline personality disorder
5. Patient does not usually search for the bearer of the voice

Answer 139

Pathognomonic of borderline personality disorder

Jaspers believed that pseudo-hallucinations are variants of fantasy/ mental imagery and, thus not carrying the same diagnostic implications as true hallucinations. Hare suggested it was more meaningful to distinguish them in terms of the degree of insight.

Question 140

Of various thought disorders classified by Andreasen, which of the following is more common in schizophrenia than mania?

Select one:
1. Circumstantiality
2. Neologisms
3. Flight of ideas
4. Clanging
5. Derailment

Answer 140

Derailment

Of various thought disorders classified by Andreasen, clanging and flight are more common in mania while derailment (loosening) and thought blocking and to some extent tangentiality and poverty of content of
speech are seen more often in schizophrenia - other items were largely non specific for the 2 diagnoses.

Question 141

A 34-year-old man with schizophrenia resists moving his limbs during a neurological examination. Despite
repeated reassurances from the examining doctor, he resists yielding his limbs for passive manipulations. He is exhibiting

Select one:
1. Mannerism
2. Automatism
3. Negativism
4. Obstruction
5. Borderline traits

Answer 141

Negativism

Negativism is an apparently motiveless resistance to all interference. It is found in catatonia, severe learning disability and dementia. Negativism may be passive when all interference is resisted and orders are not carried out, or it may manifest as active when the patient does the exact opposite of what they are asked to do, in a reflex manner.

Question 142

A middle-aged woman suffers a panic attack and believes she is going to die. Which term could be used to describe this psychopathology?

Select one:
1. Schemas
2. Overvalued idea
3. Obsessional rumination
4. Thought monitoring
5. Outcome fear

Answer 142

Outcome fear

Outcome fear is a diagnostic feature of panic disorder. The bias in information processing that leads to outcome fear is termed as catastrophic misinterpretation.

Question 143

When one of the other residents pushed a salt cellar towards him, a patient knew that he must return home
‘to greet the Pope who is visiting Ireland to see his family and reward them’. This is called

Select one:
1. Partial delusion
2. Delusional misinterpretation
3. Referential delusion
4. Grandiose delusion
5. Delusional perception

Answer 143

Delusional perception

This is a delusional perception; in grandiose delusions a sense of falsely elevated self esteem is often seen.

Question 144

The phenomenon of deja vu is

Select one:
1. Inappropriate familiarity to a new place or event
2. Transient loss of sense of familiarity to a well accustomed place
3. Inappropriate familiarity with a new thought
4. Loss of sense of familiarity to a well known person
5. Mixture of meaningless words

Answer 144

Inappropriate familiarity to a new place or event

Deja vu is a problem with the familiarity of places and events. It comprises the feeling of having experienced a current event in the past, although it has no basis in fact. The converse, jamais vu is the knowledge that an event has been experienced before but is not presently associated with the appropriate
feelings of familiarity. Deja entendu, the feeling of auditory recognition, and deja pense, a new thought recognised as having previously occurred, are related to deja vu, being different only in the modality of experience. These can be experienced by normal subjects as well as among those with temporal lobe epilepsy.

Question 145

Schnauzkrampf is associated with

Select one:
1. Dementia
2. Schizophrenia
3. Bipolar disorder
4. Depression
5. None of the above

Answer 145

Schizophrenia

Schnauzkrampf: A characteristic facial expression in which the nose and lips are drawn together.

Question 146

Which of the following statements with respect to pseudohallucinations is true?

Select one:
1. Are under the control of subject’s volition
2. Are located in the inner subjective space
3. Are experienced as real and concrete.
4. Are typically located in the outer objective space.
5. Are pathognomonic of personality disorders

Answer 146

Are located in the inner subjective space

A true hallucination is usually perceived as being in external space, distinct from imagined images, outside conscious control, and as possessing relative permanence. Pseudohallucinations are typically located in the inner subjective space. The experience is figurative, not concrete or real. They are less vivid and less clear and they are not under the control of subject’s volition. They are not pathognomonic of any particular mental illnesses.

Question 147

Choose the incorrect association from the following list

Select one:
1. Flight of Ideas-mania
2. Thought blocking-schizophrenia
3. Circumstantiality-obsessive
4. Compulsive disorder
5. Perseveration- Frontal lobe syndrome
6. Inhibition of thinking-Depression

Answer 147

Circumstantiality-obsessive compulsive disorder

Circumstantiality is associated with anankastic personality disorder (also known as Obsessive Compulsive
Personality Disorder) - not OCD.

Question 148

A voice in a flat monotone describes everything the patient is doing: ‘She is peeling potatoes, she has now got hold of the peeler, she does not want that potato…’ This is best described as

Select one:
1. Running commentary
2. Second person hallucinations
3. Imperative hallucinations
4. First person hallucinations
5. Autochthonous perceptions

Answer 148

Running commentary

Running commentary hallucinations are a part of Schneider’s first rank symptoms of schizophrenia.

Question 149

The most common type of seizure with an aura is

Select one:
1. Pseudoseizures
2. Grandmal seizure
3. Absence seizure
4. Complex partial seizure
5. Parietal seizure

Answer 149

Complex partial seizure

Episodes of temporal lobe disturbance (complex partial seizures) are often heralded by an aura involving an
unpleasant odour such as burning paint or rubber.

Question 150

A man with psychotic symptoms said: ‘When I try to think, my head gets full of noise; it is like as if my brain were in an uproar with my thoughts’. The most appropriate psychopathology is

Select one:
1. Thought diffusion
2. Thought broadcast
3. Thought provocation
4. Thought echo
5. Crowding of thoughts

Answer 150

Thought echo

Schneider described a man with schizophrenia who had the experience of his thoughts being spoken aloud,
i.e. Thought Echo in the above fashion.

Question 151

Which one of the following is not a negative symptom of schizophrenia?

Select one:
1. Anhedonia
2. Attentional impairment
3. Affective flattening or blunting
4. Alexithymia
5. Avolition

Answer 151

Alexithymia

The prominent negative symptoms include affective flattening or blunting, attentional impairment, avolition-apathy (lack of initiative), anhedonia, asociality, alogia (lack of speech output).

Question 152

“The thoughts of Elvis come into my mind. He treats my mind like a screen and flashes his thoughts on to it like you flash a picture.” This patient is experiencing

Select one:
1. Thought blocking
2. Thought insertion
3. Thought broadcast
4. Obsessions
5. Thought withdrawal

Answer 152

Thought insertion

This refers to the phenomenon of insertion of thought; the important feature is the experience of the thought
belonging to someone else being placed in one’s own stream of thoughts.

Question 153

Which of the following is a thought disorder where figure-ground differentiation apparently fails?

Select one:
1. Neologism
2. Concrete thinking
3. Tangentiality
4. Circumstantiality
5. Vorbeireden

Answer 153

Circumstantiality

Circumstantiality occurs when thinking proceeds slowly with many unnecessary and trivial details, but finally the point is reached. The goal of thinking is never completely lost and thinking proceeds towards it by an intricate and convoluted path, and is often due to the loss of figure-ground differentiation in the thought process.

Question 154

An 82-year-old lady admitted to the psychiatric ward insists that she is already dead and should be buried,
and her viscera have stopped working and are rotting away. What is the probable diagnosis?

Select one:
1. Couvade syndrome
2. Briquet syndrome
3. De Clerembault syndrome
4. Cotard’s syndrome
5. Hypochondriacal syndrome

Answer 154

Cotard’s syndrome

Cotard’s syndrome is a presentation of psychotic depressive illness seen particularly in elderly people where there is a combination of depressed mood with nihilistic delusions and hypochondriacal delusions.

Question 155

A 78-year-old patient is observed to be lying when asked what he had for breakfast or who visited him the day before. He is not embarrassed by this and does not appear to be jocular with regard to the lies; the lies are usually trivial bringing no harm to anyone. Which of the following is true?

Select one:
1. He is having memory difficulties
2. He is having Ganser’s syndrome
3. He is playing practical jokes intentionally
4. He is exhibiting pseudologia fantastica
5. He has an antisocial personality

Answer 155

He is having memory difficulties

Confabulation refers to creating stories to fill gaps in memory - an unconscious behavior seen in patients with memory impairment. It is not intentional lying.

Question 156

Which one of the following statements about first rank symptoms of schizophrenia is NOT true?

Select one:
1. They carry prognostic significance
2. They are also seen in Organic Psychosis
3. These are a group of symptoms which are useful in the diagnosis of schizophrenia
4. They are also seen in affective psychoses
5. They are neither pathognomonic nor specific to schizophrenia

Answer 156

They carry prognostic significance

Presence or absence of FRS in schizophrenia does not add any prognostic information to a presentation. We cannot say that someone has a more severe form of schizophrenia if they have a high number of FRS.

Question 157

In formal thought disorder, asyndesis refers to

Select one:
1. Lack of genuine causal links in speech
2. Lack of logical arguments in speech
3. Lack of wide vocabulary in speech
4. Lack of information in speech
5. Lack of adjectives in speech

Answer 157

Lack of genuine causal links in speech

Cameron (1944), used the term ‘asyndesis’ to describe the lack of adequate connections or causal links between successive thoughts,

Question 158

Which of the following is true concerning depersonalisation?

Select one:
1. It is experienced as an unpleasant state
2. The subject feels that the world around him is unreal
3. Multiple personalities emerge during the experience
4. It is associated with approximate answers
5. The subject cannot recall events later

Answer 158

It is experienced as an unpleasant state

Depersonalisation is a non-specific symptom that is often associated with an unpleasant subjective state, especially during situations of pathological nature.

Question 159

Agitated depression is a well-recognized feature of

Select one:
1. Depression in children
2. Depression in young men
3. Depression in young women
4. Depression in the elderly
5. Depression in middle aged women

Answer 159

Depression in the elderly

This is a mixed affective state described by Emil Kraepelin.

Question 160

Which of the following is not a culture-bound disorder?

Select one:
1. Bouffee delirante
2. Koro
3. Frigophobia
4. Windigo
5. Dysmorphophobia

Answer 160

Dysmorphophobia

Dysmorphophobia can occur in any culture and can also be of delusional intensity. By definition, culture-bound disorders are considered to be non-delusional.

Question 161

A patient repeatedly refers to computers as ‘mathscreen’. His speech exhibits numerous other disturbances. This can be termed as

Select one:
1. Stammering
2. Parapraxis
3. Stereotypy
4. Stock words
5. Metonymy

Answer 161

Metonymy

Metonyms are imprecise expressions that are used in place of more exact words that are available to describe an object or event.

Question 162

Which of the following factors predict a high persistence of delusional ideas?

Select one:
1. Younger patients
2. Having a diagnosis of schizophrenia
3. Married patients
4. Having a delusion of grandiosity
5. Having single primary delusion

Answer 162

Having a diagnosis of schizophrenia

A diagnosis of schizophrenia is the best predictor of persistence of delusional beliefs.

Question 163

Stereotypy is characterised by

Select one:
1. Mimicking examiner’s movements and speech
2. Maintenance of unchanged facial expression
3. Repetitive, non-goal-directed motor activity
4. Spontaneous maintenance of limb posture
5. Odd purposeful movements

Answer 163

Repetitive, non-goal-directed motor activity

Odd purposeful (or quasi-purposive) movements are called mannerisms. Repetitive, non-goal directed motor activity is called stereotypy. Maintaining unchanged queer facial expression is described as grimacing.

Question 164

A patient at your clinic reports, ‘When I heard the railway station master’s whistle, I knew that there was a plot to attack me.’ This is called

Select one:
1. delusion
2. Secondary delusion
3. Delusional mood
4. Delusional perception
5. Partial delusion

Answer 164

Delusional perception

A delusional perception must not be confused with delusional misinterpretation. In the former, there will be no rational link between the judgement arrived at and the original perception; but in the latter some link via mental state, mood, anxiety or relevance can be easily discerned.

Question 165

Which of the following is the commonest cause of stupor in psychiatric units?

Select one:
1. Mania
2. Epilepsy
3. Dissociation
4. Depression
5. Stroke

Answer 165

Depression

Stupor is a state of more or less complete loss of activity where there is no reaction to external stimuli; it can be regarded as an extreme form of hypokinesia and the most common cause in psychiatry wards is depression.

Question 166

Psychopathology of near death experiences include all of the following except

Select one:
1. Motor perseveration
2. Autoscopic experience
3. Depersonalisation
4. Transcendental experience
5. Out of body experience

Answer 166

Motor perseveration

In motor perseveration, the patient may draw a square when asked to do so, but continues to draw squares even when asked to draw circles (impaired set-shifting). This is not seen in Out-of-Body or Near Death Experiences.

Question 167

Hallucinations in depressive psychosis are usually

Select one:
1. Gustatory
2. Auditory
3. Olfactory
4. Visual
5. Tactile

Answer 167

Auditory

In depressive psychosis, the hallucinations are usually either second person derogatory or first person singular with a strong negative connotation.

Question 168

A patient says ‘I am constantly being followed by people I know, but I can’t recognize them because they are always in disguise’. What symptom is she exhibiting?

Select one:
1. Capgras delusion
2. Fregoli delusion
3. Intermetamorphosis
4. Cotard delusion
5. De Clerambault’s delusion

Answer 168

Fregoli delusion

In Fregoli syndrome, a patient believes that various people whom she meets are really the same previously known person (e.g. a member of the family or friend), but appearing in disguise. For example, a patient believed that her neighbour could change his appearance, clothes and even his gender at his will so as to spy on her.

Question 169

A 35 year old man in your inpatient unit keeps his ears blocked with cotton and tape. He is disturbed by two persons discussing between themselves about every movement that he makes. They also discuss his emotions and plans. The most likely description is

Select one:
1. Referential delusions
2. 2nd person hallucinations
3. 3rd person hallucinations
4. Thought broadcast
5. 1st person hallucinations

Answer 169

3rd person hallucinations

Third person hallucinations are auditory hallucinations in which patients hear voices talking about themselves, referring to them in the third person, for example ‘he is an evil person’. This type of auditory hallucination is particularly associated with schizophrenia, but can occur in affective disorders.

Question 170

A depressed patient on the ward complained of total inability to experience pleasure. What is the term used to denote this type of pathological change in mood?

Select one:
1. Apathy
2. Affective flattening
3. Affective blunting
4. Anhedonia
5. Incongruity of affect

Answer 170

Anhedonia

Anhedonia: Total inability to experience pleasure. It is divided into physical anhedonia e.g. No appreciation of beauty of sunset (not enjoying the ‘feast’ - the outcome) and social anhedonia e.g. no enjoyment of company of friends (not enjoying the ‘hunt’ - the process). Anhedonia occurs in depression and schizophrenia (Katsanis 1992).

Question 171

Which of the following is true with regard to the mental state of ecstasy?

Select one:
1. Associated with persecutory ideas
2. Associated with somatoform pain state
3. Cannot occur in the absence of pathological phenomenon
4. Associated with altered boundary of self
5. Some degree of altered consciousness is always seen

Answer 171

Associated with altered boundary of self

Ecstasy is a heightened state of happiness. It is usually self-referent (e.g., flowers of spring are blossoming for me). It occurs both in healthy people, and in patients with schizophrenia, epilepsy, mania, hysterical dissociation and organic states. There is often an alteration of the boundaries of self. Anderson described it as a ‘pantheistic experience’ that the subject and universe are one.

Question 172

Astasia-Abasia has been observed in

Select one:
1. Dissociative fugue
2. Conversion disorder
3. Depressive pseudodementia
4. Phobic anxiety disorder
5. Schizophrenia

Answer 172

Conversion disorder

Astasia-abasia is also known as Blocq’s disease. This is the inability to walk or stand in a normal manner. The gait appears bizarre, unpredictable and not suggestive of any organic lesion. It is often characterized by swaying and almost falling, with recovery at the last moment. It is a conversion symptom (dissociative motor disorder in ICD-10 and conversion disorder in DSM-IV).

Question 173

A dominating but solitary belief that is neither delusional nor obsessional but influences one’s life to a notable extent is called

Select one:
1. Compulsion
2. Stereotype
3. Rumination
4. Cognitive Distortion
5. Overvalued idea

Answer 173

Overvalued idea

Overvalued idea is a non-delusional, non-obsessional abnormal belief. The subject holds a belief which is in itself acceptable and comprehensible but comes to dominate his/her thinking and behaviour. The idea will have great significance and value to the subject.

Question 174

A patient complains that people come to know what she is thinking by looking into her eyes. This can be described as

Select one:
1. Overvalued idea
2. Thought broadcast
3. Thought alienation
4. Delusion of reference
5. Thought withdrawal

Answer 174

Delusion of reference

A patient with delusions of reference believes that other people are talking about her, slandering or spying on her. At times, it may be difficult to ascertain whether the patient has delusions alone or if she has self-referential hallucinations that are associated with the delusions.

Question 175

Which of the following is NOT a catatonic sign?

Select one:
1. Posturing
2. Flexibilitas cerea
3. Mitgehen
4. Negativism
5. Essential tremor

Answer 175

Essential tremor

Essential tremor is an autosomal dominant condition with incomplete penetrance (35% no family history); it is worsened by stress and improved by alcohol.

Question 176

“I am thinking about my mother, and suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor, and there is nothing in my mind.” This is best described as

Select one:
1. Thought blocking
2. Thought withdrawal
3. Thought insertion
4. Thought broadcast
5. Thought echo

Answer 176

Thought withdrawal

This refers to the phenomenon of withdrawal of thought; the important feature is the experience of being void followed by external attribution. External attribution is absent in thought blocking.

Question 177

A partially sighted, 77-year-old lady reports seeing Peter Rabbit images in front of her eye. She has no psychotic features. Which of the following is true about the above symptom?

Select one:
1. Her consciousness may be altered
2. It cannot occur unless she is completely blind in at least one eye
3. The Rabbit will not disappear on sleeping
4. She may retain insight
5. The objects seen are usually static

Answer 177

She may retain insight

Charles-Bonnet syndrome comprises of visual hallucinations without any other psychotic features or any evidence of psychiatric disorder. It is associated with visual impairment. The content of the hallucinations varies from straight lines to complex pictures of people and buildings. They may be enjoyable with full insight or distressing.

Question 178

In spite of being instructed not to pull his shirt up and show his abdomen, a patient does the same whenever a doctor comes to speak to him. Which of the following symptom is he exhibiting?

Select one:
1. Automatism
2. Echopraxia
3. Negativism
4. Mannerism
5. Automatic obedience

Answer 178

Automatic obedience

In automatic obedience the patient carries out every instruction regardless of the consequence. To demonstrate this, Emil Kraepelin would ask the patient to put out their tongue and he would prick it with a pin; patients with automatic obedience continued to put their tongue out when asked to, although every time they did so their tongue was pricked.

Question 179

Which of the following is characterised by patients maintaining unusual postures for long time with no
resistance to a passive movement?

Select one:
1. Cataplexy
2. Advertence
3. Spasticity
4. Mitgehen
5. Catalepsy

Answer 179

Catalepsy

Advertence is a catatonic sign wherein a schizophrenic patient dramatically turns fully towards the doctor/examiner when he is spoken to. Aversion is another catatonic feature wherein the patient turns completely away.

Question 180

In which of the following forms does morbid jealousy NOT occur usually?

Select one:
1. In dementia
2. As misidentification syndrome
3. In depression
4. As delusion
5. As an overvalued idea

Answer 180

As misidentification syndrome

The term ‘delusion of jealousy’ is a misnomer as patients with morbid jealousy tend to have delusions of infidelity, rather than delusions of jealousy (Munro, 1999). Delusions of infidelity may especially occur in schizophrenia and alcohol dependency syndrome. It is not a misidentification syndrome.

Question 181

Which of the following is a formal thought disturbance?

Select one:
1. Thought insertion
2. Obsessions
2. Tangentiality
3. Stuttering
4. Delusions of persecution

Answer 181

Tangentiality

With tangentiality, the patient can never get to the point; it is a formal thought disorder seen in schizophrenic speech samples.

Question 182

A 35 year old woman is on sodium valproate for many years. She is having lack of sleep following a holiday and tells her husband ‘Life is not a game, every idiot has to earn a name, so work hard for fame, if not you will end up feeling shame’. She is exhibiting

Select one:
1. Rhyming
2. Metonymy
3. Punning
4. Pressured speech
5. Neologisms

Answer 182

Rhyming

An example of flight of ideas associated with rhymes comes from a manic patient described by Fish. She was asked where she lived and she replied: ‘Birmingham, Kingstanding; see the king he’s standing, king, king, sing, sing, bird on the wing, wing, wing on the bird, bird, turd, turd.’

Question 183

A patient withdrawing from alcohol sees small Chinese soldiers marching on his carpet. This phenomenon is called

Select one:
1. Pseudohallucination
2. Affective illusion
3. Macropsia
4. Micropsia
5. Lilliputian hallucination

Answer 183

Lilliputian hallucination

Lilliputian hallucinations are visual hallucinations of diminutive persons or animals. Unlike the usual organic visual hallucinations, these may be accompanied by pleasure and amusement.

Question 184

Ekbom’s syndrome is least likely to be related to
Select one:

1. Cocaine use
2. Dementia
3. Autism
4. Schizophrenia
5. Alcohol withdrawal

Answer 184

Autism

Ekbom’s syndrome is a delusional belief that one’s skin is infested with multiple tiny mite like organisms. It is a mono-symptomatic delusional disorder where the core delusion pertains to parasitic infestation. It may be secondary to tactile hallucinations seen in cocaine intoxication or alcohol withdrawal.

Question 185

A patient who is almost completely bald was observed to imitate combing his hair repeatedly but without a comb or brush. He is diagnosed to have schizophrenia. Which of the following is the most likely phenomenon observed?

Select one:
1. Perseveration
2. Stereotypy
3. Mannerism
4. Passivity
5. Akathisia

Answer 185

Mannerism

This is an example of mannerism - a repetitive act that is apparently goal-directed but not necessary or
required.

Question 186

‘If I think of anything, at once those opposite to me know it and it is embarrassing’. This is best termed as

Select one:
1. Referential delusion
2. Delusional misinterpretation
3. Thought diffusion
4. Thought block
5. Thought echo

Answer 186

Thought diffusion

Thought diffusion is the same as thought broadcast, which is described here. This description was given by a shopkeeper with schizophrenia and was reported by Schneider himself.

Question 187

A 32-year-old shift worker presents with a history of headaches occurring in the mornings for a few months. His GP has been treating him for a diagnosis of tension headache. Which of the following features suggest a different pathology?

Select one:
1. Pain relieved by analgesics
2. The localisation of pain is vague.
3. Associated with low mood and anxiety
4. Postural worsening of pain
5.Pain worse with stress

Answer 187

Postural worsening of pain

Postural change may indicate intracranial pathology.

Question 188

A woman believes that the tennis player Roger Federer is in love with her. She has never seen him in person but believes that he is delivering romantic e-mails to her inbox in various disguised names. She is exhibiting

Select one:
1. De Clerambault’s delusion
2. Cotard delusion
3. Morbid jealousy
4. Capgras delusion
5. Fregoli delusion

Answer 188

De Clerambault’s delusion

This is a condition in which the patient, often a single woman, believes than an important person is in love with her. Usually, the supposed lover is a person who is often physically inaccessible as described in this example.

Question 189

Which one among the following is not a first rank symptom of schizophrenia?

Select one:
1. Thought insertion
2. Thought withdrawal
3. Thought broadcasting
4. Delusional perception
5. Thought Block

Answer 189

Thought block

Thought blocking is not described along with other first-rank symptoms. The three thought phenomena
included with FRS are thought insertion, withdrawal and broadcast.