Exam 2

Question 1

Multiple physical symptoms, with refusal to accept reassurance of negative results

Answer 1

Somatization

Question 2

What does Hoovers sign look for?

Answer 2

Distinction between organic and functional paraparesis of hip flexors; in functional, the lack of “effort” shows by the fact that the contralateral hip does not extend when the patient is asked to flex their “weak” hip

Question 3

Excessive worry about severe physical illness e.g. cancer in the absence of, or presence of mild, symptoms

Answer 3

Hypochondriasis

Question 4

Condition in which a person deliberately acts as if he has a physical disorder in order to gain medical attention

Answer 4

Factitious disorder

Question 5

Feigning illness for secondary gain

Answer 5

Malingering

Question 6

Loss of sensory or motor function, usually as a response to a mental or emotional stress/crisis

Answer 6

Conversion disorder

Question 7

How are dissociative disorder and conversion disorder distinguished?

Answer 7

Conversion = neurological symptoms
Dissociative = psychiatric e.g. fugue, amnesia, stupor

Question 8

Difference between a personality trait and a disorder

Answer 8

Disorders are pervasive and maladaptive

Question 9

Cluster B disorders (“wild”) [4]

Answer 9

Antisocial
Borderline
Histrionic
Narcissistic

Question 10

Cluster C disorder (“worried”) [3]

Answer 10

Obsessive compulsive
Avoidant
Dependent

Question 11

Instability of personal relationships, self-image, and affects, and marked impulsivity

Answer 11

Borderline personality disorder

Question 12

Detachment form social relationships and a restricted range of emotions

Answer 12

Schizoid personality disorder

Question 13

Social inhibition, feelings of inadequacy and hypersensitivy to negative evaluation

Answer 13

Avoidant personality disorder

Question 14

Excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation

Answer 14

Dependent personality disorder

Question 15

Preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency

Answer 15

Obsessive compulsive personality disorder

Question 16

Characterised by weird, “magical” thinking

Answer 16

Schizotypal personality disorder

Question 17

Distinction between schizoid and avoidant personality disorders

Answer 17

Avoidant people are distressed by their social isolation

Question 18

What are self-referential experiences?

Answer 18

Ideas of reference- the belief that external events are linked to oneself. Example- “car registration plates contain hidden codes for me”

Question 19

Disorder of thought form where the person is unable to answer a question without giving excessive unnecessary detail

Answer 19

Circumstantiality

Question 20

Difference between circumstantiality and tangential thinking

Answer 20

Circumstantiality = eventually return to the point and give information requested
Tangentiality = wander from the point and never return

Question 21

Differential diagnoses for psychotic symptoms (8)

Answer 21

Schizophrenia
Mania (bipolar)
Severe depression 
Puerperal psychosis
Schizoaffective disorder
Substance abuse
Delirium
Dementia

Question 22

Main psychotic symptoms (2)

Answer 22

Delusions (e.g. religious, grandiose, persecutory)

Hallucinations- auditory, visual, gustatory

Question 23

Three main dopaminergic brain pathways (and their function)

Answer 23

Nigrostriatal (extrapyramidal system)
Tuberoinfundibular (control of prolactin release)
Mesocortical/limbic (motivation and reward)

Question 24

What causes the negative symptoms of schizophrenia?

Answer 24

Dopamine HYPOactivity in the mesoCORTICAL system

Question 25

What causes the first-rank symptoms of schizophrenia?

Answer 25

Dopamine HYPERactivity in the mesoLIMBIC pathway

Question 26

How can amphetamine worsen/precipitate psychosis?

Answer 26

Increases dopamine release in the brain

Question 27

Risk factors for schizophrenia (4)

Answer 27

Family history
Intrauterine and perinatal complications
Social isolation
Cocaine/cannabis use

Question 28

First-rank symptoms of schizophrenia. (4) How many of these are needed for the diagnosis?

Answer 28

Auditory hallucinations
Thought insertion/withdrawal/broadcasting
Delusional perceptions
Passivity phenomena
Only one is needed

Question 29

Negative symptoms in schizophrenia (5)

Answer 29

Underactivity
Low motivation
Social withdrawal
Emotional flattening
Self neglect

Question 30

Thought patterns in schizophrenia (2)

Answer 30

Thought blocking

Loosened associations

Question 31

How long does a) an emergency detention and b) complusory treatment order under the Mental Health Act last for?

Answer 31

a) max 72 hours

b) up to 6 months

Question 32

First line treatment when tranquilisation is required?

Answer 32

If non-drug approaches fail, oral lorazapem; if oral unsuccessful, give IM

Question 33

Management of treatment resistant psychosis

Answer 33

Clozapine- requires greater monitoring

Question 34

What happens after the 6 months of a compulsory treatment order expires?

Answer 34

Re-apply for another 6 months after which 12 months can be used
Can be appealed and taken to a tribunal

Question 35

What does the Mental Health Act specifically exclude as being grounds for compulsory detention?

Answer 35

Symptoms arising from being under the influence of drugs or alcohol