History, social, ethical (MRCP) Flashcards
Which one of the following was a proponent of humane and moral treatment of insanity? A. Anton Mesmer B. Phillipe Pinel C. Jacques Lacan D. Emil Krapelin E. Melanie Klein
B. Phillipe Pinel (1745–1826) was working at Salpetriere in Paris at the time of the French
Revolution. He insisted on releasing patients from chains in asylums, emphasized systematic
clinical observations using case records and championed humane treatment of the mentally ill.
Anton Mesmer was a proponent of mesmerism, a form of clinical suggestion. Jacques Lacan is
known as the ‘French Freud’. Melanie Klein was an object relations theorist.
Morel was a French–Austrian physician associated with the term demence
precoce. He is also associated with which of the following theories?
A. Regeneration theory
B. Devolution theory
C. Degeneration theory
D. Segregation theory
E. Integration theory
C. Degeneration theory maintained that most forms of insanity resulted from continuous
deterioration of mental faculties. More alarmingly, it also stated that hereditary transmission of
nervous dysfunction was produced by noxious environmental factors. Morel was the proponent
of degeneration theory
Neurasthenia was originally described by which one of the following? A. Beard B. Freud C. Jung D. Adler E. Engel
A. American neurologist, Beard, described neurasthenia in 1880. This is retained in the
ICD-10, and is the closest diagnosis to the present day chronic fatigue syndrome. Various terms,
including myalgic encephalomyelitis and viral fatigue syndrome, are in vogue in an attempt to
emphasize infectious/ infl ammatory origin of this illness
Inducing malarial fever was proposed as a treatment for which of the following diseases? A. Hysteria B. Neurasthenia C. Tourette’s syndrome D. General paralysis of the insane E. Multiple sclerosis
D. General paresis or paralysis of the insane (GPI, also called as paralytic dementia) is a rare
encephalitic illness. GPI was common in the past due to syphilis. Malaria therapy for GPI was
proposed by Wagner von Jauregg, a Nobel laureate. Manic presentation was common in GPI. GPI
has almost disappeared now, though with the rising HIV pandemic it is speculated to have
resurgence in the future
Which one of the following hormones was used to induce coma in the treatment of schizophrenia? A. Thyroxine B. Cortisone C. Testosterone D. Insulin E. Parathormone
D. Insulin coma therapy for severe mental illness was introduced by Sakel in 1933. This was a
potentially fatal treatment complicated by seizures and encephalopathy. Chemically induced
seizures were also employed around the same period (von Meduna) for treating schizophrenia.
Who among the following described hebephrenic schizophrenia? A. Greisinger B. Falret and Baillarger C. Tuke D. Hecker E. Clouston
D. Hecker described hebephrenia – characterized by adolescent onset with disorganized
behaviour and incongruent affect. Hecker was a pupil of Karl Kahlbaum, and some consider that
he only popularized the notion of hebephrenic schizophrenia, which was originally proposed by
Kahlbaum. Sir Thomas Clouston is associated with ‘developmental insanity’. William Tuke opened
the Retreat in York, promoting moral treatment and unchaining the insane. Falret and Baillarger
are associated with folie circulaire (manic depression) while Greisinger developed views on tha
neuropathological basis for psychiatric disorders.
Which one of the following terms was coined by Esquirol? A. Nymphomania B. Monomania C. Hypomania D. Pseudomania E. Pyromania
B. Monomania was described by Esquirol and it is similar to the present day concept of
delusional disorder. Nymphomania was coined in 1775, by a French doctor Bienville, from Greek
nymphe meaning ‘bride’. It was used to describe excessive sexual desire seen in some women. The
term hypomania was coined by Mendel (1881).
First-rank symptoms in schizophrenia were proposed by A. Kurt Schneider B. Carl Schneider C. Manfred Bleuler D. Eugen Bleuler E. Emil Kraeplin
A. Kurt Schneider proposed fi rst-rank symptoms – neither diagnostic nor prognostic but only
indicative of schizophrenia. Eugen Bleuler used the term schizophrenia in 1911. Carl Schneider
classifi ed many forms of formal thought disturbances; later he was closely associated with the Nazi
movement in Germany, promoting ‘euthanasia’ for mentally retarded and epileptic patients.
All of the following are correctly matched EXCEPT A. Ribot: anhedonia B. Sifneos: alexithymia C. Kahlbaum: cyclothymia D. Moreno: chorea E. Cameron: overinclusion
D. Moreno described psychodrama, not chorea. He also introduced sociometry. Anhedonia
stands for inability to obtain pleasure from activities; alexithymia is a diffi culty in verbalizing
emotional states; Cyclothymia, retained in ICD-10, is a minor subsyndromal form of bipolar illness
described by Kahlbaum; Cameron described overinclusion as a part of formal thought
disturbances.
The fi rst antidepressants to be discovered were A. SSRIs B. MAOIs C. TCAs D. Amphetamines E. Benzodiazepines
B. Monoamine oxidase inhibitors were the earliest antidepressants. They were
serendipitously discovered when iproniazid, an antitubercular antibiotic, was found to have moodlifting
properties. This was reported by Bloch in 1954
Case studies have been traditionally useful in studying brain–behaviour
relationships. In one of such case study Phineas Gage, a railway worker,
sustained damage to which of the following brain areas?
A. Parietal lobe
B. Hypothalamus
C. Pineal gland
D. Frontal lobe
E. Temporal lobe
D. Phineas Gage was a railway workman whose frontal lobe (especially the ventromedial
prefrontal area) was accidentally drilled out by an iron bar. He survived the terrible accident but
had signifi cant personality and behavioural change, stimulating interest in studying functions of the
frontal lobe.
Lithium was used in which of the following medical illnesses before being rediscovered for mania? A. Gout B. Osteoarthritis C. Epilepsy D. Stroke E. Goitre
A. Lithium was brought to the attention of psychiatric practice in 1949 by Australian, John
Cade, who highlighted its mood-stabilizing effect. Lithium water was a popular ‘tonic for aches
and pains’ and was used for gout before this discovery
Which one of the following is the oldest treatment method employed to cure mental illness? A. Electroconvulsion B. Coma induction C. Trephination D. Lobotomy E. Rest cure
C. Trephination refers to drilling holes in skulls to release evil spirit that were believed to
haunt the insane. This practice is noted even in prehistoric skulls dated 6500 BC. Electroconvulsion
was introduced by Cerletti and Bini in the early part of the twentieth century, while Moniz
proposed neurosurgical methods to treat psychiatric disorders.
Durkheim is a name associated with the study of which of the following phenomena? A. Homicide B. Violence C. Truancy D. Arson E. Suicide
E. Durkheim described anomic, altruistic, and egoistic suicide. In anomie, the patient feels let
down by society and fails to follow norms. In altruistic suicide, over involvement with a particular
social group leads to signifi cant alteration in one’s self identity and the suicide is for the group
cause rather than personal cause, for example hara-kiri of a soldier. Egoistic suicide refers to
those suicides in people who are not strongly integrated into any social group, for example lack
of family integration in unmarried persons.
Which of the following is a correct match with respect to diagnostic scales in psychiatry? A. Negative symptoms: Jaspers B. Akathisia: Barnes C. Frontal battery: Folstein D. MMSE: Andreasen E. Formal thought disturbance: Hare
B. Barnes’ Akathisia Rating Scale is used to measure akathisia, a side-effect of antipsychotics
characterized by both subjective and, later, objective restlessness. Folstein described MMSE in a
seminal paper; Andreasen devised the Thought Language and Communication scale to measure
formal thought disturbance; Kay’s PANSS (positive and negative symptom scale) can measure
negative symptoms; Hare is a name associated with a psychopathy checklist used by forensic services
Which one of the following is regarded as an illustrative case for classical conditioning in phobia? A. Little Hans and horses B. Little Albert and rabbit C. Anna O D. Daniel Schreber E. Ratman
B. Little Albert learnt to avoid rabbits after a loud noise induced fear in him whenever he
played with a white rat. This fear later generalized to white rabbits (Watson and Rayner 1920).
Anna O was a patient with ‘hysteria’ treated by Freud and Breuer. Ratman was also a patient of
Freud who had OCD, while Schreber had delusional disorder.
Who among the following used the term agoraphobia to describe a category of anxiety disorder? A. Burton B. Schneider C. Westphal D. Jung E. Anna Freud
C. Robert Burton wrote ‘The Anatomy of Melancholy’ in which some description of
symptoms suggestive of agoraphobia is seen together with the account of depressive illness. In
1871, Carl Otto Westphal coined the term agoraphobia to describe several of his patients who
experienced severe anxiety when walking through streets or open squares. Schneider proposed
fi rst-rank symptoms; Jung belonged to the psychoanalytic school. Anna Freud, Freud’s daughter,
was involved in classifying defence mechanisms and also in child psychoanalysis.
Freud is regarded as the father of psychoanalysis. Which one of the following
techniques was developed by Freud for his own clinical practice?
A. Narcoanalysis
B. Polysomnography
C. Free association
D. Dissociation
E. Mesmerism
C. Free association was a popular technique used by Freudian analysts. Having learnt hypnosis
from Charcot, neurologist-turned-psychoanalyst Freud developed the method of free association in
which patients were encouraged to speak about their thoughts without distraction or censure. This
was intended to be a therapeutic method, though later adapted largely as an interview technique.
Narcoanalysis involves using barbiturates as truth serum. Dissociation is a psychological mechanism
and not a clinical technique. Mesmerism or animal magnetism was developed by Anton Mesmer
Phrenology refers to the study of which of the following concepts? A. Study of free will B. Study of conscience C. Study of logic D. Study of skull contour E. Study of homunculus
D. Phrenology was a popular theory which claimed to determine personality and diagnose/
predict mental symptoms using the shape of the skull. It was developed by the German physician
Gall and was very popular in the mid 1800s. Phrenologists used their bare hands and palms to
feel for fi ssures or dents in their patients’ skulls. With this information, the phrenologist would
report on the character of the patient; its popularity reached extremes when marriages and
recruitment were advised by phrenologists.
Schizophrenia was coined by Bleuler in 1911. The literal meaning of the term schizophrenia is A. Split mind B. Split skull C. Fused mind D. Exploded will E. Split will
A. The term ‘schizophrenia’ stands for split personality. Even today this is confused with
more dramatic multiple personality disorder by some of the lay public. The term was coined by
Eugene Bleuler in 1911. It is derived from the Greek words ‘schizo’ (split) and ‘phrene’ (mind).
Bleuler intended to use the name in order to capture the functional dissociation between
personality, thinking, memory, and perception in a patient with schizophrenia.
Which of the following refers to the literal meaning of the term hysteria? A. Wandering mind B. Wandering kidney C. Wandering uterus D. Wandering brain E. Wandering heart
C. The term hysteria stands for ‘wandering uterus’. It was incorrectly observed that hysteria
affects only women. The uterus is a major morphological difference between a man and a woman;
hence, rather simplistically, it was believed that uterus was the site of problems in hysteria. Also it
was believed that unmarried women often had this wandering uterus that could be tied down by
wedlock, leading to a reduction in hysterical symptoms following marriage. It was even believed in
a Greek myth that this wandering uterus could strangulate a person, leading to hysterical globus
or aphonia! Unusual treatments, including pelvic massage to induce orgasm, were offered to cure
hysteria later in history.
Which of the following diagnostic technique involved injecting air into subarachnoid space? A. Myelography B. Pneumoencephalography C. Electroencephalography D. Encephalotomography E. Encephaloultrasonography
B. Dandy, in 1919, used pneumoencephalogram as a diagnostic technique to visualize the
brain. This technique showed enlarged ventricles in patients with schizophrenia, which was later
confi rmed by investigations using various other imaging modalities that developed later. There
was a high fatality rate associated with pneumoencephalogram
In a large, multicentre trial reported in 1988, Kane demonstrated that
clozapine was superior in treatment-resistant schizophrenia patients
compared to which of the following drugs?
A. Haloperidol
B. Chlorpromazine
C. Olanzapine
D. Fluphenazine
E. Thoridazine
B. Kane revived the use of clozapine through his milestone study. He compared
chlorpromazine and clozapine in a treatment-resistant sample and demonstrated clozapine’s
superiority in this instance (in 1988) leading to FDA approval (in 1989). The multicentre trial
showed that 30% of clozapine-treated patients will respond in 6 weeks while 60% will respond in
6 months. On the other hand, only 4% improved on chlorpromazine in combination with
benztropine.
Who is the proponent of primal therapy? A. Arthur Janov B. Melanie Klein C. William Tuke D. Franz Alexander E. Mary Ainsworth
A. Primal therapy refers to a trauma-focused treatment proposed by Arthur Janov. Primal
therapy claims that only through direct experience of pain and emotions, could any psychological
treatment work. Other talking therapies use higher cortical cognitive processes to talk about
emotional experience while primal therapy attempts to engage lower brain centres during
psychotherapy.
