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STATE > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

True statements regarding the epidemiology of schizophrenia:
1) Lifetime prevalence is around 1%.
2) Onset in males occurs typically between the ages of 15 and 25 years.
3) Onset in females occurs typically between the ages of 25 and 35 years.
4) Besides smoking, the most prevalent comorbid disorder is alcohol dependence.
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

E) all of the answers are correct

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2
Q

True statements regarding the epidemiology of anxiety disorders:
1) Lifetime prevalence of panic attacks in mental disorders other than panic disorder is app. 10%.
2) Agoraphobia is more common in females.
3) Social phobia is the most common type of phobias.
4) Agoraphobia is associated with panic disorder in all cases.
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

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3
Q

Match the names with the descriptions!
A) Avshalom Caspi
B) Ugo Cerletti
C) Aaron T. Beck
D) Emil Kraepelin
E) Carl Rogers
PSY - 1.7.1 - Used the term dementia precox for the description of schizophrenia.
PSY - 1.7.2 - Developed the cognitive theory and therapy of depression.
PSY - 1.7.3 - Developed the client-centered therapy.
PSY - 1.7.4 - Was the first who used electroconvulsive therapy (ECT).
PSY - 1.7.5 - Was the first who described the role of gene-environmental interaction in the development of depression.

A

PSY - 1.7.1 - Used the term dementia precox for the description of schizophrenia. - D)
PSY - 1.7.2 - Developed the cognitive theory and therapy of depression. - C)
PSY - 1.7.3 - Developed the client-centered therapy. - E)
PSY - 1.7.4 - Was the first who used electroconvulsive therapy (ECT). - B)
PSY - 1.7.5 - Was the first who described the role of gene-environmental interaction in the development of depression. -A)

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4
Q

Misbehaviour(s) of doctors is/are:
1) identification instead of empathy
2) projection of their personal feelings onto the patient, establishment of an emotional relationship - with its ethical and legal consequences
3) treatment of the patient as an impersonal medical case because of the lack of empathy
4) balancing between confidentiality and objectivity
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
the right medical behaviour is based on the equilibrium of confidentiality and professionalism, while the impersonalization or identification with the patient is faulty. Doctors should not get involved with patients in emotional relationships; in addition this has legal and ethical consequences.

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5
Q

Differential diagnosis of aphasias:

1) Individuals with expressive aphasia are able to understand speech, but they have disordered speech (with great effort they might produce fragmented speech)
2) In receptive aphasia the disordered understanding of speech dominates (the person does not understand his own or other’s speech)
3) In conduction aphasia spontaneous speech is intact, but the patient is unable to repeat sentences.
4) Transcortical aphasia disables spontaneous speech, but they have an urge to repeat speech (echolalia)

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

E) all of the answers are correct

EXPLANATIONIndividuals with expressive aphasia are able to understand speech, but they have disordered speech because of the motoric disorder. In receptive aphasia the disordered understanding of speech dominates. In conduction aphasia spontaneous speech is intact, but the patient is unable to repeat sentences. Transcortical aphasia disables spontaneous speech, but they have echolalia.

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6
Q 
A 27-year-old female is referred to the outpatient unit with breathing difficulty, dizziness and numb limbs without any organic reasons. What do you think her diagnosis is?A)  	situative reaction
B)  	endogenous anxiety
C)  	caffeine intoxication
D)  	hyperventilation syndrome
E)  	posttraumatic stress disorder
A

ANSWER
D) hyperventilation syndrome

EXPLANATIONShortness of breath with dizziness and numb limbs indicates hyperventilation syndrome.

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7
Q

PSY - 2.16
EEG spectrum:
1) delta band is of 0.5-3.5 Hz, it is predominant in deep sleep, it is physiological until the age of 1-2 years, it might indicate frontal hypoactivity in adults in wake states
2) alpha band of 8-12 Hz, this is the baseline rhythm in adults, it correlates with the temporal coordination of information processing, it signals the activity of thalamo-cortical circuitry and it is inhibited stimuli are present
3) theta band is of 4.0-7.5 Hz, it is predominant in REM sleep, it is physiological at the ages of 1-6 years, it can occur during hypnosis and meditation, it indicates frontal and hippocampal hyperactivation in a wake state
4) gamma band is above 35 Hz and it indicates neuronal synchronization, it can also be connected to the framing of information elements and consciousness functions, therefore this band is important in understanding the neuropsychiatric disorders
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

E) all of the answers are correct

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8
Q

Brain imaging methods:
1) SPECT: radioactive method
2) fMRI: is based on magnetic resonance
3) PET: radioactive method
4) CT: radioactive method
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
CT is not a radioactive method; it is an X-ray type method

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9
Q

Which is/are true for MRI?
1) white and gray matter are well distinguishable
2) a high-frequency radio transmitter allocates energy into the nuclei of the body placed into the static magnetic field.
3) the radiation coming from the relaxing nuclei is detected by a radio receiver
4) it is based on the proton magnetization transfer effect of the transmission ionizing radiation
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
MRI does not use transmission radiation, the others are true

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10
Q

Transcranial stimulation
1) TMS is a transcranial stimulation method using an alternating magnetic field in a copper ring placed on the cranium
2) TDCS is a transcranial stimulation method, which is direct current-operated and in which electrodes are applied onto the scalp
3) the therapeutic employment of TMS is currently most accepted in depression
4) during TMS and TDCS the activity of neurons change for a short time (10-0 minutes) in the depth of 2-4 cm
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

E) all of the answers are correct

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11
Q

The sign(s) of a neuroleptic malignant syndrome during antipsychotic medication is/are:
1) progrediating disorientation + akinesia and stiffness of muscles
2) fever, hyperpyrexia + vegetative instability (instable blood pressure, tachycardia, excessive sweating, salivation)
3) increased CPK
4) leucocytosis, increased depression, high liver enzyme rates
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

E) all of the answers are correct

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12
Q

In case of emergency care of acute alcohol intoxication:
1) the most important is to measure the blood alcohol concentration (BAC)
2) BAC serves as an objective indicator for the intensity of necessary treatment
3) above 65.1 mmol/l (3.0‰) BAC there is an increased risk for respiratory depression or arrest
4) BAC level of 30-40 mmol/l indicates a moderately serious intoxication
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

E) all of the answers are correct

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13
Q

WAIS:
1) is the abbreviation of the Wechsler Adult Intelligence Scale
2) has two main factors: verbal and performance IQ
3) the level of intelligence measured by it predicts the level of life competence
4) it is a personality test
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
WAIS is an indirect indicator of life competence, it has two main factors - verbal and performance IQ - and it is a performance test, not a personality measurement

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14
Q

Which is/are (a) personality test(s)?
1) Rorschach probe
2) BPRS
3) MMPI
4) Raven matrices
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) only the 1st and 3rd answers are correct

EXPLANATION
Rorschach probe is a projective test, MMPI is a personality inventory, BPRS is a clinical rating scale, and Raven matrices measure intellectual performance

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15
Q

Dementias might be assessed with:
1) WAIS for the assessment of the level of cognitive deficit
2) Clock Drawing Test, which is an early screening test
3) MMSE, which is a complex test for the assessment of the severity of the syndrome
4) Szondi probe for the assessment of personality changes
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
Szondi test is a projective personality test and it is not appropriate for assessing dementias, MMSE and the Clock Drawing Test are dementia screening tools, the WAIS signals the level of cognitive declinev

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16
Q

Questionnaires for the assessment of the severity of depressive symptoms are:

1) Hamilton Depression Rating Scale (HAM-D)
2) Montgomery-Asberg Depression Rating Scale (MADRS)
3) Beck Depression Inventory (BDI)
4) Positive and Negative Syndrome Scale (PANSS)

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
HAM-D and MADRS are depression rating scales filled in by the examiner, BDI is a self-rating depression scale and PANSS serves for the assessment of the positive, negative and global symptoms of schizophrenia

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17
Q

Hamilton Depression Rating Scale (HAM-D)

1) measures the severity of depression.
2) has diagnostic purposes.
3) is suitable to follow-up status.
4) is a self-rating scale.

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) only the 1st and 3rd answers are correct

EXPLANATION
HAM-D is a depression rating scales filled in by the examiner, it is not a diagnostic tool, and it measures the severity of the symptoms which makes it suitable for follow-up

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18
Q

Yale-Brown Obsessive-Compulsive Scale (YBOCS)

1) is for the diagnostics of OCD
2) assess the severity of OCD
3) is a self-rating scale
4) is suitable to follow-up the severity of obsessive-compulsive symptoms

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
C) only the 2nd and 4th answers are correct

EXPLANATION
YBOCS is an examiner-rated scale for OCD, it is not a diagnostic tool, and it measures the severity of the symptoms which makes it suitable for follow-up

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19
Q

Positive and Negative Symptom Scale (PANSS)

1) assesses the severity of schizophrenia
2) is not suitable for the diagnosis of schizophrenia
3) is suitable to follow-up the severity of the symptoms of schizophrenia
4) is a semi-structured interview filled in by the doctor

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
PANSS serves for the assessment of the positive, negative and global symptoms of schizophrenia, the examiner scores it based on a semi-structured interview, it is not a diagnostic tool, and it measures the severity of the symptoms which makes it suitable for follow-up

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20
Q 
A patient starts to cry without any reason. The phenomenon can be:
A)  	Blunted affect
B)  	Anhedonia
C)  	Anxiety
D)  	Emotional incontinence
E)  	Alexithymia
A

ANSWER
D) Emotional incontinence

EXPLANATION
Emotional incontinence is typical in old patients with dementia

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21
Q 
Hallucination is a symptom of:
A)  	Thinking
B)  	Sensorium
C)  	Attention
D)  	Perception
E)  	Mood
A

D) Perception

EXPLANATION
Hallucination and illusion are symptoms of perception

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22
Q 
The most important characteristic of psychosis is:
A)  	Thought disorder
B)  	Schizophrenia
C)  	Bipolar affective disorder
D)  	Disturbed reality-testing
E)  	Hostility
A

D) Disturbed reality-testing

EXPLANATION
The essence of psychosis is the disturbed reality-testing due to symptoms

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23
Q 
An old, confused patient is admitted to the hospital. When the doctor asks ’How old are you‘, he answers: ’70 years‘. The doctor asks ’Where are we now?’, the patient answers: ’70 years’. How is this phenomenon called?
A)  	Coprolalia
B)  	Rumination
C)  	Compulsion
D)  	Perseveration
E)  	Echolalia
A

D) Perseveration

EXPLANATION
Perseveration is a sign of organic brain disease.

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24
Q

Which is not true about alexithymia?
A) The term was coined by Sifneos
B) It was originally introduced to describe psychosomatic disorders
C) It is characterized by the verbal expression of emotions
D) It is associated with somatoform disorders and substance abuse disorders

A

ANSWERC) It is characterized by the verbal expression of emotions

EXPLANATION
Alexithymia is characterized by difficulties in expressing and verbalizing emotions.

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25
Q

All of the following are examples of symptoms of the form of thinking, except:
A) Delusion
B) Flight of ideas
C) Logorrhea

A

ANSWER
A) Delusion
EXPLANATION
Delusion is a symptom of the content of thinking

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26
Q 
A female patient has a delusion that his boss loves her, the symptom is
A)  	Erotic delusion
B)  	Erotomania
C)  	Transitivism
D)  	None of the above
A

ANSWER
B) Erotomania

EXPLANATION
Erotomania is also called as De Clérambault symptom

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27
Q 
In psychotic depression the patient delusionally believes that he is not alive. The name of the symptom is:
A)  	Nihilistic delusion
B)  	Anxiety
C)  	Horror vacui
D)  	None of the above
A

A) Nihilistic delusion

EXPLANATION
Nihilistic delusions arealso called Cotard symptom.

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28
Q 
The hallucinatory voices instruct the patient to do something, the name of the symptom is:
A)  	Delusion of influence
B)  	Command hallucination
C)  	Somatic hallucinations
D)  	None of the above
A

B) Command hallucination

EXPLANATION
Command hallucinations can lead to suicide or homicide

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29
Q 
Delusion of infestation is also known as:
A)  	Capgras symptom
B)  	Ekbom symptom
C)  	Cotard symptom
D)  	None of the above
A

B) Ekbom symptom

EXPLANATION
Delusion of infestation or delusion of parasitosis is called Ekbom symptom.

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30
Q 
Ganser syndrome is commonly seen in:A)  	Schizophrenia
B)  	Mania
C)  	Pick disease
D)  	Learning disabilities
E)  	Prisoners awaiting trial
A

ANSWER
E) Prisoners awaiting trial

EXPLANATION
In Ganser syndrome approximate answers, clouding of consciousness with disorientation, severe emotional stress, pseudohallucinations and amnesia are present.

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31
Q 
The patient in stupor spits out the food, the name of the symptom is:
A)  	Passive negativism
B)  	Pica
C)  	Active negativism
D)  	Rumination
A

ANSWER
C) Active negativism

EXPLANATION
This phenomenon is a typical example of active negativism

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32
Q 
Abstract thinking can be examined by the:
A)  	Interpretation of proverbs
B)  	Ziehen probe
C)  	Bourdon probe
D)  	None of the above
A

ANSWER
A) Interpretation of proverbs
EXPLANATION
By the correct interpretation of proverbs the metaphorical level of an expression can be captured.

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33
Q 
The patient has a delusion that his mother is replaced by a double. The name of the symptom is:
A)  	Frégoli symptom
B)  	Cotard symptom
C)  	Capgras symptom
D)  	De Clérambault symptom
A

ANSWER
C) Capgras symptom

EXPLANATION
The delusion of the double is called the Capgras symptom after the French psychiatrist, Capgras.

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34
Q

Symptom related to perception:

1) Delusion
2) Obsession
3) Compulsion
4) Hallucination

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
D) only the 4th answer is correct

EXPLANATION
Only hallucination belongs to perceptual disturbances

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35
Q

Which of the following is associated with pseudologia fantastica?

1) Untruthful statements
2) Grandiosity
3) Histrionic personality disorder
4) No evidence of organic illness

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
Pseudolgia fantastica means pathological lying

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36
Q

Clouding of consciousness is characterized by a disturbance in the following areas:

1) Attention
2) Perception
3) Orientation
4) Memory

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

E) all of the answers are correct

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37
Q 
A patient who believes that strangers are actually close relatives in disguise is having which of the following?
A)  	Capgras syndrome
B)  	Ekbom syndrome
C)  	Frégoli syndrome
D)  	Persecutory delusions
A

ANSWER
C) Frégoli syndrome

EXPLANATIONFalse identification of strangers as familiar people occurs in Frégoli syndrome.

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38
Q 
Which of the following is not a motor disorder seen in schizophrenia?
A)  	Catatonia
B)  	Cataplexy
C)  	Negativism
D)  	Waxy flexibility
E)  	Automatic obedience
A

ANSWER
B) Cataplexy

EXPLANATION
Cataplexy is seen in narcolepsy, a sleep disorder, in which the subject falls down because of a sudden loss of muscle tone provoked by strong emotions.

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39
Q 
Clouding of consciousness is characterized by a disturbance in all of the following areas, except:
A)  	Mood
B)  	Attention
C)  	Concentration
D)  	Memory
E)  	Orientation
A

ANSWER

A) Mood

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40
Q 
Which of the following is not a mood-congruent delusion in depression?
A)  	Delusion of guilt
B)  	Delusion of control
C)  	Delusion of poverty
D)  	Nihilist delusion
A

ANSWER
B) Delusion of control

EXPLANATION
Delusion of control is a passivity phenomenon seen in schizophrenia.

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41
Q 
A 64-year-old man admitted to the ward has the delusion that all his wealth has been gone. He also believes that his organs are decaying. The most probable diagnosis is:
A)  	Cotard syndrome
B)  	Nihilistic delusions
C)  	Capgras syndrome
D)  	Frégoli syndrome
E)  	Münchausen syndrome
A

ANSWER

A) Cotard syndrome

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42
Q 
A tendency to produce erroneous material to fill in the gaps on being questioned about past events is known as:
A)  	Delusion
B)  	Amnesia
C)  	Confabulation
D)  	None of the above
A

ANSWER
C) Confabulation

EXPLANATION
Confabulation is seen in Korsakoff’s syndrome.

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43
Q 
Which of the following is not a disorder of perception?
A)  	Distractibility
B)  	Illusions
C)  	Pseudohallucinations
D)  	Macropsia
E)  	Somatic hallucination
A

ANSWER
A) Distractibility

EXPLANATION
Abnormal perception includes sensory distortion and false perception.

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44
Q 
Bleuler's 4 A's exclude
A)  	Ambivalence
B)  	Blunting of affect
C)  	Loosening of associations
D)  	Altruism
E)  	Autism
A

ANSWER
D) Altruism

EXPLANATION
Altruism is not part of the 4 A’s

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45
Q

Disorientation is commonly associated with:
A) Acute and transient psychotic disorder
B) Organic delusional disorder
C) Alcohol withdrawal delirium
D) Alcoholic hallucinosis

A

ANSWER
C) Alcohol withdrawal delirium

EXPLANATION
Disorientation, visual hallucinations, tremor are symptoms of alcohol withdrawal delirium.

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46
Q 
Which of the following is not an illusion?
A)  	Macropsia
B)  	Pareidolia
C)  	Dysmegalopsia
D)  	Micropsia 
E)  	Misinterpretation
A

ANSWER
E) Misinterpretation

EXPLANATION
Misinterpretation means simply making a mistake.

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47
Q

All of the following statements are true about confabulation, except:
A) It is a falsification of memory occurring in clear consciousness
B) It is usually associated with organic brain damage
C) It is seen only in Korsakoff’s syndrome
D) Suggestibility is a common feature associated with it

A

ANSWER
C) It is seen only in Korsakoff’s syndrome

EXPLANATION
Although it is commonly seen in Korsakoff’s syndrome, it is not the only condition in which confabulation is seen.

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48
Q

Indications for anxiolytics include:

1) Generalized anxiety disorder
2) Panic disorder
3) Agoraphobia
4) Anxiety in depression
5) Autism
6) Agitation related to psychosis
7) Schizophrenia

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct
C) only the 1st, 2nd, 3rd, 4th, 6th and 7th answers are correct
D) only the1st, 4th, 6th and 7th answers are correct
E) all of the answers are correct

A

ANSWER
B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct

EXPLANATION
Benzodiazepines are regularly used in the treatment of anxiety disorders and anxiety symptoms and/or agitation related to other mental disorders. They are not indicated for the treatment of the primary symptoms of autism or schizophrenia.

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49
Q

Pharmacological agents not recommended for the long-term treatment of anxiety:

1) Antipsychotics
2) Barbiturates
3) Beta blockers
4) Partial agonists of 5-HT1A receptors
5) High-potency benzodiazepines
6) Dual-action antidepressants
7) SSRI antidepressants

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct
C) only the 1st, 2nd, 3rd, 4th, 6th and 7th answers are correct
D) only the1st, 4th, 6th and 7th answers are correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
Antipsychotics have no specific anxiolytic effect. Barbiturates are out of use due to their hepatotoxic effect and high abuse potential. Beta blockers have indication only for the treatment of occasional social phobia.

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50
Q 
Match the following characteristics with a benzodiazepine:
A)  	clonazepam
B)  	midazolam
C)  	both of the above
D)  	none of the above

PSY - 5.4.1 - its antagonist is flumazenil
PSY - 5.4.2 - its elimination half-life is app. 30-40 hours
PSY - 5.4.3 - high-potency benzodiazepine
PSY - 5.4.4 - indicated for the treatment of depression
PSY - 5.4.5 - indicated for the short-term treatment (max. 2 weeks) of severe insomnia

A

ANSWER
PSY - 5.4.1 - its antagonist is flumazenil - C)
PSY - 5.4.2 - its elimination half-life is app. 30-40 hours - A)
PSY - 5.4.3 - high-potency benzodiazepine - A)
PSY - 5.4.4 - indicated for the treatment of depression - D)
PSY - 5.4.5 - indicated for the short-term treatment (max. 2 weeks) of severe insomnia -B)

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51
Q

Which of the following treatment options would you use in this case?A 35-year-old woman has been taking 0.5 mg alprazolam 3 times a day for her anxiety symptoms for 3 months. As she has recovered and fears that becomes dependent, stops taking medication. Then, anxiety symptoms come back in a more severe form and sleep disturbances occur.
1) Readministration of the original dose of alprazolam and then slow dose reduction (10-25% weekly).
2) Switch to another benzodiazepine with longer elimination half-life (e.g. clonazepam) and then slow dose reduction.
3) Psychoeducation and teaching of relaxing methods (e.g. autogenic training).
4) Readministration of alprazolam and initiation of an SSRI or dual-action antidepressant for the long-term treatment of anxiety disorder and then slow dose reduction and discontinuation of benzodiazepine.
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
As it is rebound phenomenon, the initiation of long-term treatment is not indicated. Rebound symptoms can be prevented with slower dose reduction or the administration of another agent with longer half-life. Relaxing methods can help to reduce the present symptoms. Psychoeducation can help the patient to know the effective use and the risks of sudden discontinuation of a medication.

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52
Q 
Therapeutic blood concentration of lithium:
A)  	0.1-0.2 mmol/l
B)  	0.2-0.3 mmol/l
C)  	0.5-1.0 mmol/l
D)  	1.5-2.0 mmol/l
E)  	2.0-3.0 mmol/l
A

ANSWER
C) 0.5-1.0 mmol/l
EXPLANATION
The therapeutic concentration of lithium is in the range of 0.5-1.0 mmol/l, below this level it is ineffective, and above this it is toxic.

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53
Q

Common side effects of selective serotonin reuptake inhibitors (SSRI):

1) delirium
2) sexual dysfunction (late ejaculation, anorgasmia)
3) epileptic seizures
4) nausea

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
C) only the 2nd and 4th answers are correct

EXPLANATION
delirium and epileptic seizures are very severe adverse events which don’t occur due to SSRI treatment. Sexual dysfunction and nausea are typical, less severe side effects.

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54
Q

Contraindication(s) of lithium:

1) simultaneous antipsychotic treatment
2) hypothyroidism
3) psychotic symptoms
4) renal failure

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
C) only the 2nd and 4th answers are correct

EXPLANATION
Psychotic symptoms and antipsychotic treatment are not contraindications; patients treated with lithium often are characterized by these conditions. Hypothyroidism and renal failure can be chronic side effects of lithium treatment, and lead to additional somatic symptoms. Pre-existing renal failure would lead to toxic lithium doses.

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55
Q

Which of the following pharmacological and non-pharmacological treatments can elicit depressed mood as a side-effect?

1) interferon-alpha treatment
2) oral anticoncipient treatment
3) high dose steroid treatment
4) deep brain stimulation in Parkinson’s disorder

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All of these treatments can result in depressed mood as a side effect.

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56
Q

In which psychiatric disorders have been antidepressants (tricyclics and MAO inhibitors) shown to be efficacious?
1) bulimia
2) chronic pain syndrome
3) anxiety disorders
4) atypical depression
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
Antidepressant drugs have shown efficacy in all of these disorders; bulimia, chronic pain syndromes, anxiety disorders, and atypical depression.

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57
Q

Selective serotonin reuptake inhibitor (SSRI) molecules have less severe side effects than most of the classic antidepressants, except in the case of:

1) delirium
2) blurred vision
3) dry mouth
4) hypotension
5) dysuria

A) only the 1st, 3rd and 5th answers are correct
B) only the 2nd and 4th answers are correct
C) all of the answers are correct
D) none of the answers is correct

A

ANSWER
D) none of the answers is correct

EXPLANATION
SSRIs hardly have any side effects, apart from the side effects related to serotonin (nausea, sexual dysfunction, paraesthesia). Compared to tricyclics they only block muscarinic acetylcholine receptors and alpha1 adrenergic receptors to a very small extent, therefore they don’t cause delirium, cognitive dysfunction, blurred vision, dry mouth, dysuria, or orthostatic hypotension.

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58
Q

Selective serotonin reuptake inhibitor (SSRI) antidepressants have been shown to be effective in these psychiatric disorders:
1) bulimia
2) affective disorders
3) obsessive-compulsive disorder (OCD)
4) panic disorder
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
SSRI antidepressants show effectiveness not only in affective disorders, but also in bulimia, OCD, and other anxiety disorders, like panic disorder. The dysregulation of serotonin has been implicated in all of these disorders.

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59
Q

Which of the following side effects are not typical for treatment with tricyclic antidepressants?

1) dry mouth
2) action tremor
3) obstipation
4) extrapyramidal movement disorders (dystonia, resting tremor, rigidity)

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

D) only the 4th answer is correct

EXPLANATION
Tricyclic antidepressants have no major effect on the dopaminergic pathways; therefore they cause extrapyramidal side effects very rarely.

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60
Q

What is the pharmacological base of the therapeutic effect of typical antipsychotics?
A) They are agonists of dopamine receptors in the mesolimbic pathway (excitement).
B) They are antagonists of dopamine receptors in the nigrostriatal pathway (inhibition).
C) They are antagonists of dopamine receptors in the tuberoinfundibular pathway (inhibition).
D) They are antagonists of dopamine receptors in the mesolimbic pathway (inhibition).
E) They are antagonists of dopamine receptors in the mesocortical pathway (inhibition).

A

ANSWER
D) They are antagonists of dopamine receptors in the mesolimbic pathway (inhibition).

EXPLANATION
According to the dopamine hypothesis of schizophrenia there is an increased dopaminergic neurotransmission in the limbic system and there is a decreased dopaminergic neurotransmission in the prefrontal cortex. The former accounts for the positive symptoms whereas the latter accounts for the negative and cognitive ones. The therapeutic effect of typical antipsychotics results from the blockade of dopaminergic receptors in the mesolimbic pathway. Inhibition of the nigrostriatal and the tuberoinfundibular pathways is responsible for adverse effects.

61
Q 
The following antipsychotic is a partial agonist at the dopamine D2 receptor:
A)  	clozapine
B)  	haloperidol
C)  	aripiprazole
D)  	risperidone
E)  	olanzapine
A

ANSWER
C) aripiprazole

EXPLANATION
Aripiprazole is a partial agonist at the dopamine D2 receptor. At low levels of dopamine it has an agonist effect while at high levels it has an antagonist effect.

62
Q

Every typical antipsychotic needs to be switched to an atypical one in the case of the following:

1) extrapyramidal neurological adverse effects
2) positive past pharmacological history for serotonin syndrome
3) absence of improvement
4) noncompliance
5) positive past history for leukopenia

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) only the 1st and 3rd answers are correct

EXPLANATION
atypical antipsychotics are rarely associated with extrapyramidal neurological adverse effects and they address negative and affective symptomsas well.

63
Q

What may cause the symptoms?
A young man was involuntarily admitted to a closed psychiatric hospital ward. He was extremely agitated and excited. He reported command hallucinations which made him feel intensely anxious. 10 mg of haloperidol (IM) was administered as short-term treatment, later he was given 3x4 mg (solution) of haloperidol daily. Following a transient improvement of 3 days, he reported muscular discomfort, relentless pace, intensifying agitation, insomnia despite drowsiness.
A) recurrence of hallucinations
B) akathisia
C) worsening anxiety as a result of persistent hallucinations
D) tension as a result of being closed in
E) acute dyskinesia

A

ANSWER
B) akathisia

EXPLANATION
at the initiation of an antipsychotic treatment neuroleptic-induced acute akathisia may appear with characteristic symptoms of relentless pace movement, agitation and dysphoria.

64
Q

Which therapeutic intervention is contraindicated in this case?A young man was involuntarily admitted to a closed psychiatric hospital ward. He was extremely agitated and excited. He reported command hallucinations which made him feel intensely anxious. 10 mg of haloperidol (IM) was administered as short-term treatment, later he was given 3x4 mg (solution) of haloperidol daily. Following a transient improvement of 3 days, he reported muscular discomfort, relentless pace, intensifying agitation, insomnia despite drowsiness.
A) decreasing the dosage of haloperidol
B) administering a beta blocker
C) giving clonazepam as adjuvant treatment
D) increasing the dosage of haloperidol
E) administering anticholinergics

A

CLOSE ANSWER AND EXPLANATION ×CLOSE ANSWER AND EXPLANATION ×ANSWERD) increasing the dosage of haloperidolEXPLANATIONakathisia is an early adverse effect of antipsychotic medication which is not to be underdiagnosed just because the symptoms are attributed to psychosis. In akathisia the increase of the dosage of the antipsychotic is contraindicated.

65
Q 
Sleep deprivation is an effective treatment for:
A)  	manic state
B)  	anorexia nervosa
C)  	depressed state
D)  	obsessive-compulsive disorder
E)  	organic hallucinations
A

ANSWERC) depressed state

66
Q

Which statement is true for deep brain stimulation (DBS)?

1) this method was developed for the treatment of Parkinson’s disease
2) electrodes are implanted into the patient’s brain in DBS
3) DBS is equally effective for unipolar and bipolar depression
4) DBS is also effective in the treatment of different type of dystonias
5) this method was developed in the second half of the 1980s

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWERE) all of the answers are correct

67
Q

Transcranial magnetic stimulation is an effective treatment for:

1) depression
2) mania
3) in the presence of acoustic hallucinations
4) OCD
5) sexual dysfunctions

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWERB) only the 1st and 3rd answers are correct

68
Q

Which options do you have to elicit a seizure within this session?48 years old female patient, suffering in severe depression was treated with ECT. During the 3rd session of the treatment – when propofol was used for sleep induction – stimulation intensity, that was sufficient to elicit a seizure in the previous sessions, proved ineffective.

1) restimulation with 50% increased energy
2) restimulation after applying 50% higher propofol dose
3) restimulation after administering intravenous caffeine
4) omit oral benzodiazepines from the regular therapy
5) increase the dose of regular antidepressant

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

B) only the 1st and 3rd answers are correct

69
Q

Which of the following has a proven effect on the progression of Alzheimer’s disease?

1) Vitamin C
2) acetylcholinesterase inhibitors (donepezil, rivastigmine)
3) anti-inflammatory drugs
4) partial NMDA-receptor antagonist (memantine)

A)  	answers 1, 2, and 3 are correct.
B)  	answers 1, and 3 are correct
C)  	answers 2, and 4 are correct.
D)  	only answer 4 is correct.
E)  	all answers are correct.
A

ANSWERC) answers 2, and 4 are correct.

EXPLANATION
After one year of follow-up, the progression of Alzheimer’s disease can be effectively slowed by acetylcholinesterase inhibitors and memantine.

70
Q

Which of the following is true for acetylcholinesterase inhibitors?

1) Their use is based on the “cholinergic hypothesis”
2) Acetylcholinesterase (AChE) and, in a minor capacity, buthyrilcholine esterase (BuChE) enzymes are responsible for the metabolism of acetylcholine in the central nervous system.
3) AChE inhibitors improve the cognitive and behavioural symptoms of dementia, and slow down its progression
4) They have a positive effect on the metabolism of amyloid plaques of the brain.

A)  	answers 1, 2, and 3 are correct.
B)  	answers 1, and 3 are correct
C)  	answers 2, and 4 are correct.
D)  	only answer 4 is correct.
E)  	all answers are correct.
A

ANSWERE) all answers are correct.

EXPLANATION
Their use is based on the “cholinergic hypothesis”. Acetylcholinesterase (AChE) and, in a minor capacity; buthyril choline esterase (BuChE) enzymes are responsible for the metabolism of acetylcholine in the central nervous system. AChE inhibitors improve the cognitive and behavioural symptoms of dementia, as well as slow down its progression and also have a positive effect on the metabolism of amyloid plaques of the brain.

71
Q 
Antipsychotics may have the following central anticholinergic adverse effects except for:
A)  	drowsiness
B)  	hyperthermia
C)  	myoclonus
D)  	mydriasis
E)  	delirium
A

ANSWERD) mydriasis

EXPLANATION
mydriasis is a common peripheral anticholinergic adverse effect of antipsychotics; therefore they are contraindicated in glaucoma.

72
Q

In cognitive behavioral therapy, what does the term ‘collaborative empiricism’ refer to?
A) empirically supported evidence based psychotherapy
B) a system where the therapist is in charge of the patient’s goals
C) the collaboration of people in cognitive group therapy
D) the collaborative relationship between a patient and a therapist

A

ANSWER
D) the collaborative relationship between a patient and a therapist

EXPLANATION
Collaborative empiricism is the term used to refer to a patient and therapists working together to help the patient solve specific problems and achieve personal goals.

73
Q 
In operant conditioning behavioral reinforcers:
A)  	always raise behavioral probability
B)  	are always positive
C)  	do not raise behavioral probability
D)  	are never positive
A

ANSWERA) always raise behavioral probability

74
Q 
Asking the family to develop a family crest or finish sentences such as 'being close in this family is' are ways to gain insight into
A)  	family genograms
B)  	family myths
C)  	the structural design of the family
D)  	the Milan Model
A

ANSWER
B) family myths
EXPLANATION
Family myths are essentially the ideology of the family. They are the common ways of interacting within a particular family unit, upon which the family members agree. While they tend to be distortions of reality, they generally are understood within the family unit. Roles are often assigned to members of the family based on these myths.

75
Q

The abandonment of a family ritual is often related to
A) the loss of a beloved pet
B) family members moving away from home
C) the onset of dysfunction within the family structure
D) a new member entering the family

A

ANSWERC) the onset of dysfunction within the family structure

EXPLANATION
When a patient makes statements such as, ‘we always used to have a birthday dinner, but not anymore,’ one often can note the onset of dysfunction prior to the abandonment of that family ritual.

76
Q

In family therapy, which of the following statements is described best by the term ‘disengagement’?

A) the emotional ‘disconnection’ between adult and child
B) an elevated level of intimacy between family members
C) the ending of an engagement to marry
D) the traits of a family

A

ANSWER
D) the traits of a family

EXPLANATION
The term ‘disengagement’ often describes the traits of a family or the current type of family interaction or functioning. Disengaged families lack intimacy between the members. Family members may feel isolated, have limited understanding of each other, and have limited common interests or interactions.

77
Q 
According to Yalom, \_\_\_\_\_\_\_\_\_\_ is a necessary precondition for effective group therapy.
A)  	intermember acceptance
B)  	group cohesiveness
C)  	intimacy for self disclosure
D)  	freedom
A

ANSWER

B) group cohesiveness

78
Q

One aim of community psychiatry treatment is:
A) to teach reasonable goals to the patient
B) to help the patient to identify his/her personal goals
C) to alienate the patient from his family
D) to restrict the patient’s participation in the community

A

ANSWERB) to help the patient to identify his/her personal goals

79
Q

It is NOT part of the problem solving training:
A) identification of the problem
B) brainstorming
C) selection of the problem solving strategy
D) behavior experiment
E) discussion of the results

A

CLOSE ANSWER AND EXPLANATION ×CLOSE ANSWER AND EXPLANATION ×ANSWERD) behavior experiment

80
Q

The stages of autogenic training include:
1) focus on sensation of heaviness throughout the arms and legs
2) focus on sensation of warmth throughout the arms and legs
3) focus on sensation of warmth and heaviness in the area of the heart
4) focus on hyperventilation
5) focus on breathing
6) focus on sensation of warmth in the abdomen
7) focus on sensation of coolness in the forehead
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st, 2nd, 3rd, 4th and 7th answers are correct
C) only the 1st, 2nd, 3rd, 5th, 6th and 7th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWERC) only the 1st, 2nd, 3rd, 5th, 6th and 7th answers are correct

81
Q 
Emotions appear in the therapist toward the patient during psychodynamic psychotherapy. The phenomenon is called:
A)  	transference
B)  	countertransference
C)  	identification
D)  	acting out
A

B) countertransference

EXPLANATION
Countertransference was described by Freud.

82
Q

According to person-centered psychotherapy empathy means:

1) reflexion of feelings
2) perceiving, understanding and feed-back of feelings and motivations
3) identifying and reflecting non-verbal and meta-communicative messages
4) the therapist totally and really (not only ‘as if’) feels and experiences the situation of the client (identifies with the client)

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
In person-centered therapy empathy is considered as the identification and reflexion ‘ mirroring ‘ of feelings and motivations, which also involves the decoding of meta-communicative messages. Feed-back helps to develop self-knowledge and introspection. The therapist should not identify with the client, he rather experiences an ‘as if’ reality of the client’s feelings and motivations.

83
Q 
Person-centered therapy emphasizes the reflecting ' mirroring characteristic of empathy through the following communication tool
A)  	unconditional positive regard
B)  	empathetic verbalization
C)  	congruence
D)  	interpretation
A

ANSWER

B) empathetic verbalization

84
Q

Which does NOT apply to unconditional positive regard, a core feature of therapists?
1) neutral emotional attention instead of positive
2) the ability to directly steer the relationship instead of non-directivity
3) acceptance of moral and social values as condition
4) it is based on reciprocity in therapist-client relationships similar to everyday life interpersonal relationships
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWERE) all of the answers are correct

EXPLANATION
all of the above contradict the principle of unconditional positive regard

85
Q

Which does NOT apply to a therapist with an unconditional positive regard as a core feature?

1) evaluates the personality, characteristics and behaviour of the client
2) applies his/her own views and problems as analogies during therapy session
3) steers the conversation in order to keep it in the appropriate direction
4) keeps cold distance in order to avoid unnecessary counter-transference

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

E) all of the answers are correct

EXPLANATION
all of the above contradict the principle of unconditional positive regard

86
Q

One of the core principles of person-centered therapy is unconditional positive regard. Its elements are:

1) intense attention paid to the behaviour and communication of the client in order to perceive the positive elements and values in them
2) the ability to separate the person from his characteristics and behaviour
3) faith in the preciousness of every human being in its own (independent of their characteristics), commitment towards the client
4) believing that everybody is able to change positively under the appropriate conditions

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

E) all of the answers are correct

87
Q

Congruence or genuineness as therapeutic quality means the following:
1) verbal and non-verbal messages match each other and the inner state of the therapist
2) harmony of mature self-knowledge, self-image and experiences
3) an important aspect of psychic health and maturity
4) the therapist is transparent, does not play a role, does not wear a mask and does not hide
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

E) all of the answers are correct

88
Q

Which is NOT a specific factor in person-centered therapy?A) unconditional positive regard
B) empathy
C) congruence
D) interpretation

A

ANSWER
D) interpretation
EXPLANATION
unconditional positive regard, empathy and congruence are key factors in person-centered therapy, while interpretation contradict its principles and practice)

89
Q 
Person-centered therapy is contraindicated in the case of:
A)  	anxiety disorders
B)  	sexual disorders
C)  	crisis
D)  	none of the above
A

D) none of the above

90
Q

Specific factors of person-centered therapy according to Carl Rogers are the following:
1) empathy
2) congruence
3) unconditional positive regard
4) conflict management
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

91
Q

Characteristics of behavioural experiments, EXCEPT:
A) participation in psychotherapy research
B) monitoring the adequacy of their opinions on themselves, others and the outside world
C) establishment and testing of new, more adaptive ideas
D) justification and further development of case conceptualizationCLOSE ANSWER AND EXPLANATION ×CLOSE ANSWER AND EXPLANATION ×ANSWERA) participation in psychotherapy research

A

A) participation in psychotherapy research

92
Q 
The following phenomena are part of psychodynamic psychotherapy:
A)  	transference
B)  	countertransference
C)  	empathic validation
D)  	clarification
E)  	all the above
A

E) all the above

93
Q 
The person has clear consciousness. He can hear voices that are talking about him and threatening him. For the person, the voices seem to be reality and they are a very distrubing experience, which makes him feel intensely anxious. What do you think the diagnosis is?
A)  	delirium tremens
B)  	alcoholic hallucinosis
C)  	dementia
D)  	panic disorder
E)  	obsessive-compulsive disorder
A

ANSWERB) alcoholic hallucinosis

EXPLANATION
Explanation: Auditory hallucinations especially threatening voices and hearing dialogues that result in severe anxiety in the person without an altered level of consciousness are all characteristics of alcoholic hallucinosis.

94
Q 
Match a psychoactive drug with a characteristic feature.
A)  	LSD
B)  	cocaine
C)  	THC
D)  	heroin

PSY - 4.12.4 - local anaesthesia
PSY - 4.12.5 - hepatitis C

A

ANSWER
PSY - 4.12.4 - local anaesthesia - B)
PSY - 4.12.5 - hepatitis C - D)

95
Q

Which test(s) is/are to be performed to find the correct diagnosis?A 16-year-old girl has arrived at the outpatient ward with her mother. In the past few months she has lost 15 kilos. She goes running every day. She has insomnia.

1) urine drug test
2) calculating body mass index
3) concentrations of thyroid hormones (blood test)
4) polysomnography

A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWERA) only the1st, 2nd and 3rd answers are correct

EXPLANATION
The concentrations of thyroid hormones need to be determined to exlude hyperthyreosis. Amphetamine is detectable in urine, therefore the urine drug test is also necessary. Anorexia nervosa is based on BMI, so that is to be calculated, as well. However, none of the above mentioned tests is diagnostic in itself.

96
Q

What do you think his most likely diagnosis was?An 18-year-old man arrived at the hospital on Sunday morning. He was accompanied by his friends. His symptoms were sweating, tachycardia, dilated pupils, psychomotor agitation. His behaviour was hostile, full of anger and he felt furious.

A)  	alcohol intoxication
B)  	heroin intoxication
C)  	acute psychotic state of schizophrenia
D)  	cocaine intoxication
E)  	none of the above
A

ANSWERD) cocaine intoxication

EXPLANATION
The person’s symptoms were characteristic signs of cocaine or other psychostimulant intoxication.

97
Q

The longitudinal disease course of affective psychoses is characterized by:
A) circularly returning disease episodes
B) slow progression
C) acute worsening of condition alternating with slow progression
D) single episode
E) dementia

A

A) circularly returning disease episodes

EXPLANATION
Affective psychoses are characterized by circularly returning episodes, symptoms usually resemble symptoms of the previous episode.

98
Q

The following statements are true for bipolar disorder, except:
A) it often runs in families
B) all manic episodes are followed by depression
C) equal distribution between sexes
D) usually begins before the age of 30 years
E) increased risk of substance abuse and suicide

A

ANSWER
B) all manic episodes are followed by depression

EXPLANATION
It is not a necessary criterion of bipolar affective disorder that all episodes have to be followed by an episode of opposite direction.

99
Q

Potential complications of untreated affective disorders:
1) suicide
2) pseudologia phantastica
3) alcohol dependence
4) vascular dementia
5) social dysfunction and isolation
6) bulimia
7) tardive dyskinesia
A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the1st, 3rd and 5th answers are correct
D) only the 2nd, 3rd and 5th answers are correct
E) only the1st, 2nd, 3rd, 5th and 7th answers are correct
F) only the 2nd, 3rd, 6th and 7th answers are correct
G) all of the answers are correct

A

ANSWER
C) only the1st, 3rd and 5th answers are correct

EXPLANATION
Affective disorders are often accompanied by suicide, alcohol abuse and social dysfunction, especially when no treatment is received.

100
Q

Sleep pattern in major depression is characterized by the following changes:
1) frequent frightening dreams and awakenings
2) both falling asleep (sleep onset) and awakening happens earlier than usual
3) 4th phase sleep (delta-phase) is increased
4) decreased REM-latency
A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
C) only the 2nd and 4th answers are correct

EXPLANATION
Typical changes during sleep in MDD patients include early sleep onset, wakening, and decreased REM-latency.

101
Q

Which disorders should be considered while establishing a differential diagnosis for affective disorders?

1) expansive intracranial process
2) thyroid gland dysfunction
3) phaeochromocytoma
4) adult ADHD (attention deficit and hyperactivity disorder)

A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All of these conditions might cause affective symptoms and resemble affective disorders, therefore all of them should be considered during the differential diagnostic process.

102
Q

Typical symptoms of depression:

1) decreased capability to concentrate
2) hypochondriasis
3) weight loss
4) perceptual disturbances

A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the1st, 2nd and 3rd answers are correct

EXPLANATION
concentration problems, weight loss and hypochondriacal thoughts are very typical in depression, perceptual disturbances (i.e. hallucinations) are very uncommon.

103
Q 
Who gave schizophrenia its name?
A)  	Emil Kraepelin
B)  	Eugen Bleuler
C)  	William Cullen
D)  	Kurt Schneider
E)  	Karl Kleist
A

ANSWERB) Eugen Bleuler

EXPLANATION
E. Bleuler considered the presence of schisms between thought, emotion and behaviour the essence of the disorder. In 1911, he labelled it schizophrenia uniting the Greek roots szkidzein (to split) and frenosz (mind).

104
Q

The following are the negative symptoms of schizophrenia except for:
A) apathy
B) alogia
C) lack of motivation
D) delusional guilt, sin, worthlessness
E) social withdrawal

A

ANSWER
D) delusional guilt, sin, worthlessness

EXPLANATION
delusions belong to the group of positive symptoms, regardless of their content.

105
Q

The following are characteristic of the prodromal phase of schizophrenia except for:
A) it usually begins following puberty
B) presence of changes in perceptual experiences, behaviour, performance
C) progressively intensifying symptoms
D) lack of insight
E) it usually lasts for 2-5 years

A

D) lack of insight

EXPLANATION
in the prodromal phase of schizophrenia the person has some doubts that their “mild” psychotic experiences are real.

106
Q

The following may have a role in the etiology of schizophrenia:
1) dysfunction of dopaminergic systems
2) alteration in NMDA(N-methyl-D-aspartate)-transmission
3) abnormal brain development
4) alteration in GABAergic transmission in the cerebral cortex
A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER

E) all of the answers are correct

EXPLANATION
all of the above mentioned factors have been proven to have a potential role in the etiology of schizophrenia, but none of them can be regarded as a clear etiological factor.

107
Q

Observing behaviour change one suspects psychosis when
1) the change is socially unreasonable
2) the behaviour is threatening personal safety and property
3) the change is inexplicable from the person’s aspect
4) the behaviour is different from what is culturally accepted
A) only the1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) only the 1st and 3rd answers are correct
EXPLANATION
one may suspect psychosis when the change in behaviour is socially unreasonable and it is inexplicable from the person’s aspect

108
Q

The following is/are the characteristic(s) of delusional disorder:
1) elaborate and systematized delusions
2) other criteria for schizophrenia are not fulfilled
3) impaired insight and judgement regarding delusions
4) development is not to be linked to a ‘key experience’
5) psychodynamic factors do not play a role in the development of delusions
A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
In the development of delusional disorder both ‘key experiences’ and psychodynamic factors have a significant role.

109
Q 
In which type of psychosis are the following psychiatric symptoms prominent? Match the symptoms with the most probable diagnosis. Diagnoses:
A)  	mood-congruent delusion
B)  	primary incoherence
C)  	echopraxia
D)  	real visual hallucinations

PSY - 4.56.1 - Drug-induced psychosis
PSY - 4.56.2 - Disorganized type of schizophrenia
PSY - 4.56.3 - Catatonic type of schizphrenia
PSY - 4.56.4 - Mania
PSY - 4.56.5 - Major depression

A

PSY - 4.56.1 - Drug-induced psychosis - D)
PSY - 4.56.2 - Disorganized type of schizophrenia - B)
PSY - 4.56.3 - Catatonic type of schizphrenia - C)
PSY - 4.56.4 - Mania - A)
PSY - 4.56.5 - Major depression - A)

110
Q

Who invented the following classifications of the symptoms of schizophrenia? Match the dichotomies with a name.
A) Eugen Bleuler
B) Kurt Schneider
C) Timothy Crow
D) Karl Leonhard
PSY - 4.57.1 - positive and negative symptoms
PSY - 4.57.2 - fundamental and accessory symptoms
PSY - 4.57.3 - first-rank and second-rank symptoms
PSY - 4.57.4 - systematic and unsystematic schizophrenias

A

PSY - 4.57.1 - positive and negative symptoms - C)
PSY - 4.57.2 - fudamental and accessory symptoms - A)
PSY - 4.57.3 - first-rank and second-rank symptoms - B)
PSY - 4.57.4 - systematic and unsystematic schizophrenias - D)

111
Q 
Which group of symptoms do the following refer to? Match the symptoms with an appropriate group.
A)  	positive symptoms
B)  	negative symptoms
C)  	affective symptoms
D)  	symptoms affecting neurocognition
PSY - 4.58.1 - 	auditory hallucinations
PSY - 4.58.2 - 	ambivalence
PSY - 4.58.3 - 	dysthymia
PSY - 4.58.4 - 	working memory disorder
PSY - 4.58.5 - 	alogia
A

PSY - 4.58.1 - auditory hallucinations - A)
PSY - 4.58.2 - ambivalence - B)
PSY - 4.58.3 - dysthymia - C)
PSY - 4.58.4 - working memory disorder - D)
PSY - 4.58.5 - alogia - B)

112
Q

What is likely to be the diagnosis?
The 24-year-old patient has been admitted to hospital for the second time. His sympoms appeared about 2 years ago. He has trouble focusing his attention, he feels anxious and low, and has suicidal ideation. He withdrew from his university studies due to learning difficulties. ’I always had to listen to music in order to be able to concentrate.’ he said. He has been seeing his friends rarely recently and he has given up sports, too. His father is an eccentric and reserved person, who has never been under psychiatric treatment. When being hospitalised for the first time, the patient was diagnosed with mixed anxiety-depressive disorder and he was prescribed tranquillisers and antidepressants. After a short period of taking this medication, he changed his pills for paleolithic diet on his mother’s advice. Current state of mind: auditory hallucinations, bizarre cenesthopathic symptoms, paranoid delusions, obsessive thoughts, anxiety, tension, suicidal ideation, lack of insight.

A)  	Mixed anxiety-depressive disorder
B)  	Recurrent depression
C)  	Obsessive-compulsive disorder (OCD)
D)  	Schizophrenia
E)  	Schizoid personality disorder.
A

D) Schizophrenia

EXPLANATION
Explanation: the number and the duration of prominent symptoms like auditory hallucinations, cenesthopathy and delusions meet the criteria for schizophrenia.

113
Q 
Which is the most common cause of the lack of sexual activity in marriage?
A)  	Old age
B)  	Marital conflict
C)  	Depression
D)  	Somatic illness
A

B) Marital conflict

EXPLANATIONThe most common cause is marital conflict, lack of attunement and communication between partner

114
Q 
The patient who is superstitious or claims powers of clairvoyance and believes that he has special powers of thought suffers from
A)  	Bipolar affective disorder
B)  	Schizotypal personality disorder
C)  	Borderline personality disorder
D)  	Schizophrenia
A

B) Schizotypal personality disorder

EXPLANATIONThis disorder occurs in about 3 percent of the population.

115
Q

Somatization disorder is often comorbid with:
A) Paranoid personality disorder
B) Histrionic personality disorder
C) Narcissistic personality disorder
D) Dependent personality disorder
E) Passive-agressive personality disorder

A

ANSWER
B) Histrionic personality disorder

EXPLANATION
Somatoform symptoms are common

116
Q 
Similarly to Prader-Willi syndrome, a deletion on the 15th chromosome can be detected in:
A)  	Williams syndrome
B)  	Angelman syndrome
C)  	Di George syndrome
D)  	None of the above
A

B) Angelman syndrome

EXPLANATION
The deletion in Angelman syndrome has a maternal origin, while in Prader-Willi syndrome a paternal origin is present

117
Q 
Definite diagnosis of Alzheimer's disease can be determined by:
A)  	CT
B)  	EEG
C)  	laboratory results
D)  	neurological examination
E)  	none of the above
A

E) none of the above

EXPLANATION
The definite diagnosis of Alzheimer’s disease can be determined by histopathology, CT/MRI and SPECT/PET can help to exclude other disorders.

118
Q

These are true in the differentiation of depressive pseudodementia and dementia, EXCEPT:
A) dismissive behaviour in pseudodementia (“don’t know” answers)
B) undue fluctuation of performance in pseudodementia
C) in dementia in spite of memory impairment complaints of memory problems are often lacking
D) personality change is typical for pseudodementia
E) in pseudodementia a family history of affective disorders is frequent

A

D) personality change is typical for pseudo dementia

EXPLANATION
Personality change is typical for dementia, especially for Alzheimer’s disease. In pseudodementia depressive symptoms are typical.’

119
Q

Which of the following is helpful to differentiate vascular dementia and Alzheimer’s disease?

1) MMSE (“Mini Mental State Exam”)
2) Wechsler IQ Test
3) Dementia Index in IQ tests
4) Hachinski Ischaemic Score

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

D) only the 4th answer is correct

EXPLANATION
In the differentiation between vascular dementia and Alzheimer’s disease the Hachinski Ischaemic Scale is helpful.

120
Q 
Which of the following is not a pervasive developmental disorder?
A)  	Autism
B)  	Rett syndrome
C)  	Münchausen syndrome
D)  	Asperger syndrome
A

C) Münchausen syndrome

EXPLANATION
Pervasive developmental disorders are disorders with deficits in social communication and behavioral skills.

121
Q

In moderate mental retardation the IQ is between:
A) 50-70
B) 30-50
C) <30

A

B) 30-50

EXPLANATION
In the case of moderate mental retardation, the IQ is between 30 and 50.

122
Q 
Definite diagnosis of Alzheimer's disease can be determined by:
A)  	CT
B)  	EEG
C)  	laboratory results
D)  	neurological examination
E)  	none of the above
A

ANSWERE) none of the above

EXPLANATION
The definite diagnosis of Alzheimer’s disease can be determined by histopathology, CT/MRI and SPECT/PET can help to exclude other disorders.

123
Q

Match the supposed pathology of Alzheimer’s disease with the method of examination!
A) MRI
B) SPECT
C) FDG-PET
D) histopathology
PSY - 4.104.1 - temporo-parietal hypoperfusion
PSY - 4.104.2 - β-amyloid deposition (senile plaque)
PSY - 4.104.3 - neurofibrillary tangle
PSY - 4.104.4 - temporo-parietal hypometabolism
PSY - 4.104.5 - hippocampal atrophy

A

PSY - 4.104.1 - temporo-parietal hypoperfusion - B)
PSY - 4.104.2 - β-amyloid deposition (senile plaque) - D)
PSY - 4.104.3 - neurofibrillary tangle - D)
PSY - 4.104.4 - temporo-parietal hypometabolism - C)
PSY - 4.104.5 - hippocampal atrophy - A)

124
Q

What is the supposed diagnosis according to the symptoms?
A 67-year-old woman got lost in a familiar neighbourhood; she was no longer able to do her housework without help. It was difficult for her to express herself and to calculate. The symptoms got slowly worse. She had no history of previous disorders; there were no detectable internal and neurological pathological signs.
A) Vascular dementia
B) Delirium
C) Alzheimer’s disease
D) Depression

A

C) Alzheimer’s disease

125
Q

What is the supposed diagnosis according to the symptoms?A 60-year-old man had hypertension, a month ago he had paraesthesia on the right side of his body for a short period, had trouble to find words, memory impairment also developed. Since then there have been periods without symptoms, then episodes with disorientation, and wandering occurred. His state is fluctuating, at nights agitation can arise.
A) Depression with cognitive impairment
B) Alzheimer’s disease
C) Normal pressure hydrocephalus
D) Vascular dementia

A

ANSWERD) Vascular dementia

126
Q 
These are organic and symptomatic mental disorders, EXCEPT:
A)  	delirium
B)  	dementia
C)  	amnestic syndrome
D)  	paranoia
E)  	organic hallucinosis
A

ANSWER
D) paranoia

EXPLANATION
Paranoia is a paranoid disorder, not an organic and symptomatic mental disorder.

127
Q

Which of the following are typical of organic mental disorders?

1) there is a causal relation between the psychopathology and the organic disorders
2) the somatic pathology is preceding the psychopathology
3) the course of the somatic disorder and the mental illness are parallel
4) delirium and dementia can evolve not only on the basis of somatic etiology

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
There is a causal connection between the psychopathology and organic disorders, the somatic pathology is prior to the psychopathology and the course of somatic disorder and mental illness are parallel. Delirium and dementia can evolve only on the basis of somatic etiology.

128
Q

Match the features with the diagnoses!
A) organic amnestic syndrome
B) delirium
C) organic delusional (paranoid) disorder
PSY - 4.120.1 - clouding of consciousness
PSY - 4.120.2 - impaired long term memory
PSY - 4.120.3 - hallucinations
PSY - 4.120.4 - delusions
PSY - 4.120.5 - confabulation may be an additional symptom

A

PSY - 4.120.1 - clouding of consciousness - B)
PSY - 4.120.2 - impaired long term memory - A)
PSY - 4.120.3 - hallucinations - B)
PSY - 4.120.4 - delusions - C)
PSY - 4.120.5 - confabulation may be an additional symptom - A)

129
Q

Which of the following is the least possible diagnosis?A 60-year-old man was taken to the doctor by his relatives. He visited the family and they noticed that he heard voices, and saw people who were not there. His wife died 10 years ago, since then he had lived reservedly, now he could not take care of himself anymore.

A)  	delirium
B)  	schizophrenia
C)  	dementia
D)  	depression with psychotic symptoms
E)  	organic hallucinosis
A

B) schizophrenia

EXPLANATION
The late onset is not typical for schizophrenia

130
Q 
Anxiety as a symptom can occur in all of the disorders below with the exception of:
A)  	hypoglycaemi
B)  	decreased thyroid function
C)  	pheochromocytoma
D)  	porphyria
E)  	hypocalcaemia
A

ANSWERB) decreased thyroid function

EXPLANATION
Characteristic features of the decreased thyroid function can be apathy and the slowing down of the patient, but not anxiety

131
Q

Which of the following statements are not characteristic agoraphobia?
A) the affected person has an intensive and irrational feeling of fear when he/she has to leave his/her home
B) the affected person is fully aware of the senseless nature of his/her fear
C) the administration of an antidepressant can alleviate it effectively
D) the target of the behavioural therapy is the phobia itself, thus it has no focus on the underlying psychodynamics
E) phobic anxiety disorder rarely occurs after it has been treated at least once.

A

E) phobic anxiety disorder rarely occurs after it has been treated at least once.

EXPLANATION
In an emotionally burdened life situation anxiety can recur even in case of a treated agoraphobia.

132
Q

The diagnosis of mixed anxiety depressive disorder is established, if:
A) the patient with depression has marked anxiety
B) both depressive and anxiety symptoms are present, but the severity of neither of them meets the diagnostic criteria
C) the anxiety disorder is accompanied by depressive symptoms
D) the depressive symptoms rapidly improve with antidepressant therapy

A

ANSWER
B) both depressive and anxiety symptoms are present, but the severity of neither of them meets the diagnostic criteria

EXPLANATION
The above mentioned diagnosis is given if both depressive and anxiety symptoms are present, but the severity of neither of them meets the diagnostic criteria of any other illness

133
Q

Regarding the treatment of specific phobias, improvement can be expected from the following behavioural therapy techniques, with the exception of:
A) exposition to stimulus
B) paradox intention method
C) flooding
D) imaginary, “in vitro” desensitisation
E) “in vivo” desensitisation

A

ANSWER
B) paradox intention method

EXPLANATION
The paradox intention method is a suggested method for the treatment of obsessive-compulsive symptoms

134
Q

Match the characteristic symptoms with the diagnoses!
A) it is characterised by a feeling of anxiety which occurs during attacks
B) improvement can be expected primarily from behavioural therapy (exposition therapy)
C) it is characterized by a constant feeling of anxiety which is difficult to overcome
D) the person has a fear of getting into humiliating situations in the social environment
PSY - 4.137.1 - panic disorder

A

ANSWERPSY - 4.137.1 - panic disorder -A)

135
Q

Which is the most likely diagnosis based on the symptoms of the patient?
A 38-year-old female patient works in a bank; previously, she had no problems with having to work together with many of her colleagues in a single room and that they had lots of clients. However, she has not been able to go to work for 1 month, and she tries to avoid going to places where many people are present, or to places from where getting out is difficult. She does not use public transport either, she neither dares to drive a car and or go shopping without being accompanied by her husband.

A)  	post-traumatic stress disorder
B)  	obsessive-compulsive disorder
C)  	social phobia
D)  	generalised anxiety disorder
E)  	agoraphobia
A

ANSWER
E) agoraphobia

EXPLANATION
In case of agoraphobia the person avoids to go to places from where he/she can hardly get out, or to places where, according to his/her opinion, he/she cannot get help when felling unwell. The behaviour of the social environment (in the above mentioned case: the patient is accompanied by her husband) can reinforce his/her fears and his/her illness.

136
Q

Which of the following are true for conversion disorder?

1) the symptoms can raise the question of a somatic illness
2) expresses a psychological conflict
3) attracts attention and the sympathy of others
4) is intentional

A)  	answers 1, 2, and 3 are correct
B)  	answers 1, and 3 are correct
C)  	answers 2, and 4 are correct.
D)  	only answer 4 is correct.
E)  	all answers are correct.
A

A) answers 1, 2, and 3 are correct

EXPLANATION
In conversion disorder the symptoms can resemble a somatic illness, are in definite connection with some outside event (psychotrauma), with their help the patient can escape from a conflict (Freudian primary illness-benefit) as well as evoke increased attention and sympathy of others (Freudian secondary illness-benefit)

137
Q

Match the diagnoses with the symptoms!
A) dissociative amnesia
B) dissociative fugue
C) dissociative identity disorder

PSY - 4.154.1 - Aimless wandering with a sudden onset over the period of amnesia that can last for days
PSY - 4.154.2 - The temporary inability to recall memories
PSY - 4.154.3 - The multiplication of personality
PSY - 4.154.4 - Organized foggy state
PSY - 4.154.5 - The memory lapse can be partial, only regarding emotionally significant experiences

A

PSY - 4.154.1 - Aimless wandering with a sudden onset over the period of amnesia that can last for days - B)
PSY - 4.154.2 - The temporary inability to recall memories - A)
PSY - 4.154.3 - The multiplication of personality - C)
PSY - 4.154.4 - Organized foggy state - B)
PSY - 4.154.5 - The memory lapse can be partial, only regarding emotionally significant experiences - A)

138
Q 
Which of the following illnesses should be considered when making the diagnosis above, EXPECT?
A 39-year-old woman has been suffering from pelvic pain for 10 years, which can sometimes be relieved with sedating analgesics. Multiple examinations, including explorative laparotomy have been carried out, yet doctors haven’t managed to find organic causes. The patient denies having low mood or other psychiatric problems, but feels anger towards doctors, who, she feels, cannot cure her.
1)  	simulating
2)  	organic psychiatric disorder
3)  	conversion disorder
4)  	schizophrenia
A)  	answers 1, 2, and 3 are correct.
B)  	answers 1, and 3 are correct
C)  	answers 2, and 4 are correct.
D)  	only answer 4 is correct.
E)  	all answers are correct.
A

D) only answer 4 is correct.

EXPLANATION
Since disorders of thought, perception, or bizarre behaviour etc. are not mentioned above, schizophrenia should not be considered when making a diagnosis.

139
Q

Which of the following is not effective when treating PTSD:
A) cognitive-behavioural therapy
B) psychodynamic therapy
C) haloperidol
D) selective serotonin reuptake inhibitors
E) propranolol

A

ANSWERC) haloperidol

EXPLANATION
Antipsychotics are not indicated when treating PTSD.

140
Q

Which of the following is true for adaptation disorder?

A) vast environmental disasters can cause it
B) doesn’t cease after the stressful stimulus has stopped
C) reaching a new level of adaptation doesn’t help it cease
D) everyday stressful stimuli can cause severe symptoms that hinder everyday life
E) doesn’t affect social integration

A

D) everyday stressful stimuli can cause severe symptoms that hinder everyday life

EXPLANATION
In adaptation disorder the patient experiences severe symptoms that hinder everyday life, affect social integration, which are caused by everyday stressful stimuli. They stop however, when the stressful stimulus has stopped, as well as after reaching a new level of adaptation.

141
Q

What is the most likely diagnosis?
A 32-year-old woman has survived a train accident 2 years ago, the train was derailed. Many were injured, there was chaos and despair. She’s relived the memory many times since, evoking a feeling of despair. She also has similar feelings when an external situation reminds her of it, then she sweats and starts to tremble. Since the accident she’s never travelled by train.
A) acute post-traumatic stress disorder
B) adaptation disorder
C) acute stress disorder
D) chronic post-traumatic stress disorder

A

D) chronic post-traumatic stress disorder

EXPLANATIONA prolonged pathological state after trauma indicates PTSD

142
Q

Which of the following provide suitable treatment for the diagnosis above?
A 28-yearold man lives with his parents, has a job, but has no savings; in fact, he must ask the parents for 1.500.000 Forints although he apparently has no major expenses. His behaviour doesn’t seem to have changed, he goes to work punctually, his colleagues like him. He has a reasonably good salary, but still has debts, which he wants to keep secret; he has a “winning system” for winning the money back.
1) SSRI
2) carbamazepine
3) naltrexone
4) bupropion
5) cognitive and behavioural therapy

A)  	answers 1, 2, 3 and 4 are correct.
B)  	all answers are correct.
C)  	answers 1, 2, and 4 are correct.
D)  	answers 2, 3, and 5 are correct
E)  	answers 1, 3, and 5 are correct
A

B) all answers are correct.

EXPLANATION
When treating pathological gambling SSRIs, bupropion, carbamazepine, naltrexone can decrease the impulse, along with cognitive and behavioural therapy.

143
Q 
How many times higher risk do earlier suicide attempts mean regarding a future attempt?
A)  	hundred
B)  	ten
C)  	two
D)  	one
A

A) hundred

144
Q

The indicator(s) of suicidal risk is/are:

1) the 3 criteria of the presuicidal syndrome according to Ringel
2) the score of the item regarding suicidal behaviour in the Hamilton Depression Rating Scale (HAM-D)
3) the score of the short version of the Hopelessness Scale by Beck
4) the WAIS score

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
Although suicidal behaviour cannot be predicted for sure, the risk assessment can be based on the identification of presuicidal syndrome and the score of the item regarding suicidal behaviour in the HAM-D, furthermore the score of the short version of the Hopelessness Scale by Beck is able to roughly quantify the risk. WAIS score is irrelevant from this point of view

145
Q

Crisis intervention is

1) a short treatment (1-6 sessions)
2) the re-evaluation of the triggering causes
3) activating the reserves of the personality and developing the helping potentials
4) giving advices and urging to change in order to overcome the causes

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

A) only the 1st, 2nd and 3rd answers are correct

EXPLANATION
urging and advising does not help in a crisis situation, the other statements are true

146
Q

Which of the following does NOT apply for crisis intervention?

1) it aims cognitive re-evaluation
2) the therapist is non-directive
3) it might be conducted via telephone
4) it aims to totally reconstruct the personality

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

A

C) only the 2nd and 4th answers are correct

EXPLANATION
the therapist should rather be directive in this case, the intervention does not aim to totally reconstruct the personality, it focuses rather on the re-evaluation and activation of helping potentials. It might be conducted via phone, too.

147
Q

Which diagnosis is most likely, based on the symptoms of the patient?

A 45-year-old man came back to his home country a year ago from abroad, where he worked permanently. He has had a constant feeling of anxiety since his return. He is anxious in the morning when he has to go to work, he feels restless in his workplace, he cannot concentrate, he is irritable and feels tension in his muscles. 
A)  	depression
B)  	social phobia
C)  	post-traumatic stress disorder
D)  	generalised anxiety disorder
E)  	acute stress reaction
A

D) generalised anxiety disorder

EXPLANATION
Generalised anxiety disorder is characterised by constant worrying and the presence of a persistent anxiety which is not limited to only one or two specific situations. The symptoms last at least 6 months. The anxiety is accompanied by additional symptoms for these 6 months, which involve at least three of the followings: restlessness, exhaustion, concentration problems, irritability, muscle tension, sleep disorders.

148
Q

The following criteria can help in establishing the proper diagnosis:
A 24-year-old male university student does not go out with friends due to his fear of inability to start speaking; he presumes that the others find him pathetic. He feels anxiety in those situations when he has to start speaking in front of the others at the university.
1) a constant and recurring fear of those situations or activities which can result in exposure to the attention and judgement of others
2) social situations provoke an immediate anxiety
3) it is accompanied by a passive avoiding behaviour
4) it is accompanied by an active avoiding behaviour

A)  	answers 1, 2 and 3 are correct
B)  	answers 1 and 3 are correct
C)  	answers 2 and 4 are correct
D)  	only answer 4 is correct
E)  	all of the 4 answers are correct
A

A) answers 1, 2 and 3 are correct

EXPLANATION
Social phobia means a constant and recurring fear of those situations or activities that can result in exposure to the attention and judgement of others, social situations can provoke anxiety immediately; and the condition is accompanied by a passive avoiding behaviour.

STATE (12 decks)

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