Psychopathology Flashcards
Disorientation to place is seen in A. Severe anxiety B. Wernicke's encephalopathy C. Korsakoff's psychosis D. Acute manic episode E. Depression
B. Wernicke’s encephalopathy
Disorientation is a sign of confusion and altered levels of consciousness. Among the conditions listed, only Wernicke’s encephalopathy is associated with a confusional state. Manic episode, schizophrenia, and anxiety occur on a background of clear consciousness.
Somatic symptoms of severe anxiety include all of the following except A. Diarrhea B. Constipation C. Sighing D. Hypoventilation E. Impotence
D. Hypoventilation
Somatic symptoms of anxiety include gastrointestinal symptoms like dry mouth, swallowing difficulties, diarrhea, and constipation; respiratory symptoms like difficulty inhaling and hyperventilation; cardiovascular symptoms like palpitations and chest discomfort; genitourinary symptoms like frequent micturition, erectile dysfunction, amenorrhea; and neuromuscular system symptoms like tremor, tinnitus, dizziness, and headache.
All of the following are normal experiences except A. Déjà vu B. Jamais vu C. Derealization D. Hallucinations E. Delusional perception
E. Delusional perception
In delusional perception, a normal perception acquires a delusional significance. It is a first-rank symptom of schizophrenia. In derealization, objects appear unreal and lifeless. These can be normal phenomena, especially in fatigue. Déjà vu is the recognition of events that are unfamiliar, and jamais vu is failing to recognize events that have been encountered before. Hallucinations of the hypnagogic and hypnopompic variety are not necessarily pathological.
Which of the following is true about a primary delusion?
A. It is always grandiose.
B. It can occur in normal people.
C. It is frequently systematized to secondary delusions.
D. It may be secondary to auditory hallucinations.
E. It is rarely preceded by delusional mood.
C. It is frequently systematized to secondary delusions.
The concept of primary delusions was introduced by Jaspers. Primary delusions are characterized by their “psychological irreducibility.” Secondary delusions emerge from disturbing life experiences or pathological mood states or misperceptions. Primary delusions are usually persecutory. Primary delusions always reflect an illness. “Delusional mood” or “delusional atmosphere” refers to an ensemble of miniscule and almost unnoticed experiences that impart a new and bewildering aspect or meaning to a situation. To the patient, the world seems to be subtly altered; something uncanny seems to be going on in which the patient feels personally involved without knowing how. The delusional atmosphere usually precedes a primary delusion.
Which of the following is true about concrete thinking?
A. It is usually seen in bipolar disorder.
B. It is diagnostic of schizophrenia.
C. It is diagnostic of organic brain disease.
D. It is a defect of conceptual abstract thought.
E. It is always seen in schizophrenia.
D. It is a defect of conceptual abstract thought.
In concrete thinking, the patient cannot keep in mind the abstract use of a notion relevant in a given context and slips into more concrete meanings. In organic mental disorders and subnormality of intelligence, patients may have an inability to think abstractly that may be attributed to a diminished capacity to understand the concept. It is not diagnostic of schizophrenia or organic brain disease, nor is it always seen in schizophrenia.
Psychotic depression is characterized by A. Circumstantiality B. Jamais vu C. Hypnagogic hallucinations D. Nihilistic delusions E. Flight of ideas
D. Nihilistic delusions
In nihilistic delusion, the patient believes that the real world has disappeared completely and that he no longer exists. It is seen in severe depression with psychotic features. In circumstantiality, the patient has to go through many irrelevant details in his conversation before returning to a point. Jamais vu and hypnagogic hallucinations may be normal phenomena. Flight of ideas is classically seen in mania.
Which of the following is true about pseudohallucinations?
A. They possess the vivid quality of normal perceptions.
B. They are dependent on external stimuli.
C. They cannot be overcome voluntarily.
D. They arise in inner space.
E. They do not appear spontaneously.
E. They do not appear spontaneously.
The term “pseudohallucination” is used when a hallucination is recognized as unreal. According to Jaspers, pseudohallucinations are not as tangible and real as hallucinations, though they do appear spontaneously and are discernible from real perception. They can be overcome voluntarily. They arise in inner space and are not dependent on external stimuli.
Obsessions can occur in the form of A. Cravings B. Delusions C. Panic attacks D. Sexual impulses E. Hallucinations
D. Sexual impulses
Obsessions occur as repeated thoughts, ruminations, memories, images, or impulses that patients know are their own but are unable to prevent. Compulsions are actions, rituals, or behaviors that patient recognize as their own but cannot resist successfully.
Pseudodementia is characterized by A. Abnormal EEG B. Chronic course C. Onset with depressive features D. Localized neurological signs E. Confabulation
C. Onset with depressive features
Pseudodementia is a presentation of depression, particularly in the elderly with cognitive impairment. This is not a true dementia, and patients respond to the treatment of depression. Patients typically give “Don’t know” answers rather than the confabulation seen in dementia. EEG is normal and there are no localized neurological signs unless another condition is present.
Which of the following is true of tangentiality? A. It is pathognomonic of schizophrenia. B. It is characteristic of mania. C. It is a disorder of thought. D. It is a disorder of perception. E. It is the same as circumstantiality.
C. It is a disorder of thought.
Tangentiality is a disorder of the thinking process in which ideas deviate toward an obliquely related theme. It may be seen in schizophrenia although it is not pathognomonic of schizophrenia or mania.
Which of the following is true about Capgras syndrome?
A. It is also called erotomania.
B. It is also called delusion of doubles.
C. It is usually associated with brain disease.
D. It is the same as hysteria.
E. It is seen in husbands of pregnant women.
B. It is also called delusion of doubles.
In Capgras syndrome, patients falsely perceive that someone in their environment, usually a close relative or friend, has been replaced by a double. In erotomania, the individual has strong erotic feelings toward another person and has the persistent unfounded belief that the other person is deeply in love with him or her. Erotomania is also called de Clerambault syndrome. The condition seen in husbands of pregnant women is called Couvade syndrome.
First-rank symptoms of schizophrenia
A. Include second-person and third-person hallucinations
B. Include incongruity of affect
C. Are diagnostic of schizophrenia
D. Include passivity phenomena
E. Are not seen in conditions other than schizophrenia
D. Include passivity phenomena
Schneider identified a set of phenomena that he considered strongly indicative of schizophrenia in the absence of brain disease. They are not diagnostic of schizophrenia. They include third-person hallucinations, voices commenting, and audible thoughts. Thought broadcast, withdrawal, and insertion along with made will, made affect, made acts, and somatic passivity are also first-rank symptoms. They may be seen in other organic and affective states.
Which of the following is not a Schneider first-rank symptom? A. Thought withdrawal B. Somatic passivity C. Third-person auditory hallucinations D. Delusional perception E. Thought block
E. Thought block
Thought block is not a first-rank symptom though thought withdrawal is.
Which of the following is true about obsessional thoughts?
A. They are rarely of a sexual nature.
B. They are best treated by thought stopping.
C. Desipramine is the drug of choice.
D. They always give rise to compulsions.
E. They are ego-dystonic.
E. They are ego-dystonic.
Obsessional thoughts are recurrent, intrusive, and distressing. Patients realize these are their own thoughts and find them distressing. The obsessional thoughts are commonly of a sexual nature. Thought stopping can be used as an intervention but may not be very effective. Patients respond to medications with an affinity for serotonin receptors, such as clomipramine and SSRIs. The thoughts do not always give rise to compulsions, though they commonly do.
Which of the following is true regarding passivity experiences?
A. They include echo de la pense.
B. They exclude thought broadcasting.
C. They are common in bipolar disorder.
D. They are also called made experiences.
E. They occur in obsessional states.
D. They are also called made experiences.
Passivity experiences are also called made experiences, as the patient perceives them to be under the control of an external force. Echo de la pense (thought echo) is the phenomenon in which the patient hears his thoughts aloud. Thought broadcasting is a passivity phenomenon. Psychotic symptoms are not seen in obsessional states. Passivity phenomena may be seen in bipolar disorder but are not common.
Frequent wrist cutting is seen in all of the following EXCEPT:
A. Borderline personality disorder
B. Schizophrenia
C. Depression
D. Obsessive-compulsive personality disorder
E. High states of tension
D. Obsessive-compulsive personality disorder
Frequent wrist cutting is seen in a wide range of psychiatric conditions, including schizophrenia, depression, and bipolar disorder. Patients typically report a relief of tension following the act. It is not associated with obsessive-compulsive disorder.
Which of the following is NOT a disorder of thought process? A. Omission B. Substitution C. Blurring of conceptual boundaries D. Knight's move thinking E. Paranoid delusions
E. Paranoid delusions
Paranoid delusion is a disorder of thought content. The others are examples of disorder of thought process or form.
The experience of seeing one's own body projected into external space is called A. Reflex hallucination B. Autoscopic hallucination C. Hypnagogic hallucination D. Pseudohallucination
B. Autoscopic hallucination
This phenomenon is rare and is encountered in a small minority of patients with temporal lobe epilepsy or other organic brain disorders. In reflex hallucination, a stimulus in one sensory modality results in a hallucination in another.
Which of the following is true about depersonalization? A. It is a psychotic experience. B. It is treated with phenobarbitone. C. It is usually pleasant. D. It is associated with depression. E. It is recognized as odd.
E. It is recognized as odd.
In depersonalization, one’s own feelings are experienced as being detached, distant, not being one’s own, lost, or altered. The person recognizes that this is a subjective change and not a change imposed by outside forces. It is experienced as unpleasant and odd. It is associated with depression, anxiety, and use of various substances, especially hallucinogens.
Which of the following is true about the reliability of psychiatric diagnosis?
A. It is not increased by training psychiatrists.
B. It is not important if validity is guaranteed.
C. It is increased by semistructured interviews.
D. It is not increased by operational definitions.
E. It has not been tested internationally.
C. It is increased by semistructured interviews.
The reliability of psychiatric diagnosis is increased by the use of semistructured interviews. It is increased by training. Reliability and validity are both important while making a diagnosis. The use of operational criteria like the DSM increases reliability. Most diagnoses have been tested internationally across various cultures.
