Psychopathology Flashcards

1
Q
Disorientation to place is seen in
A. Severe anxiety
B. Wernicke's encephalopathy
C. Korsakoff's psychosis
D. Acute manic episode
E. Depression
A

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.

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2
Q
Somatic symptoms of severe anxiety include all of the following except
A. Diarrhea
B. Constipation
C. Sighing
D. Hypoventilation
E. Impotence
A

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.

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3
Q
All of the following are normal experiences except
A. Déjà vu
B. Jamais vu
C. Derealization
D. Hallucinations
E. Delusional perception
A

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.

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4
Q

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.

A

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.

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5
Q

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.

A

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.

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6
Q
Psychotic depression is characterized by
A. Circumstantiality
B. Jamais vu
C. Hypnagogic hallucinations
D. Nihilistic delusions
E. Flight of ideas
A

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.

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7
Q

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.

A

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.

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8
Q
Obsessions can occur in the form of
A. Cravings
B. Delusions
C. Panic attacks
D. Sexual impulses
E. Hallucinations
A

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.

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9
Q
Pseudodementia is characterized by
A. Abnormal EEG
B. Chronic course
C. Onset with depressive features
D. Localized neurological signs
E. Confabulation
A

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.

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10
Q
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.
A

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.

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11
Q

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.

A

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.

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12
Q

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

A

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.

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13
Q
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
A

E. Thought block

Thought block is not a first-rank symptom though thought withdrawal is.

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14
Q

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.

A

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.

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15
Q

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.

A

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.

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16
Q

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

A

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.

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17
Q
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
A

E. Paranoid delusions

Paranoid delusion is a disorder of thought content. The others are examples of disorder of thought process or form.

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18
Q
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
A

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.

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19
Q
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.
A

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.

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20
Q

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.

A

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.

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21
Q

Which of the following is true regarding delusions?
A. They are usually of a bizarre nature.
B. They are reality for the patient.
C. They are held with a conviction that is shakable.
D. They are usually self-referent.
E. They may present as obsessive-compulsive disorder

A

B. They are reality for the patient.

There are various definitions of delusions. A delusion is often defined as “a false, unshakable belief that is out of keeping with the patient’s social and cultural background.” Sometimes, the contents of delusions do not go beyond the impossible and may be true. Thus, delusions may also be defined as “overriding rigid convictions that create a selfevident, private, and isolating reality requiring no proof.” Most delusions are not of a bizarre nature, and all delusions are self-referent.

22
Q
Which of the following is NOT an experience seen in normal people?
A. Depersonalization
B. Déjà vu
C. Jamais vu
D. Encapsulated delusions
E. Ideas of reference
A

D. Encapsulated delusions

Encapsulated, overvalued ideas may be seen in normal people. However, delusions are not. Depersonalization, déjà vu, jamais vu, ideas of reference, and hallucinations are all part of normal experience.

23
Q
Which of the following is NOT a feature of Gilles de la Tourette syndrome?
A. Coprolalia
B. Echopraxia
C. Echolalia
D. Coprophagia
E. Tics
A

D. Coprophagia

Tourette syndrome begins before age 21 and is characterized by motor tics, vocal tics, coprolalia (utterance of obscenities), copropraxia (obscene gestures), echolalia, echopraxia, and self-injurious behavior. It is not associated with coprophagia. Associated psychiatric conditions include depression, anxiety, personality disorder, ADHD, and obsessive-compulsive disorder.

24
Q
Pseudohallucinations occur in all of the following EXCEPT:
A. Long-distance truck drivers
B. Sensory deprivation
C. Dreams while asleep
D. Prisoners in solitary confinement
E. Dreams while awake
A

C. Dreams while asleep

The term “pseudohallucination” is used when the hallucinations are recognized as unreal. This term was introduced by Jaspers. Daydreaming can at times have the quality of a pseudohallucination. It is also seen in sensory deprivation states like long-distance truck drivers and prisoners in solitary confinement.

25
Q
Which of the following does not favor a diagnosis of delirium?
A. Symptoms worsening in the evenings
B. Visual hallucinations
C. Misidentification
D. Delusions of persecution
E. Improvement at night
A

E. Improvement at night

“Delirium” is a term used to cover all types of acute disturbance of consciousness with general impairment of cognition whether or not the patient was overactive and disturbed. The clinical features are impairment of consciousness with symptoms worse at night; agitation or hypoactivity; labile mood; incoherent speech; abnormalities of perception with visual hallucinations, illusions, and misinterpretation; cognitive dysfunction with impairment of orientation, concentration, and memory with impaired insight. Delusions may be seen, but they are fragmented and unsystematized.

26
Q
Verbigeration is seen in
A. Ganser syndrome
B. Catatonic schizophrenia
C. Malingering
D. Bereavement
E. Depression
A

B. Catatonic schizophrenia

Verbigeration is a constant repetition of syllables and sound. It is seen in schizophrenia and organic language disorders.

27
Q
The characteristic hallucinations seen in alcoholic hallucinosis are
A. Tactile
B. Auditory
C. Gustatory
D. Olfactory
E. Synesthesic
A

B. Auditory

Auditory hallucinations are the characteristic hallucinations in alcoholic hallucinosis. Auditory hallucinations are present in a clear consciousness without autonomic overactivity. They often begin as simple noises but are gradually replaced by voices that may threaten or abuse the person. Usually the remarks are addressed in the second person. Classified as a substance-induced psychotic disorder, the hallucinations usually respond rapidly to medication and abstinence, and the prognosis is good.

28
Q
Which of the following is false about ideas of reference?
A. They are always pathological.
B. They occur in alcoholics.
C. They are not delusions.
D. They may improve spontaneously.
E. They can lead to social isolation.
A

A. They are always pathological.
A. They are always pathological.

Ideas of reference can occur in normal people in the absence of any illness. They are not delusions and may resolve spontaneously. They may result in social isolation due to suspiciousness. They are common in alcoholics.

29
Q
Which of the following is not a type of catatonia?
A. Echopraxia
B. Cataplexy
C. Catalepsy
D. Psychological pillow
E. Stupor
A

B. Cataplexy

Cataplexy is the loss of muscle tone seen with sleep and narcolepsy. Echopraxia is the imitation of action of others. In catalepsy, uncomfortable and bizarre postures are maintained against gravity or efforts to rectify them. In psychological pillow, the patient holds his head above the level of the bed while lying down. This is a form of catalepsy. In stupor, the patient does not communicate or move though he or she is alert.

30
Q

Schneider first-rank symptoms are
A. Primary psychological symptoms from which all others are derived
B. Common in autistic children
C. Predictive of decline in social functioning
D. Diagnostic of schizophrenia
E. Seen in mania

A

E. Seen in mania

Schneider first-rank symptoms are phenomena that strongly indicate schizophrenia in the absence of overt brain disease. They have no prognostic value. The presence of more than one first-rank symptom does not increase the probability of schizophrenia. They may be seen in conditions other than schizophrenia; up to one-quarter of patients with mania may have first-rank symptoms.

31
Q

In history taking and mental status examination, all of the following are true except
A. Occupational history may give an indication of severity of condition.
B. Cognitive testing is not indicated if a full history is obtained.
C. Family history may give a clue about family dynamics.
D. Mental status examination need not be done in the recommended sequence.
E. Proverb interpretation demonstrates concrete thinking.

A

B. Cognitive testing is not indicated if a full history is obtained.

The ability to obtain a good history does not preclude the need for cognitive testing. Occupational history may give an indication of the severity of the condition. Proverb interpretation demonstrates concrete thinking, and mental status exam can be done and recorded in any form.

32
Q
Loosening of association is pathognomonic of
A. Schizophrenia
B. Mania
C. Depression
D. All of the above
E. None of the above
A

E. None of the above

Loosening of association is most commonly seen in schizophrenia; however, it is not pathognomonic of any particular condition.

33
Q
Obsessions in obsessive-compulsive disorder may present as
A. Hallucinations
B. Delusions
C. Mental images
D. Panic attacks
E. Thought echo
A

C. Mental images

Obsessions, by definition, cannot be psychotic phenomena. They may present as mental imagery.

34
Q
Which of the following conditions does not classically cause emotional lability?
A. Mania
B. Severe depression
C. Pseudobulbar palsy
D. Hysteria
E. Delirium
A

B. Severe depression

Emotional lability may be seen in mania, pseudobulbar palsy, hysteria, delirium, and mild to moderate depression. However, in severe depression, the patient usually has sustained low moods.

35
Q
Which of the following is NOT seen in alexithymia?
A. Lack of empathy
B. Reduced fantasy thinking
C. Reduced symbolic thinking
D. Inability to experience feelings
E. Difficulty reading
A

E. Difficulty reading

Alexithymia is an inability to describe or recognize one’s emotions. Patients also have a limited fantasy life, constriction of affective life, reduced symbolic thinking, and an inability to empathize with others. Difficulty reading is not a feature of alexithymia.

36
Q
Visual hallucinations are most commonly seen in
A. Late-onset schizophrenia
B. Temporal lobe dementia
C. Antihypertensive treatment
D. Acute organic psychosis
E. Untreated depression
A

D. Acute organic psychosis

Visual hallucinations are common in delirium. In fact, they are extremely uncommon in functional psychiatric illnesses. They are not a common feature of late-onset schizophrenia, which is more likely to be characterized by delusions and auditory hallucinations, though visual hallucinations may be present. Frontotemporal dementia presents with disorganized behavior, change in personality, poor insight, emotional blunting, and stereotyped and perseverative behavior. Untreated depression can result in hallucinations, but they are more often auditory.

37
Q
Repetitive, voluntary, purposeful movements are called
A. Stereotypy
B. Mannerism
C. Obsession
D. Ritual
E. Automatism
A

B. Mannerism

This is the definition of mannerism. Stereotypy is the constant repetition of meaningless and purposeless gestures or movements. In automatism, the individual is consciously or unconsciously, but involuntarily, compelled to perform certain motor or verbal acts.

38
Q
The diminution of emotional response is called
A. Blunting of affect
B. Flattening of affect
C. Alexithymia
D. Depression
E. Perseveration
A

A. Blunting of affect

Diminution of emotional response is called blunting of affect. Flattening of affect is strictly speaking the absence of an emotional response.

39
Q
The most commonly seen symptom in schizophrenia is
A. Delusion
B. Visual hallucinations
C. Auditory hallucinations
D. Thought withdrawal
E. Thought echo
A

C. Auditory hallucinations

Auditory hallucinations are the most commonly seen symptom in schizophrenia from among the five listed answers.

40
Q
Perseveration is most commonly seen in
A. Schizophrenia
B. Organic brain disorders
C. Depression
D. Anxiety
E. Obsessive-compulsive disorder
A

B. Organic brain disorders

Perseveration is the inability to shift from one theme to another. A thought is retained long after it has become inappropriate in the given context. It is seen in organic brain disorders.

41
Q
The experience of seeing one's own body in external space is called
A. Autoscopic hallucination
B. Extracampine hallucination
C. Reflex hallucination
D. Visual hallucination
E. Gedankenlautwerden
A

A. Autoscopic hallucination

Autoscopy is the experience of seeing one’s own body in external space. Extracampine hallucination is the experience of a hallucination outside the field of that particular sense. Reflex hallucination is the presence of hallucinations in one modality when the stimulus is in another modality. Gedankenlautwerden is also called echo de la pense or thought echo.

42
Q
When a person believes that someone known to him has been replaced by a double, the condition is known as
A. Fregoli syndrome
B. de Clerambault syndrome
C. Capgras syndrome
D. Othello syndrome
E. Diogenes syndrome
A

C. Capgras syndrome

In Capgras syndrome, a person believes that someone known to him has been replaced by an exact double. In Fregoli syndrome, the patient believes that one or more individuals have altered their appearance to resemble familiar people, usually to persecute the patient. In de Clerambault syndrome, the patient believes that another person, usually of higher social standing, is in love with him. Othello syndrome is also called pathological or morbid jealousy. Diogenes syndrome is also called senile squalor, characterized by hoarding and self-neglect.

43
Q

Which of the following is a feature of obsessions?
A. Patient believes they come from an external source.
B. Patient believes they are logical.
C. Patient finds them pleasurable.
D. Patient finds them distressing and unpleasant.
E. There is no resistance to them.

A

D. Patient finds them distressing and unpleasant.

In obsession, patients realize that the obsessive thoughts are their own and illogical, perceive the thoughts as distressing and unpleasant, and usually try to resist them, though with long-standing illness resistance may be absent.

44
Q
A patient's imitating of the examiner's movements even when asked not to do so is called
A. Echolalia
B. Echopraxia
C. Ambitendence
D. Waxy flexibility
E. Mannerism
A

B. Echopraxia

Echopraxia is the imitation of movements or actions. Echolalia is the repetition of words. Ambivalence or ambitendence is an inability to make decisions. In waxy flexibility, an awkward posture is held by the patient without distress for longer than would be possible for a normal individual.

45
Q
The patient's lack of awareness of his or her illness or condition is called
A. Anosognosia
B. Hemisomatognosis
C. Prosopagnosia
D. Autotopagnosia
E. Anton syndrome
A

A. Anosognosia

In anosognosia, patients are unaware of their illness or condition. Anton syndrome is a form of cortical blindness in which the patient denies the visual impairment. It is caused by occipital lobe damage that extends from the primary visual cortex into the visual association cortex.

46
Q

Presence of insight is suggested by all of the following except
A. Patient recognizes that he is ill.
B. Patient recognizes that the illness is of a psychological nature.
C. Patient recognizes that he needs treatment.
D. Patient is willing to accept help.
E. Patient agrees with all that the doctor says.

A

E. Patient agrees with all that the doctor says.

Agreement with all that the doctor says does not necessarily demonstrate good insight. The criteria that may be used to judge insight are (a) the patient realizes that he has an illness; (b) the patient recognizes the illness to be of a psychological nature; (c) the patient thinks he needs help with the illness; or (d) the patient is willing to accept help.

47
Q

Which of the following is a self-rating scale?
A. Hamilton Depression Rating Scale
B. Beck Depression Inventory (BDI)
C. Montgomery-Asberg Depression Rating Scale
D. Yale-Brown Obsessive-Compulsive Scale
E. Positive and Negative Syndrome Scale (PANSS)

A

B. Beck Depression Inventory (BDI)

Beck Depression Inventory (BDI) is a self-rating scale. All the others are clinician-rated or observer-rated scales.

48
Q

Which of the following is a psychological test to detect organic brain damage?
A. Cattell P-16
B. Rorschach test
C. Stanford-Binet test
D. New Word Learning Test
E. Minnesota Multiphasic Personality Inventory (MMPI)

A

D. New Word Learning Test

The New Word Learning test is a test to detect organic brain damage. Cattell P-16 and MMPI are personality inventories. Rorschach test is a projective test and Stanford-Binet is a test for intelligence.

49
Q
Tactile hallucinations are seen in
A. Dermatitis artefacta
B. Alcoholic polyneuropathy
C. Cocaine abuse
D. Obsessive-compulsive disorder
E. Panic disorder
A

C. Cocaine abuse

Tactile hallucination is classically seen in cocaine use. Alcoholic polyneuropathy does not cause hallucinations. Obsessivecompulsive disorder or panic disorder is not associated with hallucinations. Dermatitis artefacta is a self-inflicted dermatological injury produced for secondary gain. It is not associated with hallucinations.

50
Q
Nihilistic delusions are most likely to be seen in
A. Cotard syndrome
B. Schizophrenia
C. Capgras syndrome
D. Fregoli syndrome
A

A. Cotard syndrome

In Cotard syndrome, the patient has nihilistic delusions, that is, beliefs about the nonexistence of some person or thing. The thoughts are associated with extreme degrees of depressed mood. Comparable ideas concerning failures of bodily function often accompany nihilistic delusions.