Sociocultural Psychiatry

Question 1

Before being diagnosed as having schizophrenia, Mark was regarded as a suspicious young man by his
colleagues. After an acute admission, his colleagues avoided him and so he became more suspicious if any
one ever approached him. Which of the following aspect of social labeling applies to Mark’s suspiciousness following diagnostic labeling?

Select one:
1. Partial deviance
2. Formal deviance
3. Primary deviance
4. Secondary deviance
5. Spiral deviance

Answer 1

Secondary deviance

Edwin Lemert developed the idea of primary and secondary deviance to explain the social process of
labeling. Primary deviance is any general deviance before the person is labeled as deviant. Secondary
deviance is any action that takes place after primary deviance as a reaction to the institutions and the
labeling.

Question 2

A doctor wants to establish a long-term therapeutic relationship with her patient. Focusing on which of the
following provides the best likelihood for achieving this?

Select one:
1. Strengths and interests of the patient
2. Adherence to medication
3. Patient’s childhood experiences
4. Wishes of the patient’s carers
5. Insight of the patient

Answer 2

Strengths and interests of the patient

The major functions of medical interviews include gathering information, developing and maintaining a
therapeutic relationship and communicating information. The establishment of long-term therapeutic relationship hinges on understanding the strengths and interests of a patient.

Question 3

In UK which of the following disorders are most stigmatized?

Select one:
1. Learning difficulties and personality disorders
2. Schizophrenia and addictions
3. Schizophrenia and eating disorders
4. Schizophrenia and dementia
5. Schizophrenia and depression

Answer 3

Schizophrenia and addictions

Public opinion: These 4 themes (dangerousness, attribution of responsibility, poor prognosis, disruption of social interaction) formed the basis of Office of National Statistics survey in the UK where
1790 adults were interviewed to measure subjective perception of 7 different mental disorders including
schizophrenia, depression, alcoholism, drug use, dementia, panic disorder and eating disorders.
Schizophrenia and addictions were regarded most negatively; approximately 60% respondents thought
addicted individuals have only themselves to blame for their problems. Most individuals knew the difference
between various disorders and most felt that depression and anxiety are treatable.

Question 4

Immigrants carry a higher risk of schizophrenia than the native population in UK. Which of the following is
correct in this regard?

Select one:
1. Significant social disadvantage in the immigrants may explain the association
2. Pre-psychotic segregation explains the higher risk
3. Incidence rates of schizophrenia in Caribbean countries are higher than UK
4. Psychiatric hospital admission rates are lesser among ethnic minorities
5. Excess risk is specific for African and Caribbean immigrants

Answer 4

Significant social disadvantage in the immigrants may explain the association

Cooper has revisited and reappraised the data available and summarised the main findings as below:
a. The excess risk is not specific for African—Caribbean immigrants. It is also present among African-born Black immigrants to the UK, and to a lesser extent among immigrants from Asian countries. Hence, any explanation cannot be purely biological and not simply race specific.

b. Incidence rates of schizophrenia in Caribbean countries are similar to those found in the indigenous UK population; this excludes country of origin theory which proposes that the immigrants carry such higher incidence rates from where they come from. The rate for schizophrenia in second-generation African—Caribbean people born in the UK appears to be higher than in the first generation, which is strongly suggestive of an environmental rather than a genetic effect.

c. According to this notion of prepsychotic segregation, individuals who are psychosis prone find it hard to survive in the countries of birth and so immigrate to other regions. There is no evidence for selective immigration from the Caribbean as part of a pre-psychotic segregation. Also notable is the fact that apart from 1st generation immigrants having higher rates of psychosis, the 2nd generation children of immigrants also have a very high rate of psychosis (in some cases, higher than their parents), negating the probability of psychosis-induced immigration.

d. The immigrants’ pathways to psychiatric care are characterized by long delays in seeking professional help, a lower likelihood of psychiatric referral, and frequent involvement of the police and emergency services and high proportions of compulsory and intensive care and secure (locked) ward admissions. The long-term outcome tends to be correspondingly unfavourable for immigrants.

Question 5

A 12-year-old girl is called by names at her school after her dad’s admission at the local psychiatric hospital.
This is called

Select one:
1. NIMBY opposition
2. Self stigma
3. Nosophobia
4. Courtesy stigma
5. Stereotyping

Answer 5

Courtesy stigma

Family and friends may endure a stigma by association, the so-called courtesy stigma (Goffman, 1963). Courtesy stigma refers to the stigmatization an unaffected person experiences due to his or her relationship with a person who bears a stigma. Parents of children with psychiatric conditions are particularly vulnerable to courtesy stigma.

Question 6

Which of the following statements about Camberwell family interview is not true?

Select one:
1. It includes positive comments
2. The rating is based on content and vocal tone
3. It is carried out with patient
4. It is a semi-structured standard interview
5. It assess expressed emotions

Answer 6

It is carried out with patient

It is a semi-structured interview carried out with relatives of patients with Schizophrenia.

Question 7

A 40-year-old man with schizophrenia is treatment resistant. He lives with his family who apparently has
high EE. Which of the following statements about EE is true?

Select one:
1. High EE may be the cause for his schizophrenia
2. Reducing the duration of face to face time spent with family may reduce the relapse
3. High EE can cause poor insight
4. EE can be measured using Camberwell Assessment of Needs (CANE)
5. High EE has no effect on relapse rates in female patients

Answer 7

Reducing the duration of face to face time spent with family may reduce the relapse

In the majority of the studies, high expressed emotion was predictive of relapse in symptoms of
schizophrenia nine months later for both genders. A large amount of face-to-face contact (more than 35
hours per week) with a relative with a high expressed emotion score increased the risk of relapse, but in
households with a low expressed emotion score, high levels of contact appeared to be protective

Question 8

Which of the following syndromes refer to the fear of cold seen in Chinese men?

Select one:
1. Pa-Leng
2. Koro
3. Piblokto
4. Shenkui
5. Amok

Answer 8

Pa-Leng

Pa-Leng is a form of frigophobia seen in China. It is more common in men.

Question 9

According to Holmes and Rahe social readjustment scale, which of the following has the highest life change value?

Select one:
1. Birth of a child
2. Personal injury
3. Marriage
4. Road traffic offence
5. Divorce

Answer 9

Divorce

The Holmes-Rahe scale rates 43 life events by units. After the death of one’s spouse (100 units worth),
divorce tops the rest of the stressors list and generates about 73 units.

Question 10

A Chinese man is afraid of going out of his house. He believes that the cold wind will destroy his soul. What
is the cultural bound syndrome described here?

Select one:
1. Koro
2. Piblokto
3. Pa-Leng
4. Susto
5. Windigo

Answer 10

Pa-Leng

Pa Leng is seen in China. Patients may present with cold, clammy hands, tachychardia, dry mouth and other somatic symptoms that trigger panic. The
underlying belief is the fear of a fatal upset in the balance between yin and yang.

While reference to the destruction of soul is not a prominent feature, Pa leng is
known to be a disease of vitality and such references are not inconsistent.

Question 11

Which of the following type of life events predicts the onset of pure depressive illness?

Select one:
1. Humiliation
2. Threat
3. Danger
4. Entrapment
5. Loss

Answer 11

Humiliation

Combined loss and humiliation events are more depressogenic than a threat or other individual types of events. Humiliation events induce defeat and submission responses that may be directly related to
depression. In a study by Kendler et al. (2003), humiliation predicted onsets of pure major depression but not pure generalised anxiety episodes, and danger predicted pure generalised anxiety but not pure major
depression episodes. But the results had only moderate strength in prediction.

Question 12

A man doesn’t think drinking alcohol is a problem and doesn’t want to quit. According to Prochaska’s model,
which stage is he in?

Select one:
1. Relapse
2. Precontemplation stage
3. Contemplation
4. Action
5. Maintenance

Answer 12

Precontemplation stage

In pre-contemplation stage, the user does not recognize that problem use exists, although this may be increasingly obvious to those around them

Question 13

Understanding the impact of a life event in light of one’s current social context and self-perspective is called contextual rating of social adversity. Which of the following employs the above method?

Select one:
1. Holmes and Rahe social adjustment scale
2. Life cycle chart
3. Impact of Events scale
4. Life events and difficulties schedule
5. Sociogram

Answer 13

Life events and difficulties schedule

Life events can be measured using standard scores for each type of life event (e.g. Marriage 100, divorce
90 etc). Brown and Harris popularized a different method whereby life events are graded according to the inherent meaning of the events to the individual concerned i.e. contextual rating of the social adversity.
Accordingly the effect and impact of a life event is understood in light of one’s current social context and
self-perspective. LEDS=Life Events and Difficulties Schedule was devised by Brown and Harris.

Question 14

Torts are wrongs for which a person is liable in

Select one:
1. Court of Protection
2. Civil law
3. Both Civil and criminal Law
4. Criminal Law
5. Military Law

Answer 14

Civil law

Torts are errors for which a person is liable in civil as opposed to criminal law. They include negligence,
libel, slander, trespass and nuisance. If a person of unsound mind commits a wrong, then any damages
awarded in a court of law are usually only nominal.

Question 15

A patient admitted at an inpatient unit is making steady progress. But his symptoms worsen whenever he comes back from home leave. His mother criticises him of being very reluctant and lazy to get involved in
‘normal life’. The next step in management must consider

Select one:
1. Behavioural therapy
2. Increase antipsychotic dose
3. Family therapy
4. Detention
5. Antidepressant drugs

Answer 15

Family therapy

Classical studies by Brown et al., and Vaughn and Leff indicated four times higher relapse rates for patients
with schizophrenia who were discharged to parents who were hostile, critical, or overly involved (high
Expressed emotions - EE), compared to patients whose parents who did not behave this way. A greater
degree of patient adjustment and decreased relapse are associated with higher levels of family tolerance
(Spiegel and Wissle, 1986). Family therapy can help reduce the EE.

Question 16

Partial adaptation of a new culture without giving up one’s culture of origin completely is called

Select one:
1. Acculturation
2. Sojourning
3. Enculturation
4. Accommodation
5. Assimilation

Answer 16

Assimilation

Enculturation: This refers to culture being learnt through contact with family, friends, classmates, teachers and the media. This happens in everyone irrespective of migration, etc. Assimilation refers to the partial adaptation of a new culture (seen in immigrants or refugees) without giving up one’s culture of origin
completely.

Question 17

An Asian immigrant in England is observed to practice his religion and cultural traditions at home but adapts
well especially at work with a good degree of fluency in both English and his native language. This type of
enculturation is called

Select one:
1. Accommodation
2. Assimiliation
3. Melting Pot
4. Biculturalism
5. Bisection

Answer 17

Biculturalism

The acculturative process involves acquisition and retention as well as relinquishing attitudes/values and
practices in both majority and minority populations that continue over several generations. The rate of
change and the circumstances that influence it vary greatly, both between and within groups. For these
reasons, studies of groups experiencing acculturative change often divide the groups by temporal
experience into first-, second-, and third-generation immigrants. Families within such groups have been
categorized as traditional, transitional, or bicultural. Traditional families are characterized as using their
native tongues rather than English, living in ethnic enclaves, avoiding interaction with majority cultural
institutions, and maintaining preimmigration values and behaviors. Transitional families are characterized by greater fluency in the language of the host culture and by children who are becoming familiar with the
values and social behaviors of the dominant majority population through attendance at school and school related activities. Bicultural families are defined as those with a high degree of language fluency in their
native languages as well as English, economic stability, and residence in multiethnic settings. Biculturalism
appears to be more adaptive and associated with minimal acculturation stress.

Question 18

The right action is the one that has the best foreseeable consequences. This is called;

Select one:
1. Engel’s model
2. Utilitarian moral theory
3. Paternalistic model
4. Hammurabi code
5. Oath of Hippocrates

Answer 18

Utilitarian moral theory

Consequentialist moral theories are teleological: they aim at some goal state and evaluate the morality of
actions in terms of progress toward that state. The best-known version of consequentialism is utilitarianism.

As most clearly stated by Mill a proponent of the utilitarianism (teleology), the basic principle of utilitarianism is: Actions are right to the degree that they tend to promote the greatest good for the greatest number. In contrast, deontological principles are duty based. Kant’s theory is an example of a deontological or duty based ethics: it judges morality by examining the nature of actions and the will of agents rather than goals achieved. A deontological theory looks at inputs rather than outcomes.

Question 19

A boy whose mother has depression has a high likelihood to develop one of the following conditions before age 20?

Select one:
1. Schizophreniform illness
2. OCD
3. Borderline personality disorder
4. Alcohol use disorder
5. Depression

Answer 19

Depression

The strongest risk factor for depression is a personal or family history of depression.

Question 20

Which of the following is least likely to be consistent with an individual assuming the Sick Role?

Select one:
1. The individual takes time off work to aid recovery
2. The individual refuses medical help and does not accept his/her diagnosis
3. The individual is considered not responsible for his/her sickness
4. The individual is relieved of his social and vocational responsibilities
5. The individual wants to get better

Answer 20

The individual refuses medical help and does not accept his/her diagnosis

A patient assumes the sick role when ill, seeks to get well and relinquishes the sick role once better.

Question 21

Major recurring themes behind the stigma against mental illness includes all except

Select one:
1. Blaming
2. Cost of treatment required
3. Poor prognosis
4. Disruption of social interaction
5. Dangerousness

Answer 21

Cost of treatment required

Hayward and Bright described four major recurring themes or beliefs behind the stigma against mental
illness. These include
1.Dangerousness
2.Attribution of responsibility
3.Poor prognosis
4. Disruption of social interaction

Question 22

According to Nuremburg code formulated after the Second World War, human experimentation can be
carried out only if which of the following conditions is satisfied?

Select one:
1. Written consent is given for infliction of more than necessary pain
2. Voluntary consent is given
3. A study causing harm can be completed only if carers agree with patients
4. Research is economical
5. Subjects are well compensated for any suffering underwent

Answer 22

Voluntary consent is given

According to Nuremburg Code human experimentation, can be carried out only if:

1.voluntary consent is given
2.Research is intended for common good of the society
3.avoidance of unnecessary pain and suffering is guaranteed for the subjects
4.subject has liberty to withdraw at any point 5.qualified researchers undertake research
6.scientist must terminate a study if more harm is being caused than expected to the subjects

Question 23

When a psychiatric patient is unwell, family and friends report their actions to mental health professionals in
an attempt to get them admitted to an institution. What was the term used by Goffman to describe it?

Select one:
1. Role stripping
2. Batch living
3. Institutional neurosis
4. Mortification
5. Betrayal funnel

Answer 23

Betrayal funnel

Goffman also described the social/moral career of a mental patient. i.e., the process whereby a person with
social ties, friends, and family in the community is institutionalized and converted into an inmate whose
world is limited to his immediate hospital ambience. (Peele et al. 1977). The first step is process by which
patients pass through a ‘betrayal funnel’, as the people they trust most family and friends conspire against
them, reporting their actions to doctors and mental health professionals (called the ‘circuit of agents’) who
run the decision-making process.

Question 24

Which of the following is a semi-structured interview that can be used to gather information regarding
expressed emotions from family members of a patient with psychosis?

Select one:
1. Camberwell Family Interview
2. LEDS Inventory
3. Brown & Harris Family Interview
4. Cambridge Family Interview
5. Holmes & Rahe Inventory

Answer 24

Camberwell Family Interview

Camberwell Family Interview is a semi-structured interview carried out with relatives of patients with
Schizophrenia.

Question 25

The Myth of Mental Illness’ was written by

Select one:
1. Szasz
2. Cleare
3. Cooper
4. Laing
5. Foucalt

Answer 25

Szasz

Antipsychiatry refers to a confederation of psychiatrists, psychologists, nurses, social and welfare workers, lay people and patients who oppose the traditional mental health practice and treatment. Three major pioneers are
1. R.D. Laing,
2. Thomas Szasz and
3. Foucault

R.D.Laing wrote ‘The Divided Self’ (1959), Sanity, Madness and the Family (1964). Thomas Szasz wrote ‘The Myth of Mental Illness’ 1961) and ‘The Manufacture of Madness’ (1971). Foucault wrote Madness and Civilization (1965).

Question 26

A patient with acute relapse of schizophrenia was given time off the ward. He came back next day with his mother who was blaming him for his illness, and ‘what he has put himself through’. Which of the following actions is likely to be most helpful?

Select one:
1.Suggest Cognitive Behavioural Therapy for schizophrenia
2. Stop all home leave immediately
3. Suggest family therapy
4. Provide psychodynamic support to the mother
5. Use Mental Health Act to detain the patient to the ward

Answer 26

Suggest family therapy

High EE can be reduced by family therapy focussed on addressing communication patterns within the
family unit.

Question 27

Insanity sometimes is the sane response to an insane society. This was proposed by

Select one:
1. R.D. Laing
2. Anthony Cleare
3. Thomas Szasz
4. Foucault
5. Phillip Pinel

Answer 27

R.D. Laing

RD Laing was a prominent anti-psychiatrist who wrote ‘The Divided Self’.

Question 28

Which of the following is regarded as ‘Father of Sociology’?

Select one:
1. Talcott Parsons
2. Jean-Paul Sartre
3. Soren Kierkegaard
4. William Tuke
5. Emil Durkheim

Answer 28

Emil Durkheim

Emile Durkheim, a French journalist, formally established the study of sociology. He is often thought of as the ‘Father of Sociology’. Auguste Comte, who devised a system of societal reform and advanced the study of sociology, is also claimed as the Father of Sociology by some.

Question 29

Which of the following aspects best describes one’s ethnicity?

Select one:
1. social activities
2. genetic factors
3. group identification
4. their appearance
5. values and beliefs

Answer 29

Group identification

Race is perceived as a permanent entity determined by genetic ancestry and characterized by physical
appearance. Culture is perceived as a changeable entity determined by upbringing and choice and
characterized by behaviours and attitudes. Ethnicity is perceived as partially changeable entity determined
by social pressure and psychological need characterized by a sense of group identity and belonging.

Question 30

In clinical psychiatric population which of the following disorders is more common in higher social classes?

Select one:
1. Autism
2. Anorexia Nervosa
3. Bulimia Nervosa
4. ADHD
5. Schizophrenia

Answer 30

Anorexia

For a long time now it is debated whether the social class differences in anorexia reflects help seeking or
referral patterns only or the actual disease prevalence. Reappraisal of socioeconomic status from clinical
data in anorexia shows that the social class distribution is consistently weighted toward social classes 1/2.

Community studies have shown that the social class, professional status, and education were not
associated with an increased risk of reporting an eating disorder in such community samples.

Question 31

Which of the following risk factor is likely to be causative in a young man diagnosed with schizophrenia?

Select one:
1. Having lost his mother before the age of 14
2. Being a migrant
3. Living alone
4. Alcohol use
5. HLADR2 gene

Answer 31

Being a migrant

Immigration is one of the strongest known risk factors for schizophrenia.

Question 32

The notion that there are inherent distinctions among ethnic groups and that some ethnicities are
biologically superior to others can be described as

Select one:
1. Xenophobia
2. Scientology
3. Racism
4. Determinism
5. Right-centeredness

Answer 32

Racism

Racism refers to attitudes, beliefs, or behaviors that favour one group over another. The minority group
might be seen as biologically (innately) inferior and, therefore, practices involving their domination and
exploitation are justified.

Question 33

Best evidence base to decrease alcohol harm is

Select one:
1. Education of public about harm of alcohol
2. Interventions in drinking environments
3. Increasing the price of alcohol
4. Extending the times of sales
5. Media-advocacy

Answer 33

Increasing the price of alcohol

When other factors are held constant, such as income and the price of other goods, a rise in alcohol prices
leads to less alcohol consumption and vice versa. Price increases reduce the harms caused by alcohol and
can also indicate that heavier drinking has been reduced. Policies that increase alcohol prices delay the
initiation of drinking, slow young people’s progression towards drinking larger amounts and reduce heavy
drinking among them. Setting a minimum price per gram of alcohol can be as effective as an across- the board increase in tax, with both options costing heavy consumers far in excess of the cost to light consumers. Natural experiments in Europe consequent to economic treaties have shown that as alcohol
taxes and prices have gone down, so sales and alcohol consumption have usually increased. (From
Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm, WHO
2009).

Question 34

Which of the following describes the code of ethical recommendations used currently to guide clinical
research worldwide?

Select one:
1. Tuskegee code
2. GMC guidance
3. Mt Sinai declaration
4. Nuremburg Code
5. Helsinki declaration

Answer 34

Helsinki declaration

Helsinki declaration contains the current research ethics code in practice. The Helsinki Declaration adopted by the 18th World Medical Association General Assembly in 1964 and has been amended five times since, most recently in 2000. Notes of clarification were added in 2002 and 2004. The current (2004) version is the only official one. Currently since 2007 another revision has been initiated and consultation is open as of April 2008.

Question 35

Which of the following is NOT true concerning research ethics?

Select one:
1. Subjects can be recruited by contacting medical colleagues
2. Written approval must be obtained from ethics committees
3. Advertisements can be used to recruit subjects
4. Financial incentives can be offered for subjects to participate in research
5. A subject is ethically bound to complete a study after giving written informed consent

Answer 35

A subject is ethically bound to complete a study after giving written informed consent

Subjects, both healthy controls and patients, are reimbursed for their participation in research. But signing a consent form does not mean that they cannot discontinue the study during its course.

Question 36

A 20 years old immigrant Jamaican man develops schizophrenia. Which of the following is most likely to be true?

Select one:
1. His immigration is likely to be due to psychotic experiences
2. His parents are likely to be from a lower socioeconomic class compared to parents of native patients
3. He is likely to be poorly educated compared to native patients
4. He is likely to seek professional help early in the course of his illness
5. The risk of schizophrenia in his parents is likely to be similar to the risk in the parents of native patients

Answer 36

The risk of schizophrenia in his parents is likely to be similar to the risk in the parents of native patients.

Theories such as prepsychotic segregation have failed to explain the high rates of schizophrenia seen in
immigrants. The most acceptable notion at present is that this risk is mediated by social adversity faced by
immigrants.

Question 37

Which of the following is NOT a vulnerability factor for depression in Brown and Harris study?

Select one:
1. Having a long standing physical illness
2. Lack of employment outside home
3. Absence of a close confiding relationship
4. Loss of mother before age of 11
5. Having 3 or more children under 15 living at home

Answer 37

Having a long standing physical illness

Social and economic circumstances associated with the onset of depression in women living in inner urban
London were studied by Brown and Harris in 1978. They identified four vulnerability factors:
1. absence of a close confiding relationship;
2. loss of the mother before the age of 11;
3. lack of employment outside the home;
4. Having 3 or more children under 15 living at home.

Question 38

Which of the following describes an extreme anxiety symptom where a person thinks that his penis is
shrinking into his abdomen, and he may die as a result?

Select one:
1. Fag
2. Koro
3. Dhat
4. Amok
5. Latah

Answer 38

Koro

Koro is known as genital retraction syndrome. When affected, patients believe that their genitals will be
completely sucked into the body, causing death. While this condition occasionally occurs in women, it is
much more common in men. Koro is a considered a culture-bound syndrome, meaning that it only occurs in certain cultures and does not directly correspond with diseases or conditions recognised by Western
medicine. It is most common in China, Southeast Asia, and Malaysia, although outbreaks have occurred in
Africa as well. The condition tends to have a different name in every region. For example, the Chinese term
of ‘suo yang’ translates as ‘shrinking penis’.

Question 39

A clinician refuses to prescribe clozapine to an elderly lady with resistant schizophrenia as she had
developed neutropenia 13 years ago when it was first prescribed to her. Which of the following ethical
principle is maintained here?

Select one:
1. Non maleficience
2. Autonomy
3. Beneficience
4. Justice
5. Teleology

Answer 39

Non malificence

American philosophers Tom Beauchamp and James Childress and British doctor and philosopher Raanon
Gillon pioneered the following prima facie principles: Non-maleficence refers to avoiding harm (primum non
nocere).

Question 40

Which class of psychotropic medication are the most likely ones to impair driving performance?

Select one:
1. Antipsychotics
2. Psychostimulants
3. Mood stabilizers
4. Benzodiazepines
5. Antidepressants

Answer 40

Benzodiazepines

All drugs acting on the central nervous system can impair alertness, concentration and driving performance. This is particularly so at the initiation of treatment or soon after and when the dosage is being increased. Driving must cease if adversely affected.

Question 41

A West African student presents with lethargy, insomnia, palpitation and anxiety. Choose one culture-bound syndrome:

Select one:
1. Windigo
2. Dhat
3. Latah
4. Piblokto
5. Fag

Answer 41

Fag

The ‘brain fag’ syndrome, which was first reported from West Africa in 1960 among students, has been
shown to occur very widely in African students in western educational systems south of the Sahara. Seen predominantly in male students, it generally manifests as vague somatic symptoms, depression, and difficulty concentrating.

Question 42

Which of the following genetic changes have been shown to influence an individual’s response to stressful life events in terms of later depression?

Select one:
1. Prion protein polymorphisms
2. Serotonin transporter polymorphisms
3. CYP450 polymorphisms
4. COMT polymorphism
5. GABA B receptor polymorphisms

Answer 42

Serotonin transporter polymorphisms

Caspi demonstrated a link between 5HT polymorphisms and life events in depressive response.

Question 43

A Japanese man is afraid of going out with his friends as he is embarrassed about his bad body odour.
Despite repeated reassurances that he does not smell badly, he insists on being left alone. The most likely
diagnosis is

Select one:
1. Taijin-jikoshu-kyofu
2. Piblokto
3. Pa-Leng
4. Koro
5. Susto

Answer 43

Taijin-jikoshu-kyofu

Taijin refers to a fear of losing good will of others due to imagined shortcomings of oneself. Social anxiety,
tremulousness, self-consciousness and a sense of physical defect or deformity are seen; these can develop into anthropophobia (fear of people) - a severe form of social phobia.

Question 44

One year after losing her job of 15 years, a depressed woman gets another job but unfortunately within two
weeks she loses the new job. She feels ‘stuck in her life’. Which of the following category does this event
belong?

Select one:
1. Loss
2. Entrapment
3. Threat
4. Danger
5. Humiliation

Answer 44

Entrapment

Entrapment includes long-term sustained entrapment includes serious difficulties that can only get worse or
persist according to the subject; or a failed positive event where a potential fresh start went disastrously
wrong within 1-2 wk, leaving the person stuck in square one.

Question 45

A medical student is undertaking a clinical research project and is keen to know the ethical principles that
are widely implemented in medical practice. Choose the correct option:

Select one:
1. Duty of care and good will
2. Respect for autonomy, justice and confidentiality
3. Consent, confidentiality and capacity assessment.
4. Respect, justice and consent
5. Respect for autonomy, beneficence and justice

Answer 45

Respect for autonomy, beneficence and justice

American philosophers Tom Beauchamp and James Childress and British doctor & philosopher Raanon
Gillon pioneered the following prima facie principles: a) autonomy-respecting patients’ wishes and freedom
of choice
b) beneficence-acting in patients’ best interests
c) Non-maleficence-avoiding harm
d) Justice - treating problems equally, with equitable distribution of resources to the needy.

These four principles are the main guiding aspects of current medical practice, and most other related ethical discussions relevant to clinical practice can be brought under these four aspects.

Question 46

Which of the following increases the likelihood that a patient with a particular disease gets stigmatized?

Select one:
1. Disease is well concealable
2. Disease is thought to be inflicted by an external agent
3. Disease leads to disruption in social interactions
4. Disease elicits pity but no disgust in others
5. Disease is reversible

Answer 46

Disease leads to disruption in social interactions

Disruptiveness indicates the extent to which a disease strains or obstructs interpersonal interactions. The
degree of stigmatisation is directly proportional to the degree of disruption in social interaction produced by
the condition.

Question 47

A patient with paranoid schizophrenia was enraged at a shop and killed the shopkeeper. A forensic
psychiatrist who examined him feels that he needs psychiatric treatment. The court decides that he must be sentenced to prison. Which of the following ethical principle is closely related to the above scenario?

Select one:
1. Non-Maleficience
2. Distributive justice
3. Confidentiality
4. Utilitarianism
5. Paternalism

Answer 47

Utilitarianism

The strengths of utilitarianism lie in its practicality and clarity. It approximates the principle of ‘beneficence’
and fits well with approaches to public policy. Legislated responsibilities of psychiatrists, particularly in relation to issues of public safety, are invariably utilitarian in nature and have usually emerged in the context of social and political responses to issues such as public safety especially in relation to forensic patients.

Question 48

A young male doctor from India gets married and moves to the UK with his wife and his two kids. The
children are attending a primary school. His retired parents also join him soon after. Which of the following is true? (October 2008)

Select one:
1. No one can adjust to the change for next 5 years
2. The young couple will have the maximum difficulty in adjusting to change
3. The children will have the maximum difficulty in adjusting to change
4. The grandparents will have the maximum difficulty in adjusting to change
5. Everyone will adjusts with same degree of ease

Answer 48

The grandparents will have the maximum difficulty in adjusting to change

The elderly find it more challenging to acculturate when compared to the younger immigrants.

Question 49

Melting pot model refers to which of the following types of countries?

Select one:
1. Countries with increasing immigration trend
2. Countries with no immigration
3. Countries with zero population growth
4. Countries with high population attrition due to emigration
5. Countries with negative population growth

Answer 49

Countries with increasing immigration trend

The United States is often quoted as a Melting Pot of various immigrant societies.

Question 50

Which of the following is true with regards to Changing Minds campaign?

Select one:
1. It is not a part of Care Programme Approach
2. It provides a legal clause against stigma
3. It is an initiative from World Health Organisation
4. It is focussed on geriatric mental health issues
5. It is an ongoing programme against stigma

Answer 50

It is not a part of Care Programme Approach

Concern about the stigma of mental illness culminated in the Royal College of Psychiatrists’ 5-year
‘Changing Minds’ campaign (1998-2003) whose aim was to promote positive images of mental illness,
challenge misrepresentations and discrimination, encourage patient advocacy and educate the public about the real nature and treatability of mental disorder.

Question 51

A 40-year-old man received inpatient detoxification two weeks ago and since then has been staying away
from alcohol use. According to Prochaska’s model, which stage is he in?

Select one:
1. Maintenance
2. Action
3. Relapse
4. Contemplation
5. Precontemplation stage

Answer 51

Maintenance

The maintenance stage is the phase wherein the person strives to maintain gains made and while
attempting to improve those areas of life harmed by drug use.

Question 52

The four prima facie ethical principles were promulgated by

Select one:
1. Charaka
2. Beauchamp and Childress
3. Hippocrates
4. Galen
5. Aristotle

Answer 52

Beauchamp and Childress

The prima facie principles were promulgated by Beauchamp and Childress.

Question 53

The term total institution is associated with

Select one:
Szasz
Foucault
Thomas Hardy
Jacques Lacan
Goffmann

Answer 53

Goffman

A total institution is a place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life. The term was coined and defined by American sociologist Erving Goffman in his 1961 work Asylums.

Question 54

Institutional neurosis was described by

Select one:
Pavlov
Goffman
Barton
Parsons
Pilowsky

Answer 54

Barton

Russell Barton (1976) described ‘institutional neurosis’, characterized by symptoms such as apathy, lack of
initiative, loss of interest and submissiveness. Factors attributed to this state include loss of contact with the
outside world, enforced idleness, brutality and bossiness of staff, loss of friends and personal possessions, poor ward atmosphere and loss of prospects outside the institution.

Question 55

Which of the following is false with respect to Nuremburg code?

Select one:
1. Nuremburg is a place in Germany
2. Voluntary consent was upheld as a vital aspect of research
3. The code pertains to human research ethics
4. Tried Japanese doctors for unfair treatment of patients
5. It is related to World War 2

Answer 55

Tried Japanese doctors for unfair treatment of patients

Nuremburg code is related to the trial received by Nazi doctors after WWII.

Question 56

The phenomenon of relative deprivation is explained by
Select one:

1. Barthel index
2. Jarman index
3. Brian Index
4. Jasper Index
5. Haschinski index

Answer 56

Jarman index

A scoring system developed by the British general practitioner Brian Jarman for the level of social
deprivation in a community, using census data on percentages of old people living alone, single-parent
families, children younger than 5 years of age, unskilled and unemployed persons, ethnic minorities,
overcrowded dwellings, changes of address in previous year, etc. Although a valid indicator, it is not
generally accepted outside the United Kingdom.

Question 57

Mr. Brown is not feeling well and calls off sick at work. Which of the following behaviours, if expressed by
Mr.Brown under these circumstances would be regarded as abnormal?

Select one:
1. Extending absence from work when the illness continues
2. Taking self-blame for the illness
3. Complying with treatment as prescribed by the doctor
4. Not carrying out normal social roles
5. Seeking help from an internet doctor

Answer 57

Taking self-blame for the illness

The sick role is a concept described by the American sociologist Talcott Parsons. He defined the sick role as
having four chief characteristics.
1.The sick person is freed or exempted from carrying out normal social roles.
2. People who are sick are not directly responsible for their disease.
3. It is necessary that a sick person tries to get well.
4. The sick person must seek competent help and cooperate with medical care to get well.

Question 58

A 31-year-old woman of Inuit origin started becoming too excited for no apparent reason, taking her clothes
off and throwing her naked body into cold icy water. Which of the following is the most likely diagnosis?

Select one:
1. Amok
2. Tstsumu
3. Koro
4. Latah
5. Piblokto

Answer 58

Piblokto

Piblokto is seen in Arctic Eskimo communities. It is characterised by a dissociative episode with excitement often followed by seizures and coma lasting up to 12 hours. Patients may be withdrawn before the attack and usually has amnesia for the episode; they may tear off clothing, shout obscenities, eat faeces, and jump naked into ice cold water.

Question 59

A depressed 55-year-old man reports a high amount of adverse life events, but no positive events
preceding his first episode of depression. Which of the following explanation is NOT correct?

Select one:
1. His depression is probably due to absence of positive life events
2. Social adversity experienced from an event depends on contextual rating by the patient
3. Recurrent episodes have less preceding life events than the first episode
4. Stressful life events have established association with depressive disorder
5. He is recalling more stressful life events due to cognitive bias

Answer 59

His depression is probably due to absence of positive life events

Depressed patients may recall more stressful life events due to cognitive bias. It is shown that the
frequency of desirable (or entrance life events) was comparable in controls and the depressed population;
so the absence of positive events cannot be the simple explanation for depression. It is demonstrated that
those with a recurrent episode of depression have less preceding life events than those with a first episode
of depression. This may be related to kindling phenomenon.

Question 60

Which one among the following is classified under higher-level principle?

Select one:
1. Maleficence
2. Justice
3. Beneficience
4. Respect for autonomy
5. Best interests

Answer 60

Best interests

Higher level principles include Deontology (Rights and duties or Rules) and Teleology (practice based on
best interests / outcomes). The prima-facie principles (constituting the ethical principlism) are lower level
principles.

Question 60

What is the number of women that have been reported being amputated in the genital area?

Select one:
1. 10 million
2. 1 million
3. 100 million
4. 10000
5. 100, 000

Answer 60

100 million

WHO has estimated that 100 to 140 million girls and women worldwide are currently living with the
consequences of FGM.

Question 60

A patient refuses to have a nasogastric intubation after an overdose, and the A&E consultant feels this
procedure is potentially lifesaving and complies with expected standard of care. The best course of action is

Select one:
1. Refer the patient to a psychiatrist
2. Do not perform the procedure if the patient is determined to have the capacity to make this decision
3. Assume that the patient does not have the capacity to decide whether to have the procedure or not
4. Try repeatedly and convince the patient that the procedure is necessary until they eventually consent
5. Sedate the patient first and then carry out the procedure

Answer 60

Do not perform the procedure if the patient is determined to have the capacity to make this decision

Patients have the right to refuse medical care, even when it seems medically necessary to save their life.
The risks and benefits of accepting or refusing the procedure must be explained to and understood by the patient in order for them to make an informed decision about such a refusal. If they show good understanding of the risks and benefits, then they have the capacity to decide. Bullying them into changing their mind is inappropriate, although they should be made aware that the procedure will likely still be made available to them at a later date should they voluntarily change their mind about having it done. A psychiatry consult may be helpful in this case if there is concern that an underlying mental illness is affecting the patient’s judgment but is not necessary for determining the patient’s capacity to make this decision.

Question 61

In which of the following disorder an overrepresentation of higher social class is seen in brothers and children of the patients?

Select one:
1. Anorexia nervosa
2. Bipolar disorder
3. Alcoholism
4. Depressive disorder
5. Antisocial personality

Answer 61

Bipolar disorder

An overrepresentation is found in the higher occupational class in bipolar probands’ brothers and children. It is consistently noted that the family of origin in bipolar probands belong to a higher social class thought the patients themselves might be at a lower social class. A study (Tsuchiya et al. 2004) that examined the above phenomenon in two merged Danish registers had nearly 950 probands and 50 matched control for each case. The results of this study clearly showed that higher social class of parents together with longer paternal education history and larger possession of wealth increased the risk of bipolar disorder in the offspring. It is speculated that bipolar genes may offer some survival benefits such as excessive creativity or productivity which uplifts the families to higher social status.

Question 62

Which of the following ethical principles is not associated with Charaka?

Select one:
1. Compassion towards patients
2. Updating medical knowledge
3. Sympathy towards the sick
4. Maintaining medical records
5. Confidentiality

Answer 62

Maintaining medical records

Charaka promoted 4 Cs - confidentiality, caring practice, continuous professional development and
compassion.

Question 63

The term refrigerator mother is associated with which of the following mental illness?

Select one:
1. Autism
2. Panic disorder
3. Schizophrenia
4. ADHD
5. Depression

Answer 63

Autism

Mothers with autistic children were blamed to be ‘refrigerator mothers’ who ‘defrosted just enough to
produce a baby’ but remained emotionally cold, inflexible and lacking warmth in the parental relationship.

This theory has been widely discussed and refuted as no proof exists to support this claim.

Question 64

Which of the following is NOT a measure of expressed emotions?

Select one:
1. Critical comments
2. Positive comments and warmth
3. Emotional over involvement
4. Hostility
5. Social isolation

Answer 64

Social isolation

Expressed emotions concept was developed by Brown and Rutter in 1966 as a part of the Camberwell
Family Interview (audiotaped interview with a carer), and later modified by Vaughn and Leff in 1976. The
ratings were based on content and prosodic aspects and emphasis of speech. Five measures are
considered (including positive regard and emotional warmth); The final scores of emotional overinvolvement, critical comments and hostility were the most predictive measures for relapse.

Question 65

Which of the following statements is correct about abuse of children?

Select one:
1. Children with disabilities were less likely to be maltreated than children without disabilities
2. Boys are more likely to be the subject of sexual abuse
3. Girls are more likely to be the subject of physical abuse and are at a greater risk of physical injury
4. Abuse is inversely proportional to family size
5. People who were subjected to physical abuse in childhood are more likely to abuse their own children

Answer 65

People who were subjected to physical abuse in childhood are more likely to abuse their own children

About one-third of all individuals who were maltreated would subject their children to maltreatment. Children
with disabilities are 1.7 times more likely to be maltreated than children without disabilities. Girls are
sexually abused three times more often than boys. Boys are at a greater risk of serious injury and of
emotional neglect than are girls.

Question 66

The following are true in relation to the biopsychosocial model except

Select one:
1. It is based on the fact that each system is at the same time a component of higher system
2. The hierarchy and continuum of natural systems were discussed to explain biopsychosocial model
3. It is based on systems theory
4. It is similar to biomedical model
5. It was proposed by George Engel

Answer 66

It is similar to biomedical model

The biopsychosocial model is a systems theory-based explanation of disease models. It is not similar to the
biomedical model. Engel GL. The clinical application of the biopsychosocial model. Am J Psych May 1980;
137(5):535-44.

Question 67

A 40-year-old man has chest pain and dizziness but his blood tests and ECG are normal. He is advised to
take medications, fat-restricted diet, exercise. This is called

Select one:
1. Sick role
2. Illness
3. Depression
4. Worried well
5. Illness behaviour

Answer 67

Illness behaviour

The concept of illness behaviour was largely defined and adopted during the second half of the twentieth
century. Broadly speaking, it is any behavior undertaken by an individual who feels ill to relieve that
experience or to better define the meaning of the illness experience.

Question 68

The concept of schizophrenogenic-mother was proposed by

Select one:
1. Lidz
2. Fromm-Reichmann
3. Rutter
4. Bateson
5. Wynne

Answer 68

Fromm-Reichmann

The concept of schizophrenogenic-mother was coined by Freida Fromm-Reichmann. These mothers were
described to be ‘rejecting, impervious to the feelings of others, rigid in moralism concerning sex and had a
significant fear of intimacy’.

Question 69

A doctor carries out what is best for the patient, regardless of patient’s own wishes. This approach can be termed as

Select one:
1. utilitarianism
2. maternalism
3. paternalism
4. deontology
5. consequentialism

Answer 69

Paternalism

Paternalism is the interference with people’s liberties or autonomy with an argument that this is done “for
their own good.”

Question 70

In prematurely born infants, after which week of pregnancy are we legally able to resuscitate an infant
irrespective of parental wishes?

Select one:
1. 22 wks
2. 16 wks
3. 20 wks
4. 21 wks
5. 24 wks

Answer 70

24 weeks

In United Kingdom women have access to termination of pregnancy for maternal reasons until 24 weeks
completed gestation; so it is rational children born at or beyond 25 weeks gestation are treated according to
the child’s perceived best interests even if this is not in accordance with parental wishes. There is no
legislation imposing an age limit in UK for resuscitating premature babies as of now.

Question 71

Identify the study that is related to deliberately infected individuals with hepatitis

Select one:
1. ECA study
2. Willowbrook study
3. Isle of wight study
4. Belmont study
5. Tuskesse study

Answer 71

Willowbrook study

From 1963 through 1966, studies were carried out at the Willowbrook State School, a New York State
institution for “mentally defective persons.” These studies were designed to gain an understanding of the
natural history of infectious hepatitis and subsequently to test the effects of gamma globulin in preventing or ameliorating the disease. The subjects, all children, were deliberately infected with the hepatitis virus; early subjects were fed extracts of stools from infected individuals, and later subjects received injections of more purified virus preparations. Investigators defended the deliberate injection of these children by pointing out that the vast majority of them acquired the infection anyway while at Willowbrook, and perhaps it would be
better for them to be infected under carefully controlled research conditions.

During the course of these studies, Willowbrook closed its doors to new inmates, claiming overcrowded conditions. However, the hepatitis program, because it occupied its own space at the institution, was able to continue to admit new patients. Thus, in some cases, parents found that they were unable to admit their child to Willowbrook
unless they agreed to his or her participation in the studies. This case caused a public outcry because of
the perception that parents and their children were given little choice about whether or not to participate in research (Willowbrook Hepatitis Studies - Human Subjects Training,