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 o HiYield Paper A(2)SmartReviseA(2)HiYield Paper A(1) Mock Paper
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5. Paper A Mock Exam 10

Started on Monday, 24 June 2024, 12:36 AM

State Finished
Completed on Monday, 24 June 2024, 12:36 AM
Time taken 10 secs
Grade 0.00 out of 150.00 (0%)
Question 1
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How many episodes of mania and/or depression should be seen in 12 months time to
diagnose rapid cycling bipolar disorder?

Select one:
3
4
2
6
8
Feedback
Explanation:

‘Rapid cycling’ in bipolar disorder is defined as four or more episodes per year.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 328.

The correct answer is: 4

Question 2
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The Global Assessment of Functioning Scale is a rating scale measuring overall psychosocial
functioning. What is the maximum score in the GAF scale?

Select one:
7
100
10
60
80
Feedback
Explanation:

The Global Assessment of Functioning Scale (GAF) is a rating scale measuring overall
psychosocial functioning. The maximum score on the GAF is 100.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 96.

The correct answer is: 100

Question 3
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The term simple schizophrenia was added as to the categories of existing schizophrenias by

Select one:
Bleuler
Kraepelin
Hecker
Angst
Liddle
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Explanation:
In 1896, Emil Kraepelin described and separated the two major forms of insanity on the
basis of different symptoms, course, and outcome. The first, ‘manic-depressive insanity’, had
a relapsing and remitting course, with full recovery after each episode. The second grouped
together catatonia, hebephrenia, and the paranoid psychoses under the term ‘dementia
praecox’, which had a progressive, deteriorating course. Eugen Bleuler added ‘simple
schizophrenia’ to Kraepelin’s subtypes and did not consider hallucinations, delusions, and
catatonic symptoms to be necessary for the diagnosis. He believed the disorder to be due to
a ‘loosening of associations’ between psychic functions, with fundamental symptoms being
thought disorder, blunting/incongruity of affect, autism, and ambivalence.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 182.

The correct answer is: Bleuler

Question 4
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Which of the following is correct with regard to a diagnosis of post schizophrenic
depression?

Select one:
The patient must not have a previous history of depression
The patient must not be on any antipsychotic medication
Some positive symptoms must be present along with depression
It can be diagnosed only 12 months after the last psychotic episode
It is classified along with psychotic disorders
Feedback
Post-schizophrenic depression was a category in the prior version of ICD (ICD-10 F20.4)
where it was described as a type of schizophrenia along with other psychotic disorders.
While the general criteria for schizophrenia must have been met within the past twelve
months, they must not be met in full at present. But one of either positive/negative
symptoms/formal thought disorder/catatonia symptoms must be present. The depressive
symptoms must be sufficiently prolonged, severe and extensive to meet criteria for at least
a mild depressive episode. The patient may or may not be on treatment with antipsychotics
or antidepressants. Previous history of depression does not preclude a diagnosis. But
since ICD-11 has introduced a symptom specifier to replace the subtypes of schizophrenia.
These specifiers include positive, negative, depressive, manic, psychomotor and cognitive
deficits. A patient has to be constantly assessed for the presence or absence of these
specifiers, their longitudinal course, response to treatment and prognosis. The specifier's
clinical severity can vary between patients and in the same patient at different times.
Ref: Valle R. Schizophrenia in ICD-11: Comparison of ICD-10 and DSM-5. Revista de
Psiquiatría y Salud Mental (English Edition). 2020 Apr 1;13(2):95-104.

The correct answer is: It is classified along with psychotic disorders

Question 5
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Which of the following features seen in a person suffering from grief reaction 1 year after
the loss suggests depression?

Select one:
Mummification
Guilt regarding omission of care
Physical health problems
Preoccupation with the relative
Anniversary reaction
Feedback
Signs of difficulty in assimilating the loss vary from the slight (e.g., expecting the person to
return home from work and setting two places for dinner) to the extreme of mummification
(e.g., retaining a child's room exactly as it was on the day of death for years). These signs
may be harbingers of depression if they persist for more than one year. Mummification was
first described by Gorer in 1965.

The correct answer is: Mummification

Question 6
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In order to make a ICD-11 diagnosis of delusional disorder, the delusions must be present
for at least

Select one:
3 days
1 month
6 months
2 weeks
3 months
Feedback
Explanation:

Delusional disorder is characterised by the development of a delusion or set of related

delusions, typically persisting for at least 3 months and often much longer, in the absence of
a depressive, manic, or mixed mood episode. The delusions are variable in content across
individuals, but typically stable within individuals, although they may evolve over time. Other
characteristic symptoms of schizophrenia (i.e. clear and persistent hallucinations, negative
symptoms, disorganised thinking, or experiences of influence, passivity, or control) are not
present, although various forms of perceptual disturbances (e.g. hallucinations, illusions,
misidentification of persons) thematically related to the delusion are still consistent with the
diagnosis. Apart from actions and attitudes directly related to the delusion or delusional
system, affect, speech, and behaviour are typically unaffected.

Ref: International Statistical Classification of Diseases and Related Health Problems

(11th ed. ICD-11; World Health Organization, 2020)

The correct answer is: 3 months

Question 7
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The most common co-morbid psychiatric condition associated with panic disorder is

Select one:
Alcohol use disorder

Schizophrenia
Agoraphobia
Borderline personality disorder
Social phobia
Feedback
Explanation:

Common comorbidities with panic disorder include agoraphobia (community surveys: 30-50%;
psychiatric clinics: 75%), depressive disorder (anywhere from 40-80% of all patients, as estimated
by various studies), other anxiety and related disorders (up to 50%, e.g. social phobia, specific
phobia), alcohol (up to 30%) and other substance use disorders, and bipolar disorder (20%). Some
medical conditions also share comorbidity with panic disorder (COPD, irritable bowel syndrome,
migraine, mitral valve prolapse, hypertension, cardiomyopathy, stroke).
Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 369.

Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p. 406.

The correct answer is: Agoraphobia

Question 8
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A person drinks alcohol as soon as he wakes up in the morning. During working hours, he
again drinks in the lunch time and after getting home he needs to have at least 6 units of
alcohol. His behaviour is best described as

Select one:
Compulsive behaviour
Alcohol dependence
Rumination
Impulsivity
Obsessions
Feedback
Explanation:

Alcohol dependence is characterised by harmful use of alcohol and an established

dependence syndrome. Usually this includes a daily stereotyped drinking pattern, with
increased tolerance, withdrawal features on abstinence, and ‘relief drinking’ (i.e. further
drinking to alleviate the effects of withdrawals).

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 600.

The correct answer is: Alcohol dependence

Question 9
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Which of the following enzymes is the most sensitive marker of thiamine deficiency?
Select one:
Alcohol dehydrogenase
Lactate dehydrogenase
Transketolase
Aldehyde dehydrogenase
Alpha ketoglutarate
Feedback
Explanation:

Thiamine is an essential nutrient required by all tissues for the assembly and efficient
functioning of different enzymes involved in the utilisation of carbohydrates for cellular
function. Both the neurons and glial cells in the brain are affected by thiamine deficiency
and have been implicated in the development of Wernicke encephalopathy as well as other
forms of alcohol-related brain injury. Thiamine is metabolised by the liver to its biologically
active form thiamine pyrophosphate (TPP). TPP is a vital co-enzyme involved in carbohydrate
metabolism, and deficiency of thiamine can lead to decreased functioning of enzymes
involved in the tricarboxylic acid cycle, pentose phosphate pathway (transketolase), and
branched-chain amino acid metabolism. Transketolase is the most sensitive marker of
thiamine deficiency; its activity can be reduced by up to 90% in areas of the brain that have a
high sensitivity to thiamine levels. A decline in transketolase is correlated with the
development of ataxia.

ef: Chandrakumar A et al. Review of thiamine deficiency disorders: Wernicke

encephalopathy and Korsakoff psychosis. Journal of basic and clinical physiology and
pharmacology. 2019 Mar 1;30(2):153-62.

The correct answer is: Transketolase

Question 10
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Length of time cannabis can be detected in the urine of a person who has used it only once
is

Select one:
3 months
24 hours
1 month
7 days
3 days
Feedback
Explanation:

Single use of cannabis can be detected in the urine for 3 days. With chronic, heavy use, it can
be detected for up to one month.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 631.

The correct answer is: 3 days

Question 11
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Which of the following reflexes may NOT be exaggerated in upper motor neuron lesions?

Select one:
Abdominal reflex
Ankle jerk reflex
Biceps reflex
Knee jerk reflex
Jaw jerk reflex
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Deep tendon reflexes are exaggerated. Abdominal reflex is not a deep tendon reflex; it is a
superficial reflex.

The correct answer is: Abdominal reflex

Question 12
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Which of the following syndromes is named after the person who initially described them?

Select one:
Othello syndrome
Fregoli syndrome
Munchaussen syndrome
Rabbit syndrome
Cotard syndrome
Feedback
Explanation:

Cotard syndrome is a presentation of psychotic depressive illness seen particularly in elderly

people. There is a combination of severely depressed mood with nihilistic delusions and/or
hypochondriacal delusions. The patient may state that they are already dead and should be
buried, that their insides have stopped working and are rotting away, or that they have
stopped existing altogether. It is named after the French neurologist Jules Cotard, who first
described it in 1880.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 105.

Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: Cotard syndrome

Question 13
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Which of the following is the most important discriminating feature between mild cognitive
impairment and dementia?

Select one:
Educational attainment
Duration of symptoms of memory disturbances
Family history of Alzheimer
Activities of daily living
MMSE score
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Explanation:

Mild cognitive impairment (MCI) represents the preclinical, transitional stage between
healthy ageing and dementia. MCI is separated from mild dementia by an absence of global
intellectual deterioration and the preservation of activities of daily living (ADL). Recent
clinical guidelines on MCI put forth by the National Institute on Aging-Alzheimer Association
(NIA-AA) are as follows:

1.Concern regarding a change in cognition, from the patient, an informant, or a skilled

clinician
2.Impairment in one or more cognitive domain(s) relative to a person’s age and educational
attainment

3.Independence in functional abilities/activities of daily living (although they may take more
time or be performed less efficiently)

4.Not demented

Ref: Anderson ND. State of the science on mild cognitive impairment (MCI). CNS spectrums.
2019 Feb;24(1):78-87.

The correct answer is: Activities of daily living

Question 14
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You are interviewing a newly admitted patient in your ward. When asked what he had for
breakfast, he says 'cereals'. Then when you asked 'what is your name?' he says 'cereals'.
When you asked 'what is his date of birth?' he continues to say 'cereals'. The most likely
symptom exhibited here is

Select one:
Mannerism
Automatism
Perseveration
Stuttering
Stereotypy
Feedback
Explanation:

Perseveration is characterised by continuing with a verbal response or action that was

initially appropriate after it ceases to be apposite. It is associated with organic brain disease
and is occasionally seen in schizophrenia.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 115.

The correct answer is: Perseveration

Question 15
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Which one of the following is best suited for a detailed assessment of global cognitive
functioning?

Select one:
Mini-COG
Clock drawing test
MMSE
Montreal cognitive assessment guide
Addenbrooke's cognitive examination
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Explanation:

When time permits, or the clinical presentation is more complex, the Addenbrooke’s
Cognitive Examination (3rd edition) (ACE-III) provides a more detailed, 100-item, clinician-
administered bedside test of cognitive function. Questions cover five areas of function:
attention and orientation, memory, verbal fluency, language, and visuospatial awareness.
The ACE-III has a reported sensitivity of 94% and a specificity of 89% for dementia, with a
cut-off score of 88/100.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 86.

The correct answer is: Addenbrooke's cognitive examination

Question 16
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Which of the following is not a feature of Kubler-Ross model of grief?

Select one:
Agitation
Bargaining
Denial
Depression
Acceptance
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Explanation:
Elisabeth Kubler-Ross, a psychiatrist and thanatologist, made a comprehensive and useful
organisation of reactions to impending death. She proposed the following five stages (which
can be remembered using the acronym DABDA):

Stage 1: Shock and Denial

Stage 2: Anger

Stage 3: Bargaining

Stage 4: Depression

Stage 5: Acceptance

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
847.

The correct answer is: Agitation

Question 17
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Inability to verbalize one's strong emotions is termed as

Select one:
Anhedonia
Avolition
Apathy
Ambivalence
Alexithymia
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Explanation:

Alexithymia is the inability to describe one’s subjective emotional experiences verbally. It

may be a personality characteristic but is also associated with somatisation.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 102.

The correct answer is: Alexithymia

Question 18
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Which of the following may indicate poor response to psychotherapeutic interventions?

Select one:
alexithymia
insomnia
apraxia
anhedonia
amnesia
Feedback
Explanation:

The literature shows that alexithymia is a potent predictor of resistance to treatment.

Available data tend largely to correlate low baseline, and/or post-treatment of levels of
alexithymia, and/or improvement in levels of alexithymia over the course of treatment, with
a more favourable outcome of therapeutic interventions in several mental disorders.
However, the presence of numerous discordant findings prevents any firm conclusions as to
the actual impact produced by alexithymia on the treatment of psychiatric disorders both in
general and in specific diagnostic groups.

Ref: Pinna F et al. The impact of alexithymia on treatment response in psychiatric disorders:
a systematic review. Frontiers in psychiatry. 2020 Apr 16;11:311.

The correct answer is: alexithymia

Question 19
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A patient with schizophrenia protrudes his tongue repeatedly in and out when asked to do it
once. He is exhibiting which of the following symptoms?

Select one:
Chorea
Stereotypy
Ambivalence
Hemiballism
Ambitendency
Feedback
Explanation:

Ambitendency can be regarded as a mild variety of negativism. Some consider this as an

alternating mixture of automatic obedience and negativism. The presence of opposing
tendencies for motor acts may also be regarded as a 'motor' form of ambivalence. The
patient appears to be in conflict with opposing tendencies to action resulting in a 'jack in the
box' feature of catatonia.

In ambitendency, the patient makes a series of tentative movements that do not reach the
intended goal when they are expected to carry out a voluntary action. For example, when the
examiner puts his hand out to shake hands, the patient moves their hand towards the examiner’s
hand, stops, starts moving the hand, stops, and so on, until the hand finally comes to rest without
touching the examiner’s hand.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 102.

Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4th Edition. 2019.
p. 95.

The correct answer is: Ambitendency

Question 20
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Ben is worried that he has to shout 'Willy Wonka' whenever he sees an attractive woman,
despite his best efforts to keep calm. This is best termed as

Select one:
A first rank symptom of schizophrenia
A mental compulsion
An obsessional impulse
Somatic passivity
A made act
Feedback
Explanation:

The essential feature of an obsession is that it appears against the patient’s will. It naturally
follows that we can only call a mental event an obsession if it is normally under the control
of the patient and can be resisted by the patient. Thus, we have obsessional mental images,
ideas, fears, and impulses, but not obsessional hallucinations or moods. Obsessional
impulses may be impulses to touch, count or arrange objects, or impulses to commit
antisocial acts. It is generally unusual for the patient to carry out an obsessive impulse.

Ref: Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4 th Edition.
2019. p. 46.

The correct answer is: An obsessional impulse

Question 21
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Mr Y has a cardiac arrest. He is in the resuscitation room and experiences seeing himself
outside of his body. This experience is called

Select one:
Somatic hallucination
Lilliputian hallucination
Reflex hallucination
Autoscopic hallucination
Extracampine hallucination
Feedback
Explanation:

Autoscopy (also known as ‘phantom mirror image’) is the experience of seeing a visual
hallucination or pseudo-hallucination of oneself. The cause of autoscopic phenomenon is
unknown, but a biological hypothesis is that abnormal, episodic activity in areas of the
temporoparietal lobes is involved with the sense of self, perhaps combined with abnormal
activity in parts of the visual cortex. It is an uncommon symptom reported in epilepsy, focal
lesions/tumours (particularly in the parieto-occipital region), toxic infective states,
schizophrenia, depression, anxiety, and dissociative disorders. Near-death experiences
often involve an out-of-body experience of viewing one’s own body (autoscopy) and
overhearing conversations, feelings of peace, hearing a distant voice, entering a dark tunnel,
leaving the body behind, meeting dead loved ones, witnessing beings of light, returning to
life to complete unfinished business, and deep sadness on leaving this new dimension.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 103.

Anzellotti F et al. Autoscopic phenomena: case report and review of literature. Behavioral
and Brain Functions. 2011 Dec;7(1):1-1.
Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4th Edition. 2019.
p. 36.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
848.

The correct answer is: Autoscopic hallucination

Question 22
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On listening to a joke shared by a friend, a woman loses her muscle tone and collapses
suddenly. This is described as

Select one:
Drop attacks
Cataplexy
Syncope
Catatonia
Catalepsy
Feedback
Explanation:

Cataplexy is a sudden loss of muscle tone during wakefulness that is evoked by strong,
mainly positive, emotions. It is often seen in narcolepsy. The clinical manifestations are
varied, ranging from involuntary eye closure and neck weakness to a subtle buckling of the
knees to generalized muscle weakness that causes the patient to collapse. Consciousness
and awareness of the environment are preserved throughout the episode.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 104.

Kornum BR et al. Narcolepsy. Nature reviews Disease primers. 2017 Feb 9;3(1):1-9.

The correct answer is: Cataplexy

Question 23
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With regard to the psychology of attention, all of the following are correct except

Select one:
Focused attention is modality specific
Sustained attention refers to vigilance
Divided attention is the ability to attend to multiple task demands
Alternating attention is the highest form of attention
Shadowing is a test for selective attention
Feedback
Sohlberg and Mateer proposed a hierarchic model based on the recovering of attention
processes of brain-damaged patients when coming out of a coma. 1. Focused attention: The
ability to respond discretely to specific visual, auditory or tactile stimuli. This is the most
primitive form of attention 2. Sustained attention (vigilance): The ability to maintain a
consistent behavioral response during continuous and repetitive activity. 3. Selective
attention: The ability to maintain a behavioral or cognitive set in the face of distracting or
competing stimuli. Shadowing is a test for selective attention in which simultaneously two
different inputs are provided, one to each ear, and the subject is required to 'shadow' or
follow one of the inputs. 4. Alternating attention: The ability of mental flexibility that allows
individuals to shift their focus of attention and move between tasks having different
cognitive requirements. 5. Divided attention: This is the highest level of attention, and it
refers to the ability to respond simultaneously to multiple tasks or multiple task demands. In
dual-task technique which tests divided attention, the subject is asked to attend to both
inputs in an attempt to divide attention. Thus the ability to attend to multiple task demands
is tested.

The correct answer is: Alternating attention is the highest form of attention

Question 24
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Cognitive theory suggests the following as the underlying factor for anxiety disorders:

Select one:
Somatisation
Catastrophisation
Nihilism
Depersonalisation
Personalisation
Feedback
The term catastrophizing was used by Albert Ellis, the founder of rational-emotional therapy,
almost four decades ago. Catastrophizing is related to anxiety (e.g., anxiety is associated
with the tendency to overemphasize the probability of a catastrophic outcome and the
possible consequences of such an outcome). During the past decade, cognitive models of
panic disorder have emphasized the role of catastrophizing in panic attacks (Retrieved from
http://journals.lww.com/clinicalpain/Fulltext/2001/03000)

The correct answer is: Catastrophisation

Question 25
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Visual or iconic stimuli in immediate memory lasts for

Select one:
20-30 minutes
0.5 seconds
2-3 seconds
20-30 seconds
0.05 seconds
Feedback
Explanation:

Iconic memory (or iconic store) is one of the sensory registers, allowing a visual image to
persist for about half a second (depending on brightness) after a stimulus has ceased. It
enables television, which presents 25 still images per second, each given twice to raise the
flicker rate to 50 per second, to convey the illusion of a single continuous image which can
be perceived as a moving image.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: 0.5 seconds

Question 26
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Which one of the following is an example of non homeostatic motives?

Select one:
Thirst
Temperature control
Achievement
Hunger
All of the listed options
Feedback
There are two types of motivating forces; homeostatic and non homeostatic. Homeostatic
motives arise from physiological needs such as thirst, hunger and temperature control and
are concerned with basic survival. Non homeostatic motives refer to psychological drives
such as curiosity, adventure, achievement, etc.

The correct answer is: Achievement

Question 27
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Perceptual constancy can be demonstrated for

Select one:
Location
Size
Brightness constancies
Colour
All of the listed options
Feedback
Perceptual constancy: It refers to the ability to perceive the appearance of objects as
constant, even though, their retinal images keep changing. It includes several components:
size, shape, colour, location and brightness constancies.

The correct answer is: All of the listed options

Question 28
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One of the local newspaper reports that drug addicts carry out muggings. An 83-year-old
lady was mugged and the public concluded the attacker was a drug addict. Select the
cognitive heuristic in this case.

Select one:
Framing
Availability
Simulation
Representation
Anchoring
Feedback
Explanation:

A heuristic is a rough-and-ready procedure or rule of thumb for making a decision, forming

a judgement, or solving a problem without the application of an algorithm or an exhaustive
comparison of all available options, and hence without any guarantee of obtaining a correct
or optimal result. The availability heuristic is a cognitive heuristic through which the
frequency or probability of an event is judged by the number of instances of it that can be
readily brought to mind. It can generate biased or incorrect judgements.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015

The correct answer is: Availability

Question 29
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In a program aimed at cessation of smoking, a 45-year-old woman is required to smoke
many cigarettes in a small booth and over a short period of time. What is the process that is
employed in this approach?

Select one:
Aversive conditioning
Stimulus control
Systematic desensitisation
Variable ratio reinforcement
Habituation
Feedback
Explanation:

Aversive smoking has been investigated as a smoking cessation technique that involves
rapid smoking in a clinic or laboratory. It consists of smoking rapidly to produce an
unpleasant syndrome that becomes a conditioned response to smoking and might help the
individual stop smoking. However, existing studies have provided insufficient evidence to
determine the efficacy of rapid smoking. Its practice has been mostly abandoned.
Ref: Hajek P, Stead LF. Aversive smoking for smoking cessation. Cochrane Database of
Systematic Reviews. 2001(3).

Williams JM et al. Rapid smoking may not be aversive in schizophrenia. Nicotine & Tobacco
Research. 2012 Feb 7;15(1):262-6.

The correct answer is: Aversive conditioning

Question 30
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A rat in the cage initially got electric shocks whenever goes to a particular area of the cage.
Now it stays in electric shock free area. What is the learning process involved?

Select one:
Avoidance conditioning
Classical conditioning
Reciprocal inhibition
Shaping
Higher order conditioning
Feedback
Explanation:

In operant conditioning, avoidance conditioning is a form of negative reinforcement in which

an organism avoids an aversive stimulus by making a particular response. Typically, a rat is
placed in a long, narrow alleyway with a grid floor that become electrified and delivers a
shock a few seconds after the presentation of a conditioned stimulus such as a light, and the
rat can avoid the painful stimulation by running to the end of the alley and stepping into a
non-electrified goal box in the time interval between the signal and the shock.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015

The correct answer is: Avoidance conditioning

Question 31
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A forensic investigator tries to reconstruct the crime scene and encourages visits to scene of
crime by witnesses. Which recall phenomenon is replicated in this study?

Select one:
Blocking
Failure of prospective memory
Encoding failure
State dependent memory
Context dependent memory
Feedback
Explanation:

Context-dependent memory is a form of state-dependent memory associated with the

context in which information is learned and recalled. In a frequently-cited British experiment
on context-dependent memory, lists of words that were learned by divers while they were
underwater were best recalled when they were again underwater, and conversely words
learned on land were best recalled on land. This phenomenon has been useful particularly
in crime detection. Reconstructing the crime scene and visits to scenes of crime has been
found to be effective in triggering recall of details of the crime. Similarly, returning to a
childhood home village/ town or old school/college brings long forgotten memories flooding
back. It is sometimes not even necessary to visit a place to evoke memories but simply
imagining the place or situation may be sufficient to retrieve a flood of memories.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: Context dependent memory

Question 32
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Which of the following is a test that primarily measures sustained attention?

Select one:
Tower of London test
Wisconsin card sorting test
Rey verbal learning test
Continuous performance test
Trail making test B
Feedback
Explanation:
Continuous performance tasks are used to measure individual differences in sustained
attention. The task is conceptualised as a measure of both selective and sustained attention,
though to a lesser degree it may also gauge aspects of impulsivity. It is based on a simple
go-no go design, but many variants of it have been described. Sustained attention is the
ability to maintain a consistent focus on some continuous activity or stimuli and is
associated with impulsivity. Selective attention is the ability to focus on relevant stimuli and
ignore competing stimuli.

Ref: Roebuck H et al. Continuous performance tasks: Not just about sustaining attention.
Journal of speech, language, and hearing research. 2016 Jun;59(3):501-10.

The correct answer is: Continuous performance test

Question 33
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A person with a fear of heights takes to parachute jumping for a hobby. This is best
described as

Select one:
Counterphobic behaviour
Reciprocal inhibition
Desensitisation
reaction formation
Projection
Feedback
Counterphobic behaviour is any behavior that seeks out experiences that are consciously or
unconsciously feared in an attempt to master those fears. An example would be parachute
jumping for a person with a fear of heights.

The correct answer is: Counterphobic behaviour

Question 34
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Fundamental attribution error refers to

Select one:
Attributing personal factors for one's own behaviours
Attributing external factors for others' behaviours
Failure to make attributions for observed behaviours
Attributing personal factors for others' behaviours
Attributing external factors for one's own behaviours
Feedback
Explanation:

Fundamental attribution error is a pervasive tendency to underestimate the importance of

external situational pressures and to overestimate the importance of internal motives and
dispositions in interpreting the behaviour of others.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: Attributing personal factors for others' behaviours

Question 35
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According to Allport, the denial of opportunity to the minority group due to the majority
group practicing their prejudice is termed as

Select one:
Avoidance
Discrimination
Antilocution
Physical attack
Extermination
Feedback
Allport identified the following processes operating during conflicts between the minority
and the majority: 1. Antilocution 2. Avoidance 3. Discrimination: Minority group is
discriminated against by denying them opportunity and equality. 4. Physical attack 5.
Extermination.

The correct answer is: Discrimination

Question 36
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Which of the following is NOT true with regard to research ethics?

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

The correct answer is: A subject is ethically bound to complete a study after giving written
informed consent

Question 37
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Which of the following is true with regard to aetiological theories of suicide?

Select one:
Sensational media reports of suicide reduce acute risk of suicide
Serotonin receptor binding is decreased in suicidal patients
The stressors in the stress-diathesis model can include genetic factors, physical illness or
childhood experiences
Serotonin transporter binding is increased in suicidal patients
Durkheim proposed social models of suicide
Feedback
Explanation:

Emile Durkheim, in his book Suicide, used survey data purporting to show that egoistic
suicide, resulting from feelings of self-reproach and sense of failure, arises from a lack of
social cohesion; that altruistic suicide, carried out for the benefit of others, arises from a
sense of failure to society; and that anomic suicide, arising from a sense that life is pointless,
arises from an absence of social norms that he called anomie.

According to stress-diathesis model, a typical stressor includes the acute worsening of a

psychiatric disorder or an acute psychosocial crisis. Pessimism and aggression/impulsivity
are components of the diathesis for suicidal behaviour; sex, religion, familial/genetic factors,
childhood experiences and various other factors influence this diathesis. In the prefrontal
cortex of people who committed suicide, serotonin transporter binding was decreased but
serotonin receptor binding was increased. Mann (2003). Nature Reviews Neuroscience 4,
819-828.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: Durkheim proposed social models of suicide

Question 38
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A patient is has decided to stop alcohol use and is accepting the need for a positive change,
though she has not taken any steps yet. According to Prochaska and DiClemente she in the
stage of

Select one:
Precontemplation
Action
Preparation
Maintenance
Acting out
Feedback
Explanation:

Six stages of change:

(1) Precontemplation: not even considering changing behaviour; does not see the
behaviour as a problem, minimizes and denies associated risks, and avoids information to
the contrary

(2) Contemplation: has become aware that the behaviour is a problem but is ambivalent
about changing, and likely sees equal or more benefits than costs from the behaviour

(3) Preparation: has made a decision to attempt change

(4) Action: has implemented a plan and is changing the behaviour

(5) Maintenance: maintaining gains made and attempting to improve areas of life that have
been harmed
(6) Relapse: return to previous behaviour, but with the possibility of gaining useful
strategies to extend the maintenance period on the next attempt

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 575.

The correct answer is: Preparation

Question 39
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How many women and girls alive today have been subjected to female genital mutilation?

Select one:
1 million
10 millions
100 millions
100, 000
10000
Feedback
Explanation:

At least 200 million girls and women alive today have been cut in 30 countries in Africa, the
Middle East, and Asia where female genital mutilation (FGM) is concentrated. FGM involves
the partial or total removal of external female genitalia or other injury to the female genital
organs for non-medical reasons. The practice has no health benefits for girls and women
and is a violation of human rights.

Ref: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation

The correct answer is: 100 millions

Question 40
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Schizophrenic patients were more likely to relapse if discharged to families exhibiting 'high
expressed' emotion for more than:
Select one:
55 hours per week
35 hours per week
15 hours per week
24 hours per week
45 hours per week
Feedback
Explanation:

Brown et al in 1962 found that schizophrenic patients were more likely to relapse if
discharged to families exhibiting high expressed emotion (hostility, critical comments and
emotional over-involvement) especially if they were exposed to these families for more than
35 hours per week.

Expressed emotion (EE) is a construct that reflects potentially problematic aspects of the
family environment, particularly for people with psychiatric disorder. EE is a measure of how
critical, hostile, or overly involved a family member is toward an identified patient and it is
thought to represent relational disturbances and transactional patterns between the family
member and that patient. Individuals with schizophrenia appear to be at elevated risk for
relapse if they live in family environments characterised by high levels of EE. The original EE-
relapse link research involved three major criteria: (1) patients who have schizophrenia, (2)
the Camberwell Family Interview used as the method of assessing for EE, and (3) a relapse
period of nine to twelve months.

Ref: Weintraub MJ et al. Integrity of literature on expressed emotion and relapse in patients
with schizophrenia verified by ap‐curve analysis. Family process. 2017 Jun;56(2):436-44.

The correct answer is: 35 hours per week

Question 41
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All of the following are potential boundary violations between a therapist and a patient
except

Select one:
A private therapist expecting payment for each session of therapy
A therapist colludes with a patient against a third party
A clinician accepts gifts from one patient but not others
Influencing patient for political causes
A clinician tries to be impressive often by disclosing personal information
Feedback
If the therapist expects all patients to pay for each session, then he may not be violating any
boundaries by asking a patient do so.

The correct answer is: A private therapist expecting payment for each session of therapy

Question 42
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Which of the following is true regarding the association of socioeconomic status (SES) with
dementia?

Select one:
Factors explaining socioeconomic inequalities in dementia risk are well understood
Low SES is a barrier in facilitating behaviours that might prevent dementia
Socioeconomic differences in dementia risk are explained by genetic factors
People with high socioeconomic status are at higher risk for dementia
There is no association between socioeconomic status and dementia
Feedback
Explanation:

Differences in dementia risk across the gradient of socioeconomic status (SES) exist, but
their determinants are not well understood. Social determinants of health, such as income,
education, housing quality, and employment, are associated with disparities in Alzheimer
disease and health generally. Low SES has been identified as one of the key barriers in
facilitating healthy behaviour in midlife in order to prevent dementia in late-life. Several
mechanisms can account for this observation. Low SES has been associated with low health
literacy, less access to health resources and proper medical care, and poor health
behaviours and health outcomes, some of which are related to increased risk of cognitive
decline or dementia.

Ref: Powell WR et al. Association of neighborhood-level disadvantage with Alzheimer disease

neuropathology. JAMA network open. 2020 Jun 1;3(6):e207559-.

Deckers K et al. Modifiable risk factors explain socioeconomic inequalities in dementia risk:
evidence from a population-based prospective cohort study. Journal of Alzheimer's Disease.
2019 Jan 1;71(2):549-57.

The correct answer is: Low SES is a barrier in facilitating behaviours that might prevent
dementia

Question 43
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Who proposed theories on cognitive development?

Select one:
Sullivan
Ainsworth
Munroe
Piaget
Fromm
Feedback
Explanation:

Swiss psychologist Jean Piaget created a broad theoretical system for the development of
cognitive abilities. He emphasised how children think and acquire knowledge.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
1007.

The correct answer is: Piaget

Question 44
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Which of the following is a normal stage of grief, according to Lindemann?

Select one:
Mourning
Protest
Acting Out
Ambivalence
Bargaining
Feedback
The classic work on stages of grief came from Erich Lindemann at Massachusetts General
Hospital, who studied 101 bereaved people. He wrote an article, published in 1944, titled
'Symptomology and Management of Acute Grief.' In this article he described a set pattern:
After an unexpected death, there is an initial shock that lasts 10-14 days. After the initial
shock comes a period of intense sadness, and the grieving person may withdraw from social
contact. Next comes anger, as the grieving person seems to 'protest' the unexpected death.
Finally, within a year or so, the grief is resolved, and the person returns to normal.

The correct answer is: Protest

Question 45
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Which period refers to the autistic phase of Mahler's stages of early development?

Select one:
6-36 months
0-2 months
2-6 months
6-12 months
12-24 months
Feedback
Explanation:

Margaret Mahler proposed a theory to describe how young children acquire a sense of
identity separate from that of their mothers’. The first stage is ‘normal autism’ from birth to
2 months. In this stage, periods of sleep outweigh periods of arousal in a state reminiscent
of intrauterine life.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022.
pp. 892-893.

The correct answer is: 0-2 months

Question 46
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The annual incidence of tardive dyskinesia in patients with chronic schizophrenia who are
on any antipsychotic treatment is

Select one:
4%
3%
10%
1%
20%
Feedback
Explanation:

The cumulative incidence of tardive dyskinesia is about 4% to 5% annually; the prevalence

rate is 20% to 30% (Caroff, 2019). Thus, of 100 patients started on antipsychotics, four would
have some manifestations of tardive dyskinesia at the end of 1 year. That rate increases
after the second or third year. The risk is lower for second-generation antipsychotics (0.8%,
with range=0.0%-1.5% in adults and 5.3% in patients aged 54 years and older) compared to
5.4% in adults treated with haloperidol.

Ref: Caroff SN. Overcoming barriers to effective management of tardive dyskinesia.

Neuropsychiatric disease and treatment. 2019;15:785.

The correct answer is: 4%

Question 47
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The risk of fetal malformations with sodium valproate is approximately

Select one:
10%
28%
1%
70%
90%
Feedback
Explanation:

Valproate is associated with strong evidence for increased risk of congenital and major
congenital malformations (as many as 11% of exposed children); cleft lip and/or palate, neural
tube defects (risk of spina bifida 1-2%), congenital heart anomalies, radial ray defects,
ophthalmological and genitourinary anomalies; developmental delay (delayed walking and
talking, memory problems, difficulty with speech and language), low IQ, and autism. This risk
increases with increasing doses of valproic acid, especially when the dose is more than
1gm/day.
Ref: McAllister-Williams RH et al. British Association for Psychopharmacology consensus
guidance on the use of psychotropic medication preconception, in pregnancy and
postpartum 2017. Journal of Psychopharmacology. 2017 May;31(5):519-52.

National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health:
clinical management and service guide. Updated edition 2020.

Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th
Edition. 2021. pp. 690-691.

The correct answer is: 10%

Question 48
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What percentage of patients on clozapine develop agranulocytosis during the first year of
treatment?

Select one:
15 percent
10 percent
5 percent
1 percent
20 percent
Feedback
Explanation:

Multiple studies have found that agranulocytosis develops in approximately 0.8% of

clozapine-treated patients in the first year.

Ref: Mijovic A, MacCabe JH. Clozapine-induced agranulocytosis. Annals of Hematology. 2020

Aug 20:1-6.

The correct answer is: 1 percent

Question 49
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The average age of the start of puberty in boys is

Select one:
11-12 years
10-11 years
8-9 years
9-10 years
14-15 years
Feedback
Explanation:

In the UK, the average age for boys to begin puberty is 12 years. For girls, it is 11 years.

Ref: https://www.nhs.uk/live-well/sexual-health/stages-of-puberty-what-happens-to-boys-
and-girls/

The correct answer is: 11-12 years

Question 50
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The strange-situation study of attachment was carried out on

Select one:
Children aged 6-9 years
Infants between 1-6 months
Newborn babies
Toddlers
Children aged 12-24 months
Feedback
Explanation:

Mary Ainsworth devised the Strange Situation procedure with 12- to 18-month infants,
which categorised infant-parent relationships. The procedure involves separations and
reunions with caregivers and observes response. It has three phases with the infant's
reactions being noted in each of the phases: 1. Reaction to a stranger in the presence of the
mother 2. Reaction when left alone with a stranger 3. Reaction when reunited with the
mother.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 658.
The correct answer is: Children aged 12-24 months

Question 51
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Which of the following drugs is currently thought to cause least QT prolongation of all
antipsychotics?

Select one:
Olanzapine
Quetiapine
Thioridazine

Clozapine
Lurasidone

Feedback
Effects of antipsychotics on QTc:
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. p. 143.

The correct answer is: Lurasidone

Question 52
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According to the CATIE study of patients with schizophrenia, the number of patients meeting
criteria for metabolic syndrome ranges between what percentages?

Select one:
11-25%
71-85%
56-70%
26-40%
41-55%
Feedback
Explanation:

Depending on the definition of ‘metabolic syndrome’ (MS), its prevalence at baseline in CATIE
was 41-43% in males and 52-54% in females.

Ref: McEvoy JP et al. Prevalence of the metabolic syndrome in patients with schizophrenia:
baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)
schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia
research. 2005 Dec 1;80(1):19-32.

The correct answer is: 41-55%

Question 53
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The upper normal QTc level in female subjects is

Select one:
440 ms
450 ms
500 ms
470 ms
420 ms
Feedback
Explanation:

The upper limit of normal QTc interval is 440ms for men and 470ms for women. Rather
strong evidence links QTc values over 500ms to a clearly increased risk of arrhythmia.
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. p. 142.

The correct answer is: 470 ms

Question 54
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A 44-year-old woman on clozapine has gained 15Kgs in 3 months after starting the
treatment. This antipsychotic induced weight gain is most likely to be due to;

Select one:
Hypoprolactinaemia
Leptin sensitisation
5-HT2C antagonism
M4 blockade
H2 antagonism
Feedback
Explanation:

The weight gain induced by clozapine may be partially associated with its potent blockade of
both H1 histamine and 5HT2C receptors. Agonists at the 5HT2 family of receptors cause
hypophagia and can cause weight loss in animals and human beings. In rats, 5HT2C
antagonists cause an increase in feeding. 5HT2C knockout mice are overweight and exhibit
increased feeding.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical
Applications, 5th Edition. 2021. p. 225.

The correct answer is: 5-HT2C antagonism

Question 55
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Which of the following is true with regard to acetylcholine (Ach) ?

Select one:
Acetylcholinergic projections are more predominant than serotonergic projections in the
cortex
Tricyclics increase acetylcholine levels
Antidementia drugs reduce acetylcholine concentration
Acetylcholine agonists are useful in mild to moderate dementia of Alzheimer's type
Acetylcholine is synthesised by acetyl cholinesterase
Feedback
The distribution of cholinergic innervation in the human cerebral cortex reveals that all
cytoarchitectonic regions and layers of the cerebral cortex display a dense cholinergic
innervation The density of cholinergic axons is higher in the more superficial layers (layers I
and II and the upper parts of layer III) of the cerebral cortex. Distinct patterns of lamination
exist in individual cytoarchitectonic regions ( Structure and Function of Cholinergic
Pathways. http://www.acnp.org/g4/GN401000012/CH012.html (accessed April 13, 2015)).

The correct answer is: Acetylcholinergic projections are more predominant than
serotonergic projections in the cortex

Question 56
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Which of the following antidepressants is least likely to be associated with sexual
dysfunction in male depressed patients?

Select one:
Agomelatine
Trazodone
Venlafaxine
Fluoxetine
Amitriptyline
Feedback
Explanation:

Lower risk antidepressants include agomelatine, bupropion, mirtazapine, vilazodone,

vortioxetine, and moclobemide. Of these, agomelatine, bupropion, and vortioxetine have
the best evidence supporting a more favourable sexual adverse-effect profile. Rates of
sexual dysfunction with agomelatine may be similar to placebo.

Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. pp. 405-406.

The correct answer is: Agomelatine

Question 57
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Mr. X is taking trazodone for his depressive symptoms. He complains of excessive sedation.
This effect is most likely to be due to the blockade of which of the following receptors?

Select one:
Nicotinic
Beta adrenergic
Alpha adrenergic
Muscarinic
Dopaminergic
Feedback
Explanation:

Trazodone blocks the serotonin transporter at antidepressant doses. It also has serotonin
2A and 2C, H1 histamine, and alpha-1-adrenergic antagonist properties, which can make it
very sedating. At low doses, trazodone does not adequately block serotonin reuptake but
retains its other properties.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical
Applications, 5th Edition. 2021. p. 535.

The correct answer is: Alpha adrenergic

Question 58
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Mr.Z is a 26 year old gentleman who was diagnosed with paranoid schizophrenia 4 years
ago and has had 6 hospitalisations over last 3 year period. Most of his relapses have been
associated with non-adherence to medication. Which of the following interventions are most
likely to improve compliance for this patient?

Select one:
Adherence therapy
Addressing patient-specific barriers
Supportive psychotherapy
Family therapy
Psychoeducational intervention
Feedback
Explanation:

Current guidelines recommend that interventions to improve medication adherence should

be patient specific, in that they should target the barriers to achieving adherence as
perceived or noted by the clinical team to be present in that patient (Barnes et al., 2020).

Of various other psychosocial approaches, Adherence Therapy, a brief psychological intervention

based on aspects of motivational interviewing and CBT, is the best studied. While this
intervention showed some early promise for improving insight, adherence, attitudes towards
medication, and rehospitalisation rates in an inpatient sample of patients with schizophrenia,
further studies failed to replicate these positive findings for improving adherence. A well-
conducted, adequately powered RCT found adherence therapy to be ineffective in improving
adherence, psychotic symptoms, or quality of life in people with schizophrenia. Meta-analysis of
adjunct use of adherence therapy support its use in reducing symptom burden but surprisingly,
no significant changes in adherence per se (Gray et al, 2016).

Similarly, psychoeducation alone or family therapy alone are also ineffective. There is no evidence
based data available for supportive psychotherapy and insight orientated psychotherapy for
improving medication adherence (Curto et al., 2021).

Ref: Barnes TR et al. Evidence-based guidelines for the pharmacological treatment of

schizophrenia: updated recommendations from the British Association for
Psychopharmacology. Journal of Psychopharmacology. 2020 Jan;34(1):3-78.

Gray R, et al. Is adherence therapy an effective adjunct treatment for patients with
schizophrenia spectrum disorders? A systematic review and meta-analysis. BMC psychiatry.
2016 Dec;16(1):1-2.

Curto M, Fazio F, Ulivieri M, Navari S, Lionetto L, Baldessarini RJ. Improving adherence to

pharmacological treatment for schizophrenia: a systematic assessment. Expert Opinion on
Pharmacotherapy. 2021 Jun 13;22(9):1143-55.

The correct answer is: Addressing patient-specific barriers

Question 59
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Choose the most accurate statement about cannabis

Select one:
Cannabis commonly causes physical dependence
9-delta-tetrahydrocannabinol is the active substance
Fatal overdose is reported in several countries
Urine tests usually remain positive for up to a week after regular use has ceased
Anandamide is a specific cannabinoid receptor and a naturally occurring antagonist at this
receptor
Feedback
Explanation:

Cannabis is a mixture of hundreds of chemical and over 100 alkaloid cannabinoids. The
most important of these are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC
interacts with cannabinoid 1 and 2 (CB 1 and CB2) receptors and has psychoactive
properties. CBD is an isomer of THC and relatively inactive at CB1 and CB2 receptors. CBD
does not have psychoactive properties and its mechanism of action is unknown. Cannabis
comes in various mixtures of THC and CBD.

Anandamide is a specific cannabinoid receptor and a naturally occurring agonist at this

receptor. Cannabis is not usually associated with physical dependence. Urine tests usually
remain positive for up to 4weeks after regular use has ceased. Unlike most other drugs of
abuse, there are no reports of fatal overdose from cannabis.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical
Applications, 5th Edition. 2021. p. 563.

The correct answer is: 9-delta-tetrahydrocannabinol is the active substance

Question 60
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A 66 year old man taking antidepressant therapy develops dizziness every morning. He gives
a history of palpitations accompanied by the dizziness. There is no history of vertigo or falls
but the dizziness improves spontaneously on reclining. Which of the following receptor
blockade can explain the above symptoms?

Select one:
Alpha 1 adrenergic
Cholinergic nicotinic
Cholinergic muscarinic
Alpha 2 adrenergic
Beta adrenergic
Feedback
Explanation:

Alpha-1 adrenergic blockade can cause dizziness, sedation, and hypotension.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7th Edition. 2021.

The correct answer is: Alpha 1 adrenergic

Question 61
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Carlsson is associated with which of the following?

Select one:
learned helplessness hypothesis of depression
hairline triggers in borderline personality
endocrine hypothesis of depression
kindling hypothesis of depression
dopamine hypothesis of schizophrenia
Feedback
Explanation:

Arvid Carlsson, a Swedish pharmacologist, is best known for his contributions on the
neurotransmitter, dopamine, for which he won the Nobel Prize in 2000 for
Medicine/Physiology. The co-recipients were Eric Kendel and Paul Greengard. In 1957,
Carlsson showed that dopamine was a neurotransmitter in the brain and not just a
precursor of norepinephrine, which was the prevailing view at the time. He was also
instrumental in developing the ‘dopamine theory of schizophrenia’ and the role of dopamine
in the development of extrapyramidal side effects of antipsychotic medications.

Ref: Yeragani VK et al. Arvid Carlsson, and the story of dopamine. Indian journal of
psychiatry. 2010 Jan;52(1):87.

The correct answer is: dopamine hypothesis of schizophrenia

Question 62
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The risk factor predicting poor response to lithium prophylaxis in bipolar illness is

Select one:
Dominant personality
Social support
High social status
High age of illness onset
High number of previous hospitalizations
Feedback
Predictors of poor response to lithium in bipolar prophylaxis include High number of
previous hospitalization, stress, high expressed emotion, and high number of life events,
episodic patterns of depression- mania interval, continuous cycling, and unemployment and
neurotic personality.

The correct answer is: High number of previous hospitalizations

Question 63
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Which of the following antipsychotics is recommended for mixed affective states in bipolar
disorder?

Select one:
perphenazine
amisulpride
sulpride
clozapine
olanzapine
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Explanation:

According to current guidelines, if a patient with bipolar disorder presents in a mixed state,
consider stopping the antidepressant (if the patient is taking one) and offer an antipsychotic
(haloperidol, olanzapine, quetiapine, or risperidone).

Ref: National Institute for Health and Clinical Excellence. The NICE guideline on the
assessment and management of bipolar disorder in adults, children and young people in
primary and secondary care. Updated edition 2020.

The correct answer is: olanzapine

Question 64
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A 36-year-old cocaine user notices that the longer he uses the drug, the more of it he
requires to achieve the same effect. This is best described as

Select one:
Addiction
Dependence
Tolerance
Sensitisation
Compliance
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Explanation:

The development of tolerance is marked by a need, over time, to use increased doses of a
drug for it to achieve the same effect.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
604.

The correct answer is: Tolerance

Question 65
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Which of the following is true with regard to nicotinic receptors?

Select one:
Blockade causes problems with fine motor movements
Mediate anti-parkinsonian effects of amantadine
All nicotinic receptors are excitatory
Mediate sympathomimetic actions of dopamine
Anticholinergic effects of antipsychotics are mediated by nicotinic receptors
Feedback
Explanation:

There are numerous receptors for acetylcholine. The major subtypes are nicotinic and
muscarinic subtypes of cholinergic receptors. Nicotinic receptors are all ligand-gated, rapid-
onset, and excitatory ion channels blocked by curare. Muscarinic receptors, by contrast, are
G-protein-linked, can be excitatory or inhibitory, and many are blocked by atropine,
scopolamine, and other well-known so-called ‘anticholinergics’.
Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical
Applications, 5th Edition. 2021. p. 506.

The correct answer is: All nicotinic receptors are excitatory

Question 66
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Agonistic effect of fluoxetine on which of the following receptors results in anorgasmia?

Select one:
Alpha-1 adrenergic receptors
5HT-1A stimulation
D-2 receptors
5HT-2C stimulation
Mu opioid receptors
Feedback
Explanation:

Psychotropics affect sexual functioning through the dopamine and 5-HT systems.
Antipsychotics blocking the D2 receptors and antidepressants increasing 5-HT transmission
via 5-HT2 receptors affect sexual functioning. D2 blockade (direct or indirectly via 5HT2A
stimulation) can cause apathy and reduced libido. Agonistic stimulation of 5-HT2A and 5-
HT2C inhibits the spinal reflexes of orgasm and ejaculation leading to anorgasmia and
delayed ejaculation, as seen with the use of SSRIs in some patients. 5-HT2A antagonists
(mirtazapine) and 5-HT1A autoreceptor agonists (e.g., buspirone) reverse serotonergic
inhibition and thus have a more favourable sexual side effect profile.

Ref: Lew-Starowicz, M. and Giraldi, A., 2021. Impact of Psychotropic Medications on Sexual
Functioning. In Psychiatry and Sexual Medicine (pp. 353-371). Springer, Cham.

The correct answer is: 5HT-2C stimulation

Question 67
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SSRIs, on stimulating which receptors, will induce sleep disturbances?
Select one:
5-HT2A
5-HT3
5-HT1A
H-1
5-HT1D
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5-HT2A stimulation by SSRIs will lead to insomnia

The correct answer is: 5-HT2A

Question 68
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Aripiprazole has an antagonistic effect on which of the following receptors?

Select one:
D2 receptors
5-HT3 receptors
5-HT2A receptors
5-HT1A receptors
D1 receptors
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Explanation:

Aripiprazole is a D2 receptor partial agonist. It is also a partial agonist at 5-HT1A receptors, a

high affinity antagonist at 5-HT2A receptors, and a low-/moderate affinity antagonist at H1
and alpha-1 receptors.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 212.

The correct answer is: 5-HT2A receptors

Question 69
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Which of the following is a noncompetitive NMDA blocker?
Select one:
Lamotrigine
Bupropion
Acamprosate
Disulfiram
Varenicline
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Explanation:

Acamprosate is a synthetic taurine analogue that acts as a functional glutaminergic NMDA

antagonist and also increases GABA-ergic function. Thus, it interacts both with the glutamate
system to inhibit it, and with the GABA system to enhance it, a bit like a form of ‘artificial
alcohol’.

Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. p. 463.

Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical

Applications, 5th Edition. 2021. p. 556.

The correct answer is: Acamprosate

Question 70
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The number of half-lives normally taken by drugs to reach steady plasma levels is;

Select one:
7
9
2
3
5
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Explanation:

It usually takes 4-5 drug half-lives to reach steady-state levels.

Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. p. 833.

The correct answer is: 5

Question 71
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Which of the following is correct with regard to benzodiazepine metabolism?

Select one:
Desmethyldiazepam is an inactive metabolite
Diazepam achieves nearly 10 times greater plasma level in the elderly
Diazepam is around 95% protein bound
Duration of action depends primarily on elimination half-life
Elimination half-life is reduced in the elderly
Feedback
Explanation:

Clinically, half-life alone does not necessarily determine the duration of action for most
benzodiazepines. The fact that all benzodiazepines are lipid-soluble to varying degrees means
that benzodiazepines and their active metabolites bind to plasma proteins. The extent of this
binding is proportional to their lipid solubility. The amount of protein binding varies from 70-99%
(approximately 95% for diazepam). Distribution, onset, and termination of action after a single
dose are thus determined mainly by benzodiazepine lipid solubility, not elimination half-life.
Diazepam is oxidised to desmethyldiazepam, which, in turn, is hydroxylated to produce
oxazepam. These active metabolites undergo glucuronidation to inactive metabolites. The
elimination half-life of diazepam is increased by 100% in elderly (around 90 hrs) as clearance is
reduced.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
670.

Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7 th Edition. 2021.

The correct answer is: Diazepam is around 95% protein bound

Question 72
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Mr Y is a 27 year old gentleman who has recently been started on lithium for treatment of
his acute phase of his manic episode. What is the therapeutic blood lithium level you would
aim for?
Select one:
0.6 - 0.8 M Eq/ L
0.4 - 0.5 M Eq/ L
0.2 - 0.4 M Eq/ L
1.5 - 2.0 M Eq/ L
0.8 - 1.0 M Eq/ L
Feedback
Explanation:

Lithium is currently the drug of choice for treatment of the acute phase of a manic episode
as well as for prevention of further episodes of bipolar mood disorder. The treatment is
closely monitored by repeated blood levels as the difference between therapeutic and lethal
blood levels is not very wide.

Lithium is effective for the treatment of acute mania, at a plasma level of 0.8-1.0mmol/L. For
maintenance treatment, aim for the highest possible tolerable lithium plasma level in the
range of 0.6-0.8 mmol/L. A blood lithium level of more than 2 mmol per litre may be
associated with toxicity while a level of more than 2.5 may be lethal.

Note that lithium is a monovalent cation; so the therapeutic range expressed in mEq/L is
identical to mmol/L
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. pp. 247-248.

Goodwin GM et al. Evidence-based guidelines for treating bipolar disorder: revised third
edition recommendations from the British Association for Psychopharmacology. Journal of
Psychopharmacology. 2016 Jun;30(6):495-553.

The correct answer is: 0.8 - 1.0 M Eq/ L

Question 73
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The minimum effective dose of Aripiprazole in treating a psychotic episode is
Select one:
20mg
15mg
10mg
25mg
5mg
Feedback
Explanation:

Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. p. 9.

The correct answer is: 10mg

Question 74
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The minimum duration of gap recommended between stopping venlafaxine and starting
duloxetine is

Select one:
No gap necessary
2 months
2 days
1 day
1 week
Feedback
Explanation:

A direct switch can be made when switching from venlafaxine to duloxetine.

Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021, p. 341.

The correct answer is: No gap necessary

Question 75
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The rate-limiting enzyme in the metabolism of alcohol is;

Select one:
Alcohol dehydrogenase
Acetyl co A dehydrgenase
Aldehyde dehydrogenase
Acetic acid
Acetyl dehydrogenase
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The major site of alcohol metabolism is the liver. Alcohol dehydrogenase is the rate-limiting
enzyme in the metabolism of alcohol which makes it impossible to speed up alcohol
metabolism.

The correct answer is: Alcohol dehydrogenase

Question 76
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Which of the following is a localising sign for frontal lesions?
Select one:
Postural headache
Ptosis
Nystagmus
Olfactory disturbances
Myoclonus
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The most classic presentation of frontal lobe dysfunction is an olfactory groove meningioma
characterized by anosmia, loss of inhibition, memory impairment, headaches, and visual
symptoms. But anosmia itself is not a good localising sign as often the cause of olfactory
disturbance is peripheral - related to nostrils (Frontal Lobe Syndromes Clinical Presentation,
http://emedicine.medscape.com/article/1135866-clinical (accessed April 13, 2015).).

The correct answer is: Olfactory disturbances

Question 77
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National adult reading test is used to assess

Select one:
Visuospatial ability
Premorbid intelligence
Attentional bias
Nonverbal intelligence
Frontal lobe functions
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Explanation:

First published in 1982, the 50-item National Adult Reading Test (NART) is a widely adopted
method for estimating premorbid intelligence both for clinical and research purposes. The
validity of NART as a measure of premorbid ability rests upon the assumptions that reading
ability (of irregular words) is relatively independent of brain damage, and that it is a strong
predictor of intelligence in the normal population.

Ref: Bright P et al. The National Adult Reading Test: restandardisation against the Wechsler
adult intelligence scale—fourth edition. Neuropsychological Rehabilitation. 2018 Aug
18;28(6):1019-27.

The correct answer is: Premorbid intelligence

Question 78
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Which of the following drugs have a half-life of 3 days?

Select one:
Carbamazepine
Aripiprazole
Quetiapine
Reboxetine
Fluoxetine
Feedback
Explanation:

The mean elimination half-life is 75 hours for aripiprazole and 94 hours for the major
metabolite dehydro-aripiprazole.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7th Edition. 2021. p.
57.

The correct answer is: Aripiprazole

Question 79
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Which of the following drugs is least dependent on hepatic metabolism?

Select one:
Chlorpromazine
Clozapine
Olanzapine
Amisulpride
Risperidone
Feedback
Explanation:

Gabapentin, sulpiride, amisulpride, and lithium all undergo no or minimal hepatic

metabolism.
Ref: Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry,
14th Edition. 2021. p. 724.

The correct answer is: Amisulpride

Question 80
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A 34-year-old man unable to remember any of the events that happened at the hospital
during the time of his admission for a head injury even after two years after recovery. He
has no other memory problems. This is

Select one:
Confabulation
Anterograde amnesia
Retrograde amnesia
Episodic memory loss
Dissociative memory loss
Feedback
Explanation:

Anterograde amnesia is the period of amnesia between an event (e.g. head injury) and the
resumption of continuous memory. The length of anterograde amnesia is correlated with
the extent of brain injury.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 102.

The correct answer is: Anterograde amnesia

Question 81
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A 70-year-old man presents with sudden onset of right arm weakness following severe
headache and inability to understand speech. His speech problem is accurately described as

Select one:
Aphasia
Alexia
Aphemia
Agraphia
Amusia
Feedback
Explanation:

Aphasia is an impairment of expression or comprehension of language caused by injury or

disease in the language centres of the brain. This case is receptive aphasia (Wernicke's area
damage).

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: Aphasia

Question 82
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On routine examination of eyes, accommodation reflexes were present but pupils were
small irregular with absent light reflexes. This type of pupil is called

Select one:
Marcus Gunn pupil
Senile pupil
Anosognosia
Kayser-Fleischer pupil
Argyll-Robertson pupil
Feedback
Explanation:

An Argyll-Robertson pupil is a pupil of the eye that manifests accommodation by constricting

when watching a finger that is brought close to the face but does not respond to light by
constricting, a neurological sign of damage to the midbrain relays of the oculomotor
nerve. Douglas Argyll Robertson's (1837-1909) conducted experimental work with
physostigmine in 1863. He observed patients with spinal cord disease who had lost the
response to light even though accommodation to near objects was normal. This
phenomenon, known subsequently as the Argyll Robertson pupil, came to be considered
pathognomonic of tabes dorsalis, general paresis and neurovascular syphilis.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015.

The correct answer is: Argyll-Robertson pupil

Question 83
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Abnormalities in Stroop test suggests

Select one:
Short term memory disturbance
Damage to occipital cortex
Attentional bias
Cortical blindness
Lesion of optic chiasma
Feedback
Explanation:

The Stroop effect is the delay and disruption in naming the colours of words printed in non-
matching coloured ink, as when the word ‘red’ is printed in blue ink, the word ‘blue’ in green
ink, and so on. To perform the task it is necessary to ignore the meanings of the printed
words and to respond only to the colours in which they are printed, but with experienced
adult readers automatic processing tends to occur, causing interference in the processing of
information and a significant increase in the time required to name the colours, compared
with the time taken to name the colours of meaningless strings of letters.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015

The correct answer is: Attentional bias

Question 84
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Which of the following instruments can be used to screen for cognitive deficits after head
injury?

Select one:
Bender visual motor gestalt test
National adult reading test
Glasgow coma scale
Weschler adult intelligence scale
Raven's progressive matrices
Feedback
Explanation:

The Bender Visual-Motor Gestalt Test is designed to help in the diagnosis of loss of function
and organic brain damage in children and adults. It consists of nine geometrical figures that
are copied by the respondent, the drawings being evaluated according to the overall quality
of the reproductions, their organisation in relation to the Gestalt grouping laws, and the
errors made. Individuals who have suffered a traumatic brain injury may be given the
Bender-Gestalt as part of a battery of neuropsychological measures or tests.

Ref: Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015

The correct answer is: Bender visual motor gestalt test

Question 85
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A 64-year-old man has behavioural changes with irritability. He is found wandering in the
streets near his home. On neurological examination, there is evidence of mild aphasia and
cognitive dysfunction, but motor function is preserved. He seems to have no awareness
regarding his difficulties and has a silly, jocular affect. Which of the following is most likely to
be seen in CT/MRI scan?

Select one:
Dilated ventricles without cerebral atrophy
Predominant occipito parietal atrophy
Diffuse cortical atrophy with apparently dilated ventricles
Bilateral frontal atrophy
Space occupying lesion obstructing third ventricle
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The presence of reduced verbal fluency, loss of insight and having a silly affect points
towards frontal lesions.

The correct answer is: Bilateral frontal atrophy

Question 86
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The gene implicated in Huntington disease is present on the chromosome
Select one:
21
14
7
4
1
Feedback
Explanation:

Huntington disease results from expansion of a CAG trinucleotide repeat in the HTT
(huntingtin) gene on the short arm of chromosome 4. Alleles with 40 or more trinucleotide
repeats are fully penetrant.

Ref: Bachoud-Lévi AC et al. International Guidelines for the treatment of Huntington’s

Disease. Frontiers in neurology. 2019;10:710.

The correct answer is: 4

Question 87
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Which of the following is associated with narcolepsy?

Select one:
Waxy flexibility
Unrefreshing sleep attacks
2% prevalence
Prolonged REM latency
HLA-DR2
Feedback
Explanation:

Narcolepsy is a chronic disorder that is primarily characterised by excessive daytime

sleepiness and, in most individuals, cataplexy (NOT catalepsy / waxy flexibility - these are
catatonic features). Narcolepsy is the most common neurological cause of hypersomnia with
an estimated prevalence of 0.20-0.40 per 1000 in the general population. The absence of the
hypocretin peptides (also known as orexins; which are neuropeptides with a role in the
regulation of sleep and wakefulness) is a fundamental marker in most patients with
narcolepsy with cataplexy. The hypocretin deficiency in narcolepsy is thought to result in an
unstable switch mechanism, with uncontrolled daytime sleep attacks (which may be
refreshing, as they are REM attacks). There is a strong association between HLA-DR2
haplotypes coded on chromosome 6 and narcolepsy - HLA-DQB1*0602 and DQA1*0102 are
found in up to 85-95% of individuals, compared with 12-38% in the general population.

Ref: Kornum BR et al. Narcolepsy. Nature reviews Disease primers. 2017 Feb 9;3(1):1-9.

Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. p.
450-451.

The correct answer is: HLA-DR2

Question 88
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Mr. Y has a well-established diagnosis of bipolar affective disorder. His younger brother,
who is also his main carer, is aware that this disorder has a strong genetic loading and is
worried. What is the prevalence rate in first-degree relatives of patients with bipolar
affective disorder?

Select one:
10-15%
20-40%
1-2%
5-7%
60-70%
Feedback
Explanation:

Bipolar disorder has a multifactorial aetiology. Both family studies and twin studies have
demonstrated a strong genetic loading for it.

First-degree relatives of those with bipolar disorder are 7 times more likely to develop
bipolar disorder than the general population (i.e. 10-15% risk). Monozygotic twins have a
concordance of 33-90%. Dizygotic twins have a concordance of approximately 23%.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. pp. 332-333.

Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Therapeutic
advances in psychopharmacology. 2018 Sep;8(9):251-69.

The correct answer is: 10-15%

Question 89
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What is the concordance rate of schizophrenia in monozygotic twins?

Select one:
22%
48%
18%
14%
8%
Feedback
Explanation:

Genetic factors account for most of the liability to schizophrenia. Estimated

heritability ranges from 64% (pedigree studies) to 81% (twin studies). Most studies suggest
that the concordance rates are 44-50% for monozygotic twins and 10-15% for dizygotic
twins, i.e., a three times higher concordance in monozygotic than in dizygotic twins. The risk
of developing schizophrenia when one has an affected identical twin is approximately 46-
48%.
Ref: Jauhar, S et al. Schizophrenia (Seminar). The Lancet, 2022: 399, 10323, pg473-486

Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. pp.
190-191.

The correct answer is: 48%

Question 90
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Nonfluent aphasia is associated with lesions in or near which of the following brain regions?

Select one:
Parietal operculum
Anterior cingulate
Superior temporal gyrus
Insula
Broca area
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Explanation:
Broca aphasia (also called non-fluent or expressive aphasia) had traditionally been
characterised by non-fluent speech and impaired repetition but intact auditory
comprehension. It has long been thought to be associated with damage to Broca area (i.e.
left inferior frontal convolution) or Brodmann area 44. Temporal and parietal lobes are
usually not impaired. Therefore, receptive language and comprehension are not usually
impaired in nonfluent aphasia.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
48.

The correct answer is: Broca area

Question 91
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Bobby is an 8-year-old boy who has consistently shown callous-unemotional traits (low
empathy, callousness, and low interpersonal emotions). What is the heritability (genetic
contribution) of these traits?

Select one:
5-10%
70-80%
1-2%
10-20%
40-60%
Feedback
Explanation:

Twin studies suggest that callous-unemotional traits in middle childhood are highly
heritable. Heritability estimates range from 0.45 to 0.67.

Ref: Hyde LW et al. Heritable and nonheritable pathways to early callous-unemotional

behaviors. American Journal of Psychiatry. 2016 Sep 1;173(9):903-10.

Moore AA et al. The Inventory of Callous-Unemotional Traits (ICU) in children: reliability and
heritability. Behavior genetics. 2017 Mar 1;47(2):141-51.

The correct answer is: 40-60%

Question 92
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Which of the following substances is found in reduced levels in patients with high impulsive
suicidality?

Select one:
CYP4503A4
COMT
5-HIAA
BDNF
Neuregulin
Feedback
Explanation:

Much of the clinical data relating 5-HT and impulsivity have been provided by investigations
of suicide. Early studies reported lower CSF and plasma 5-HIAA levels as well as blunted
prolactin response to fenfluramine in both suicide attempters and completers, as well as
lower brain 5-HT, 5-HT transporter, and abnormal 5-HT receptor binding at post-mortem in
suicide completers. Research into individuals with antisocial personality disorder
categorised according to whether their violent behaviour was aggressive or non-aggressive
has revealed similar results, with impulsive aggressive individuals reported to have lower
levels of CSF 5-HIAA and blunted prolactin response to fenfluramine.

Ref: Dalley JW, Roiser JP. Dopamine, serotonin and impulsivity. Neuroscience. 2012 Jul
26;215:42-58.

The correct answer is: 5-HIAA

Question 93
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Which of the following types of chromosomes undergo Robertsonian translocation?

Select one:
submetacentric
Metacentric
telocentric
Holocentric
acrocentric
Feedback
Robertsonian translocation is a non-reciprocal (i.e. unequal exchange) that results in a single
fused chromosome from 2 acrocentric (non-homologous) chromosomes. A metacentric
chromosome has centromere right in the middle. So p and q arms are of equal length. Most
chromosomes are submetacentric where the arms are of unequal length. If the centromere
is at the tail of a chromosome, it is called telocentric. With holocentric chromosomes, the
entire length of the chromosome acts as the centromere. These latter two types are not
seen in humans.

The correct answer is: acrocentric

Question 94
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Which of the following statements is true about sex linked recessive disorders?

Select one:
25% of sons of heterozygous mothers are affected
25% of daughters of heterozygous mothers are affected
Females more affected than males
All daughters of affected fathers are carriers of the disease
Affected fathers pass disease to sons
Feedback
In sex-linked recessive disorders, an affected male can transmit the disease-causing
mutation to his daughters, who remains normal phenotypically but carries and transmits the
disease-causing allele to her sons. As females have two copies of the X chromosome, they
need a double identical mutation for disease expression that is extremely rare.

The correct answer is: All daughters of affected fathers are carriers of the disease

Question 95
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The gene implicated in early-onset Alzheimer disease in people with Down syndrome is

Select one:
Amyloid precursor protein
Presenilin 1
Presenilin 2
Apolipoprotein e3
Apolipoprotein e4
Feedback
Explanation:

Individuals with Down syndrome (trisomy 21) have an increased risk of Alzheimer disease
(AD) due to genetic factors (amyloid precursor protein gene on chromosome 21 is
implicated in early-onset AD). Post-mortem studies (of those over the age of 40) show a high
incidence of senile plaques and neurofibrillary tangles as seen in AD. Almost all Down
patients above age 40 show neuropathological evidence for AD even if there is no clinical
dementia.

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022.
pp. 101-102.

Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. p.
807.

The correct answer is: Amyloid precursor protein

Question 96
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Which of the following structures is involved in addictive behaviour?

Select one:
Suprachiasmatic nucleus
Nucleus tractus solitarius
Substantia nigra
Ventral tegmental area
Preoptic nucleus
Feedback
Explanation:

The midbrain ventral tegmental area (VTA) lies medial to the substantia nigra and contains
dopaminergic neurons that give rise to the mesocorticolimbic dopamine system. These
neurons send ascending projections that innervate limbic structures, such as the nucleus
accumbens and amygdala; the mesoaccumbens pathways is a central element in the neural
representation of reward, and intense research has been devoted to this area. All known
drugs of abuse activate the mesoaccumbens dopamine pathway, and plastic changes in this
pathway are thought to underlie drug addiction.
For an extended circuitry relevant to addiction see the illustration below:

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
955.

The correct answer is: Ventral tegmental area

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Which brain structure is spared during normal aging?

Select one:
Cerebellum
Motor neuron
Cerebral cortex
Sub thalamic nuclei
Cranial nerves nuclei
Feedback
Cranial nerve nuclei are spared during the normal ageing process. All the other structures
could be affected.

The correct answer is: Cranial nerves nuclei

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Which of the following specific phobias has a strongly genetic aetiology?

Select one:
Spider phobia
Acrophobia
Animal phobia
Space phobia
Blood injury injection phobia
Feedback
Blood injury injection phobia is oddly different from other phobias in that the response to
exposure is not tachycardia and sympathetically driven heart rate, etc. Instead, a fainting
response occurs where the patient may drop fainting with low BP and bradycardia.

The correct answer is: Blood injury injection phobia

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Loss of taste sensation in the anterior part of tongue is related to

Select one:
5th Nerve Palsy
9th Nerve Palsy
8th Nerve Palsy
6th Nerve Palsy
7th Nerve Palsy
Feedback
The facial nerve supplies the taste sensation in the anterior tongue. The chorda tympani (the
branch mediating this sensation) leaves the parent nerve, crossing through the middle ear,
where it can also be damaged by severe infections, etc.

The correct answer is: 7th Nerve Palsy

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In which of the following types of inheritance, 75% of children inherit a disease when both
parents have the disease and share a similar genotype?

Select one:
Mitochondrial
Autosomal dominant
X linked recessive
X linked dominant
Autosomal recessive
Feedback
If both parents are diseased and have an autosomal recessive condition, then all children
will be diseased (100%). If both are diseased with heterozygous genotype, an autosomal
dominant disease will be transmitted 3 out of 4 occasions to their children.

The correct answer is: Autosomal dominant

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Hirano bodies seen in which one of the following types of dementia?

Select one:
Vascular
Lewy body type
HIV-associated
Frontotemporal
Alzheimer
Feedback
Explanation:

Hirano bodies are brightly eosinophilic rod-shaped or elliptical cytoplasmic inclusions that
appear to overlap the cell boarder of a neuron cell body. They are mostly found in the
hippocampus and are particularly numerous in Alzheimer disease and Pick disease and in
patients with the Guam parkinsonism-dementia complex.

Ref: Gray F, Duyckaerts C, de Girolami U. Escourolle and Poirier’s Manual of Basic

Neuropathology, 6th Edition. 2019. p. 7.
The correct answer is: Alzheimer

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Tom is a 12-year-old boy with reduced social interactions, poor communication abilities and
repetitive stereotypical behaviour. The macroscopic changes involved in the pathogenesis of
this condition would be hypoplasia of the

Select one:
Hippocampus
Fusiform gyrus
Cerebellar vermis
Amygdala
Angular gyrus
Feedback
Explanation:

The cerebellum is involved in a broad range of cognitive functions including emotion

regulation and social cognition. Abnormalities in the cerebellum are among the most
reproducibly reported alterations in autism spectrum disorder. Differences in the volume, as
compared to healthy people, of Crus I, cerebellar vermis, and anterior cerebellum have been
reported in individuals with autism spectrum disorder.

Ref: Laidi C et al. Cerebellar anatomical alterations and attention to eyes in autism. Scientific
reports. 2017 Sep 20;7(1):1-11.

The correct answer is: Cerebellar vermis

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Dangerous complications of eating disorders
Identify the metabolic abnormalities commonly seen in the following clinical situations

A 16-year-old Answer 1Choose...HypophosphatemiaHypokalemiaLow cortisol, high T3 and growth

girl with hormoneHyperkalemiaHypothyroidismHyponatremiaHyperhomocystinemiaHyperpho
history of T3, high growth hormone and cortisolHypercortisolemia
significant
weight loss,
body image
distortions
and morbid
fear of
fatness had
shown some
endocrine
abnormalities
in her blood
A 23-year-old
woman with
history of
bulimia
nervosa and Answer 2Choose...HypophosphatemiaHypokalemiaLow cortisol, high T3 and growth
is hormoneHyperkalemiaHypothyroidismHyponatremiaHyperhomocystinemiaHyperpho
determined T3, high growth hormone and cortisolHypercortisolemia
to reduce
weight by
repetitive
vomiting
A 20-year-old
woman uses
regular
laxatives for
last two years
in order to
reduce
weight. In
addition to Answer 3Choose...HypophosphatemiaHypokalemiaLow cortisol, high T3 and growth
hypokalemia hormoneHyperkalemiaHypothyroidismHyponatremiaHyperhomocystinemiaHyperpho
associated T3, high growth hormone and cortisolHypercortisolemia
with acidosis,
what other
electrolyte
abnormalities
results from
chronic
laxative
abuse?
Feedback
Explanation: The diagnosis is anorexia nervosa. The common endocrine changes in anorexia
include low concentrations of luteinising hormone, follicle stimulating hormone and
oestradiol, low T3 but T4 in low normal range, average concentrations of thyroid stimulating
hormone (low T3 syndrome), increase in plasma cortisol and raised growth hormone level.

Electrolyte disturbances can be of variable nature and are present in those who frequently
vomit or misuse large quantities of laxatives or diuretics. Vomiting results in metabolic
alkalosis and hypokalemia. In repetitive vomiting, loss of hydrochloric acid from gastric
juices lead to metabolic alkalosis (loss of acid - alkalosis). Laxative misuse results in
metabolic acidosis, hyponatraemia, hypokalemia. During laxative induced diarrhoea, a
considerable amount of bicarbonate may be lost in the stool. With healthy kidneys, the lost
bicarbonate is replaced adequately, and a serious base deficit does not develop. When there
is poor renal blood flow due to hypovolaemia/starvation, base deficit and acidosis develop
rapidly. Acidosis also results from excessive production of lactic acid when patients have
severe diarrhoea.

Ref: Støving RK. Mechanisms in endocrinology: Anorexia nervosa and endocrinology: A clinical update.
European journal of endocrinology. 2019 Jan 1;180(1):R9-27.

The correct answer is: A 16-year-old girl with history of significant weight loss, body image
distortions and morbid fear of fatness had shown some endocrine abnormalities in her
blood → Low T3, high growth hormone and cortisol, A 23-year-old woman with history of
bulimia nervosa and is determined to reduce weight by repetitive vomiting → Hypokalemia,
A 20-year-old woman uses regular laxatives for last two years in order to reduce weight. In
addition to hypokalemia associated with acidosis, what other electrolyte abnormalities
results from chronic laxative abuse? → Hyponatremia

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Features of defence mechanisms
For each of the characteristic features described below chose the most appropriate defence
mechanism suitable from the above list

Ascribing Answer 1Choose...AltruismProjectionActing

unacceptable outIdentificationRegressionTurning into
motivations to others selfRepressionSuppressionPassive aggressionHumourDenial
Answer 2Choose...AltruismProjectionActing
Resentment by
outIdentificationRegressionTurning into
noncooperation
selfRepressionSuppressionPassive aggressionHumourDenial
 Answer 3Choose...AltruismProjectionActing
Failure to accept or
outIdentificationRegressionTurning into
face conflicts
selfRepressionSuppressionPassive aggressionHumourDenial
Feedback
Explanation:

Projection is a primitive or immature defense mechanism that involves attributing one’s own
internal unacceptable ideas and impulses to an external target, such as another individual,
and reacting accordingly to them. It includes severe prejudice, rejection of intimacy through
suspiciousness, hypervigilance to external danger, and injustice collecting.

Passive aggression is aggression toward an object expressed indirectly and ineffectively

through passivity, masochism, and turning against the self.

Seeing, but refusing to acknowledge what one sees, or hearing and negating what is heard
are examples of denial. Denial avoids becoming aware of some painful aspect of reality.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p. 892.

Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
1066.

The correct answer is: Ascribing unacceptable motivations to others → Projection,

Resentment by noncooperation → Passive aggression, Failure to accept or face conflicts →
Denial

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Supportive techniques
For each of the following examples, identify the type of supportive techniques aimed at
eliciting information

Sometimes when
people are upset and Answer 1Choose...Acknowledgment of
low in their mood, they affectPartneringPostponementValidationStatement of
think of hurting respectAdviceReassuranceDisapprovalPositive
themselves. Has this reinforcement
been true for you?
I think it is best for you
to consider Answer 2Choose...Acknowledgment of
psychotherapy at this affectPartneringPostponementValidationStatement of
time. If I am you, I will respectAdviceReassuranceDisapprovalPositive
give this a serious reinforcement
thought
This depression may be
very difficult for you. Answer 3Choose...Acknowledgment of
But I think it is very affectPartneringPostponementValidationStatement of
likely with the proper respectAdviceReassuranceDisapprovalPositive
treatment you can get reinforcement
back to your job.
Feedback
Explanation:

Validation/normalization: It helps to decrease a patient's sense of embarrassment about a

feeling or behaviour. It can be done by quoting how it is normal for people to have different
emotions/ reactions/ behaviours, etc.

Advice: Many patients seek help directly; it is acceptable to provide advice but based on
sound understanding of the context. Premature advice can be obstructive than facilitative.

Ref: Adapted from Kay J & Tasman A. Essentials of Psychiatry, 2nd edition, 2006. John Wiley
& Sons, Ltd.

The correct answer is: Sometimes when people are upset and low in their mood, they think
of hurting themselves. Has this been true for you? → Validation, I think it is best for you to
consider psychotherapy at this time. If I am you, I will give this a serious thought → Advice,
This depression may be very difficult for you. But I think it is very likely with the proper
treatment you can get back to your job. → Reassurance

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Rating scales and their uses
For each description given below, select the relevant rating scale from the list above;

Answer 1Choose...Mini-mental state examination

This scale is useful for
(MMSE)Positive and negative symptoms scale (PANSS)Brief
rating severity in
psychiatric rating scale (BPRS)Young mania rating scale
patients with a pre-
(YMRS)Minnesota multiphasic personality inventory
existing diagnosis of (MMPI)Hospital anxiety and depression scale (HADS)Yale-
OCD Brown obsessive compulsive scales (YBOCS)General health
questionnaire (GHQ)Global assessment of functioning scale
(GAF)Clinical Global impressions scale (CGI)
Answer 2Choose...Mini-mental state examination
(MMSE)Positive and negative symptoms scale (PANSS)Brief
Commonly used
psychiatric rating scale (BPRS)Young mania rating scale
screening tool used in
(YMRS)Minnesota multiphasic personality inventory
primary care and
(MMPI)Hospital anxiety and depression scale (HADS)Yale-
general population
Brown obsessive compulsive scales (YBOCS)General health
studies
questionnaire (GHQ)Global assessment of functioning scale
(GAF)Clinical Global impressions scale (CGI)
Answer 3Choose...Mini-mental state examination
(MMSE)Positive and negative symptoms scale (PANSS)Brief
psychiatric rating scale (BPRS)Young mania rating scale
This scale measures
(YMRS)Minnesota multiphasic personality inventory
overall psychosocial
(MMPI)Hospital anxiety and depression scale (HADS)Yale-
functioning
Brown obsessive compulsive scales (YBOCS)General health
questionnaire (GHQ)Global assessment of functioning scale
(GAF)Clinical Global impressions scale (CGI)
Answer 4Choose...Mini-mental state examination
(MMSE)Positive and negative symptoms scale (PANSS)Brief
7-point scale useful to psychiatric rating scale (BPRS)Young mania rating scale
assess global (YMRS)Minnesota multiphasic personality inventory
observation of severity (MMPI)Hospital anxiety and depression scale (HADS)Yale-
of psychiatric illness Brown obsessive compulsive scales (YBOCS)General health
questionnaire (GHQ)Global assessment of functioning scale
(GAF)Clinical Global impressions scale (CGI)
Feedback
Explanation:

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a clinician-administered semi-

structured interview allowing the rating of severity in patients with a pre-existing diagnosis
of OCD.

The General Health Questionnaire (GHQ) is a self-rated questionnaire used as a screening

instrument for the presence of psychiatric illness. The patient is asked to report the
presence of a list of symptoms in the preceding weeks. Four versions are available, using 12,
28 (max score = 84), 30, and 60 items.

The Global Assessment of Functioning Scale (GAF) is a rating scale measuring overall
psychosocial functioning. The maximum score on the GAF is 100.
The Clinical Global Impression (CGI) scales were developed as simplified measures to reflect
the clinician’s overall impression of a patient’s condition (CGI-Severity rated 1-7 from
‘normal’ to ‘among the most extremely ill’) and change over time (CGI-Improvement, CGI-I,
rated from ‘very much improved’ to ‘very much worse’).

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. pp. 96-97.

Dunlop BW et al. Transdiagnostic clinical global impression scoring for routine clinical
settings. Behavioral Sciences. 2017 Sep;7(3):40.

The correct answer is: This scale is useful for rating severity in patients with a pre-existing
diagnosis of OCD → Yale-Brown obsessive compulsive scales (YBOCS), Commonly used
screening tool used in primary care and general population studies → General health
questionnaire (GHQ), This scale measures overall psychosocial functioning → Global
assessment of functioning scale (GAF), 7-point scale useful to assess global observation of
severity of psychiatric illness → Clinical Global impressions scale (CGI)

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Adverse effects
For each of the following drugs, identify the most important side effect associated with its
therapeutic use

Answer 1Choose...Glucose dysregulationPolydipsiaBlurred

Procyclidine visionWeight lossHypersalivationNasal stuffinessBradycardiaProlactin
elevationQTc prolongationAmenorrhoeaDiastolic Hypertension
Answer 2Choose...Glucose dysregulationPolydipsiaBlurred
Ziprasidone visionWeight lossHypersalivationNasal stuffinessBradycardiaProlactin
elevationQTc prolongationAmenorrhoeaDiastolic Hypertension
Answer 3Choose...Glucose dysregulationPolydipsiaBlurred
Olanzapine visionWeight lossHypersalivationNasal stuffinessBradycardiaProlactin
elevationQTc prolongationAmenorrhoeaDiastolic Hypertension
Feedback
Procyclidine, Benztropine, Orphenadrine and Biperiden are anticholinergic drugs that can
cause dry mouth, constipation, urinary retention and blurred vision. The latter is associated
with impaired visual accommodation, causing difficulty in reading.
There are concerns over the use of Ziprasidone, as it can increase QTc. However with this
drug, EPSE is equivalent to placebo, no appreciable weight gain, and no appreciable
anticholinergic side effects are noted.

Although possible glucose dysregulation and metabolic syndrome are reported with most
atypical antipsychotics, Olanzapine is the most common offender. Metabolic syndrome is a
cluster of disorders comprising of obesity(central and abdominal), dyslipidaemias, glucose
intolerance, insulin resistance (or hyperinsulinaemia) and hypertension.

The correct answer is: Procyclidine → Blurred vision, Ziprasidone → QTc prolongation,
Olanzapine → Glucose dysregulation

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Research studies in genetics
Select the most appropriate type of study for each description given below

An investigator is interested in Answer 1Choose...Population studiesPedigree

calculating the risk of illness within studiesFamily studiesAdoption
families among first, second and studiesSegregation analysisGenome-wide
third degree relatives and compare association studiesTransgenic
the rates with the established risk in studiesOutcome studiesAssociation
the general population. studiesLinkage studiesTreatment studies
Answer 2Choose...Population studiesPedigree
An investigator wants to compare the
studiesFamily studiesAdoption
likelihood of the observed rate of
studiesSegregation analysisGenome-wide
illness in a given pedigree with those
association studiesTransgenic
families that have a differing mode of
studiesOutcome studiesAssociation
transmission
studiesLinkage studiesTreatment studies
A researcher has no candidate genes
Answer 3Choose...Population studiesPedigree
of a priori interest but wants to study
studiesFamily studiesAdoption
the whole genome in large samples
studiesSegregation analysisGenome-wide
of patients and controls to
association studiesTransgenic
investigate the most commonly
studiesOutcome studiesAssociation
observed polymorphic variations in
studiesLinkage studiesTreatment studies
the patients.
Feedback
Family studies aid in determining the likelihood of illness among relatives. Segregation
analysis is used to investigate whether familial data for a disorder or trait suggests any
particular modes of inheritance. Both monogenic (Mendelian) or polygenic models can be
tested in this fashion. In addition, age of onset and sex effects can be taken into account
besides the specific genetic hypothesis under consideration. In Genome-Wide Association
Studies (GWAS), a 'candidate gene' approach is not used. Instead, several thousands of
single nucleotide polymorphisms are assayed in thousands of individuals.

The correct answer is: An investigator is interested in calculating the risk of illness within
families among first, second and third degree relatives and compare the rates with the
established risk in the general population. → Family studies, An investigator wants to
compare the likelihood of the observed rate of illness in a given pedigree with those families
that have a differing mode of transmission → Segregation analysis, A researcher has no
candidate genes of a priori interest but wants to study the whole genome in large samples
of patients and controls to investigate the most commonly observed polymorphic variations
in the patients. → Genome-wide association studies

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Clinically notable motor disorders
Choose one option for each of the following descriptions

Sustained
abnormalities of
Answer 1Choose...RigidityTicsAsterixisFasciculationsTardive
posture occurring
dyskinesiaChoreaMyoclonusDystoniaHemiballismusFibrillation
focally in writer's
cramp or torticollis
Brief jerky
downward
movements of the
wrist, when the
patient extend Answer 2Choose...RigidityTicsAsterixisFasciculationsTardive
both arms with the dyskinesiaChoreaMyoclonusDystoniaHemiballismusFibrillation
wrists dorsiflexed,
palms facing
forward, and eyes
closed
Quasi-purposeful
movements
Answer 3Choose...RigidityTicsAsterixisFasciculationsTardive
affecting multiple
dyskinesiaChoreaMyoclonusDystoniaHemiballismusFibrillation
joints with a distal
preponderance
Quivering of the
muscle seen under
Answer 4Choose...RigidityTicsAsterixisFasciculationsTardive
the skin in
dyskinesiaChoreaMyoclonusDystoniaHemiballismusFibrillation
neuromuscular
disorder
Feedback
Explanation:

Writer's cramp is a form of focal dystonia. Dystonia is an extrapyramidal motor disturbance

consisting of slow, sustained contractions of the axial or appendicular musculature. These
include torticollis, trismus, blepharospasm, oculogyric crisis, and opisthotonus. In contrast,
tics are spontaneous, repetitive, rhythmic movements that are semi-voluntary (may be
resisted for a short time with difficulty).

Asterixis can be elicited by having the patient extend both arms with the wrists dorsiflexed
and palms facing forward and eyes closed. Brief jerky downward movements of the wrist
are considered a positive sign. Asterixis is commonly seen with metabolic encephalopathies.

The term chorea means dance. Chorea is the sudden and involuntary movement of several
muscle groups, with the resultant action appearing like part of a voluntary movement.

Fasciculations may be seen under the skin as quivering of the muscle. Although
fasciculations are typically benign (particularly when they occur in the calf), if widespread,
they can be associated with neuromuscular disease, including amyotrophic lateral sclerosis
(ALS).

Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
1138.

Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30.
pp.104, 1016.

Neurological History and Physical Examination - Medscape,

http://emedicine.medscape.com/article/1147993-overview (accessed May 5, 2021)

The correct answer is: Sustained abnormalities of posture occurring focally in writer's cramp
or torticollis → Dystonia, Brief jerky downward movements of the wrist, when the patient
extend both arms with the wrists dorsiflexed, palms facing forward, and eyes closed →
Asterixis, Quasi-purposeful movements affecting multiple joints with a distal preponderance
→ Chorea, Quivering of the muscle seen under the skin in neuromuscular disorder →
Fasciculations

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Bedside tests of cognition
For each of the following options below, choose the most appropriate test from the given
list:

A test of visual memory where a Answer 1Choose...Wisconsin card sorting

child is shown ten geometric testPaired associates testRey-Osterreith
designs, one at a time, and asked testRaven's progressive matricesTrail making
to reproduce each one as exactly testNational adult reading testStanford-Binet
as possible on plain paper from testDigit span test.Stroop testBenton
memory. testVocabulary test
Answer 2Choose...Wisconsin card sorting
testPaired associates testRey-Osterreith
A test to check inhibitory control testRaven's progressive matricesTrail making
aspect of executive function. testNational adult reading testStanford-Binet
testDigit span test.Stroop testBenton
testVocabulary test
Answer 3Choose...Wisconsin card sorting
This test measures the recall of
testPaired associates testRey-Osterreith
learned material. It is a complex
testRaven's progressive matricesTrail making
figure test, which distinguishes
testNational adult reading testStanford-Binet
between brain damage and
testDigit span test.Stroop testBenton
mental retardation.
testVocabulary test
Feedback
Explanation:

The Benton Visual Retention Test assesses memory for 10 geometric designs after 10-
second exposure. It is often found useful in detecting intellectual disability.

The Stroop effect is the delay and disruption in naming the colours of words printed in non-
matching coloured ink, as when the word ‘red’ is printed in blue ink, the word ‘blue’ in green
ink, and so on. To perform the task it is necessary to ignore the meanings of the printed
words and to respond only to the colours in which they are printed, but with experienced
adult readers automatic processing tends to occur, causing interference in the processing of
information and a significant increase in the time required to name the colours, compared
with the time taken to name the colours of meaningless strings of letters. The Stroop Effect
is utilised in testing the executive faculty of inhibition (suppression of interferences) and
error correction.

The Rey-Osterrieth Complex Figure test examines the ability to draw and later recall a
complex geometric configuration. It tests visual memory as well as executive deficits in the
development of strategies and planning. Performance is impaired in patients with dementia
and amnesic syndrome.
Ref: Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p.
53.

Colman AM. Oxford Dictionary of Psychology, 4th Edition. 2015

The correct answer is: A test of visual memory where a child is shown ten geometric designs,
one at a time, and asked to reproduce each one as exactly as possible on plain paper from
memory. → Benton test, A test to check inhibitory control aspect of executive function. →
Stroop test, This test measures the recall of learned material. It is a complex figure test,
which distinguishes between brain damage and mental retardation. → Rey-Osterreith test

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Psychodynamic reactions
Identify the defence mechanisms involved in each of the following situations:

A 39-year-old
woman is
diagnosed with
metastatic
cervical cancer.
She exhibits no
emotions with
Answer
respect to her
1Choose...RationalisationSplittingRepressionOmnipotenceRegressionIsolationDisplac
physical health
FormationIntellectualisationSublimation
but discusses
at great length
about the
pathology of
cervical cancer
and anatomy
of cervix.
A 34-year-old
man is served
debt collection
Answer
notice for
2Choose...RationalisationSplittingRepressionOmnipotenceRegressionIsolationDisplac
unpaid bills.
FormationIntellectualisationSublimation
He does not
react to this
note but soon
gets furious at
his wife for no
apparent fault
of hers.
A 20-year-old
woman is
diagnosed with
borderline
personality
disorder. She
finds it difficult
to trust people
and cannot
accept that
Answer
people can
3Choose...RationalisationSplittingRepressionOmnipotenceRegressionIsolationDisplac
have both
FormationIntellectualisationSublimation
good and bad
qualities. She
thinks that
everyone in
this world
must be either
good or bad
with no
moderation in
between.
The above-
described
woman
undergoes
psychotherapy.
She calls her
Answer
therapist as
4Choose...RationalisationSplittingRepressionOmnipotenceRegressionIsolationDisplac
"the best
FormationIntellectualisationSublimation
person in the
world" within
the first few
weeks of
uninterrupted
sessions.
The same
Answer
woman calls
5Choose...RationalisationSplittingRepressionOmnipotenceRegressionIsolationDisplac
her therapist
FormationIntellectualisationSublimation
the "the worst
person in the
world" and
demands a
change in
therapist when
the therapist
announces a
short break in
sessions due
to a planned
holiday.
Feedback
Explanation:

Intellectualisation is characterised by focusing on abstract concepts, logic, and other forms

of intellectual reasoning to avoid facing painful emotions (e.g. a victim of a traumatic abuse
experience may discuss the statistics of abuse instead of talking about the particular
experience).

Displacement is the process by which interest and/or emotion is shifted from one object
onto another less threatening one. For example, the person who is having problems at work
may displace the anger felt for their boss onto their family by displaying irritability and
moodiness at home.

Functionally, patients with borderline personality disorder distort their relationships by

considering each person to be either all good or all bad. They see people as either nurturing
attachment figures or as hateful, sadistic figures who deprive them of security needs and
threaten them with abandonment whenever they feel dependent. As a result of this
splitting, the good person is idealised, and the bad person devalued and denigrated.

Ref: Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul
30. p.893.

Casey P, Kelly B. Fish’s clinical pathology: Signs and symptoms in psychiatry, 4th Edition.
2019.p. 129.

Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p. 564.

The correct answer is: A 39-year-old woman is diagnosed with metastatic cervical cancer.
She exhibits no emotions with respect to her physical health but discusses at great length
about the pathology of cervical cancer and anatomy of cervix. → Intellectualisation, A 34-
year-old man is served debt collection notice for unpaid bills. He does not react to this note
but soon gets furious at his wife for no apparent fault of hers. → Displacement, A 20-year-
old woman is diagnosed with borderline personality disorder. She finds it difficult to trust
people and cannot accept that people can have both good and bad qualities. She thinks that
everyone in this world must be either good or bad with no moderation in between. →
Splitting, The above-described woman undergoes psychotherapy. She calls her therapist as
"the best person in the world" within the first few weeks of uninterrupted sessions. →
Idealisation, The same woman calls her therapist the "the worst person in the world" and
demands a change in therapist when the therapist announces a short break in sessions due
to a planned holiday. → Denigration

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Mechanism of drug action
Find the drug that matches each of the following mechanisms of action;

Phosphodiesterase-5 Answer
inhibitor 1Choose...SildenafilRivastigmineReboxetineBupropionGalantamineDuloxetine
Butyrylcholinesterase Answer
inhibitor 2Choose...SildenafilRivastigmineReboxetineBupropionGalantamineDuloxetine
Dopamine reuptake Answer
inhibitor 3Choose...SildenafilRivastigmineReboxetineBupropionGalantamineDuloxetine
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Explanation:

Sildenafil is a phosphodiesterase-5 inhibitor.

Rivastigmine is a cholinesterase inhibitor. It is both an acetylcholinesterase inhibitor and a

butyrylcholinesterase inhibitor.

Bupropion is a noradrenergic and dopaminergic reuptake inhibitor. It is indicated for

depression but is only licensed in the UK for treatment of nicotine dependence.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7th Edition. 2021. p.
699, 729.

Semple D, Smyth R. Oxford handbook of psychiatry. Oxford university press; 2019 Jul 30. p.
290.

The correct answer is: Phosphodiesterase-5 inhibitor → Sildenafil, Butyrylcholinesterase

inhibitor → Rivastigmine, Dopamine reuptake inhibitor → Bupropion

Question 113
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EEG Changes
For which of the following psychiatric conditions, identify the EEG changes most likely to
occur:

Answer 1Choose...Periodic generalized 1-2 Hz sharp wavesDiffuse

giant waves with a chaotic background of multifocal spikes and
sharp wavesFlattened traceNon-specific increase in slow wavesHigh
Angelman's
amplitude 2-3 Hz frontal activity with superimposed epileptiform
syndrome
dischargesFocal or regional delta activityGeneralized multiple spike-
wave dischargesEpisodic discharges recurring every 1-3
secondsTriphasic waves
Answer 2Choose...Periodic generalized 1-2 Hz sharp wavesDiffuse
giant waves with a chaotic background of multifocal spikes and
sharp wavesFlattened traceNon-specific increase in slow wavesHigh
Infantile
amplitude 2-3 Hz frontal activity with superimposed epileptiform
spasms
dischargesFocal or regional delta activityGeneralized multiple spike-
wave dischargesEpisodic discharges recurring every 1-3
secondsTriphasic waves
Answer 3Choose...Periodic generalized 1-2 Hz sharp wavesDiffuse
giant waves with a chaotic background of multifocal spikes and
sharp wavesFlattened traceNon-specific increase in slow wavesHigh
Neurosyphilis amplitude 2-3 Hz frontal activity with superimposed epileptiform
dischargesFocal or regional delta activityGeneralized multiple spike-
wave dischargesEpisodic discharges recurring every 1-3
secondsTriphasic waves
Answer 4Choose...Periodic generalized 1-2 Hz sharp wavesDiffuse
giant waves with a chaotic background of multifocal spikes and
sharp wavesFlattened traceNon-specific increase in slow wavesHigh
Stroke amplitude 2-3 Hz frontal activity with superimposed epileptiform
dischargesFocal or regional delta activityGeneralized multiple spike-
wave dischargesEpisodic discharges recurring every 1-3
secondsTriphasic waves
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In Angelman syndrome, EEG changes are notable by the age of 2. There are prolonged runs
of high amplitude 2-3 Hz frontal activity with superimposed inter-ictal epileptiform
discharges in patients of all ages. There is occipital high amplitude rhythmic 4-6 Hz activity
facilitated by eye closure, which is seen under the age of 12. There is no difference in EEG
patterns between AS patients with or without seizures.
In infantile spasms (seen in tuberous sclerosis), the EEG finding is described as
hypsarrhythmia. Diffuse high voltage waves (>400 microvolts) with irregular, chaotic
multifocal spikes and sharp waves in the background is the characteristic feature of
hypsarrythmia. Clinical seizures are associated with a marked suppression of the
background; this is called the electrodecremental response.

In neurosyphilis, there is a non-specific increase in slow waves occurring diffusely over the
scalp.

In stroke, there is focal or regional delta activity.

The correct answer is: Angelman's syndrome → High amplitude 2-3 Hz frontal activity with
superimposed epileptiform discharges, Infantile spasms → Diffuse giant waves with a
chaotic background of multifocal spikes and sharp waves, Neurosyphilis → Non-specific
increase in slow waves, Stroke → Focal or regional delta activity

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MoK Pharmacology CXEMI004

Pharmacokinetics of antipsychotics
Identify the antipsychotic drug using descriptions below;

1. Half life more than

50 hours AnswerChlorpromazinePromazineHaloperidolSertindoleOlanzapineRisperidoneAri
piprazoleAmisulprideClozapineQuetiapine

Not answered
The correct answer is: Aripiprazole
Mark 0.00 out of 1.00
2. Antipsychotics with a fast dissociation profile (choose two drugs)
AnswerChlorpromazinePromazineHaloperidolSertindoleOlanzapineRisperidoneAripiprazole
AmisulprideClozapineQuetiapine

Not answered
The correct answer is: Clozapine
Mark 0.00 out of 1.00
AnswerChlorpromazinePromazineHaloperidolSertindoleOlanzapineRisperidoneAripiprazole
AmisulprideClozapineQuetiapine
Not answered
The correct answer is: Clozapine
Mark 0.00 out of 1.00
3. D2 and D3 antagonist, with weak 5HT-7 antagonist actions
AnswerChlorpromazinePromazineHaloperidolSertindoleOlanzapineRisperidoneAripiprazole
AmisulprideClozapineQuetiapine

Not answered
The correct answer is: Amisulpride
Mark 0.00 out of 1.00
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Explanation:

The half-life of antipsychotics varies greatly. Shorter half-life medications, such as quetiapine
and ziprasidone, have 7-12 hours of half-life. Risperidone has a 3-hour half-life, but it is
metabolized to 9-hydroxy risperidone (aka paliperidone), which has a 24-28-hour half-life
while olanzapine has a 30-hour half-life. The longest half-life, about three days, is seen with
more recently introduced agents aripiprazole, brexpiprazole and cariprazine. The mean
elimination half-life is 75 hours for aripiprazole and 94 hours for the major metabolite
dehydro-aripiprazole.

See below for a table.

Clozapine has relatively low potency as a D2 receptor antagonist. At therapeutic doses,

clozapine occupies fewer D2 receptors than the other drugs that treat psychosis. Clinically
effective doses of clozapine occupy only 40-50% of striatal D2 receptors. Similarly, the
receptor antagonism for quetiapine is generally lower than that for other antipsychotic
drugs. This is probably why clozapine and quetiapine have low propensity to cause EPS. It
has also been postulated that clozapine binds more loosely to the D2 receptor, and because
of this ‘fast dissociation’, more normal dopamine neurotransmission is possible. Quetiapine
also shares this unique fast dissociation profile with clozapine, leading to the description of
‘hit-and’run mechanism’ ('hit' the D2 receptor (blockade) only for a short while to cause
antipsychotic effects and then 'run' (dissociate) before they cause extrapyramidal side
effects). As a result, they are recommended for use in Parkinson's disease with psychosis.

In addition to its actions at D2 receptors, amisulpride has some D3 antagonist actions and
some weak 5HT-7 antagonist actions, which may explain some of its negative symptom and
antidepressant actions.

Ref: Stahl SM. Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 7th Edition. 2021. p.
57.

Boland R, Verduin M. Kaplan and Sadock's Synopsis of Psychiatry, 12th Edition. 2022. p. 613.

Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical

Applications, 5th Edition. 2021. p. 223.

The correct answer is:

Half life more than 50 hours - Aripiprazole
Antipsychotics with a fast dissociation profile (choose two drugs) - Clozapine, Quetiapine

D2 antagonistic effect - Amisulpride

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MoK Psychology CXEMI 005

Cloninger's Theory of Personality

Identify the correct behavioural traits to match the dimensions of temperament described
by Cloninger.

1. Harm avoidance traits (Choose TWO) AnswerAmotivationFear of uncertainityFrustration

AvoidanceImpulsivityPerseverancePessimismPraise dependenceSelf
directednessSentimentalitySet-shifting

Not answered
The correct answer is: Fear of uncertainity
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AnswerAmotivationFear of uncertainityFrustration
AvoidanceImpulsivityPerseverancePessimismPraise dependenceSelf
directednessSentimentalitySet-shifting
Not answered
The correct answer is: Fear of uncertainity
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2. Novelty seeking traits (Choose TWO) AnswerAmotivationFear of uncertainityFrustration

AvoidanceImpulsivityPerseverancePessimismPraise dependenceSelf
directednessSentimentalitySet-shifting

Not answered
The correct answer is: Frustration Avoidance
Mark 0.00 out of 1.00
AnswerAmotivationFear of uncertainityFrustration
AvoidanceImpulsivityPerseverancePessimismPraise dependenceSelf
directednessSentimentalitySet-shifting
Not answered
The correct answer is: Frustration Avoidance
Mark 0.00 out of 1.00

3. Reward dependence traits (Choose TWO) AnswerAmotivationFear of

uncertainityFrustration AvoidanceImpulsivityPerseverancePessimismPraise dependenceSelf
directednessSentimentalitySet-shifting

Not answered
The correct answer is: Praise dependence
Mark 0.00 out of 1.00
AnswerAmotivationFear of uncertainityFrustration
AvoidanceImpulsivityPerseverancePessimismPraise dependenceSelf
directednessSentimentalitySet-shifting
 Not answered
The correct answer is: Praise dependence
Mark 0.00 out of 1.00
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Explanation: Cloninger's psychobiological model of personality includes four dimensions of
temperament (each 50 to 60 % heritable), which manifest early in life and 3 components of
character, which are shaped by environment. The temperamental dimensions include

• (1) Novelty-seeking (includes frustration avoidance, impulsive decision-making)

• (2) Harm-avoidance (pessimistic worry about the future, passive avoidant behaviour,
fear of uncertainty);
• (3) Reward-dependence (sentimentality, social attachment, and dependence on
praise and approval)
• (4) Persistence (high perseverance and tolerance of frustration). The character
dimensions are self-directedness, cooperativeness, and self-transcendence.

The correct answer is:

Harm avoidance traits (Choose TWO)- Fear of uncertainty, Pessimism,

Novelty seeking traits (Choose TWO)- Frustration Avoidance, Impulsivity,

Reward dependence traits (Choose TWO)- Praise dependence, Sentimentality

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