ABSTRACT
Which of the following statements about the psychological treatment of premenstrual syndrome is true?
Cognitive therapy is superior to information-focused therapy
Combining fluoxetine and CBT is more effective than either treatment alone
The National Association for Premenstrual Syndrome is run by patient-only groups
Relaxation training is superior to coping-skills training
Support groups have a good level of evidentiary support (APT 2007)
All of the following statements about suicide and antidepressants are true except:
Anxiety disorder is a high-risk factor for suicidal acts for patients who are taking antidepressants
The natural history of the disorder accounts for up to 10% of the placebo response
The risk of suicidal acts for patients taking fluoxetine is 1.9 relative to those taking a placebo
The CI for risk of suicidal acts for patients with bulimia who are taking fluoxetine is 0.3–6.9
The risk of suicidal acts for patients taking SSRIs is 1.6 relative to those taking other antidepressants (APT 2006)
184All of the following statements about the cognitive–behavioural therapy model for OCD are true except:
According to this model, intrusive thoughts are universal, with a content indistinguishable from that of clinical obsessions
Avoidance is not a part of the definition of OCD
Excessive attentional bias on monitoring intrusive thoughts is specific to OCD
Rumination covers both the obsession and any accompanying mental compulsion
Thought–action fusion is also known as magical thinking (APT 2007)
Mrs Bentley is being considered for CBT for OCD. All of the following aspects are related to her treatment except:
Combining actual and imagined exposure is superior to actual exposure alone
The degree of family involvement is an area to be covered in the assessment
In response prevention, patients are never forced to stop a compulsion
The Obsessive-Compulsive Inventory is an objectively rated tool
Prolonged exposure and response-prevention sessions with frequent homework will result in symptom reduction (APT 2007)
185All of the following statements about the practice of psychological therapies for OCD are true except:
Among those who are adherent to therapy, approximately 75% show improvement
CBT is superior to exposure and response prevention
Challenging a patient’s appraisal of intrusive thoughts is associated with less success than challenging their content
Hazardous CBT involves the therapist becoming engaged in subtle requests for reassurance
Around 25% of all patients refuse or drop out from exposure and response prevention (APT 2007)
Mrs Schmidt is being considered for CBT for OCD. The psychologist in your team wants to know from your assessment the factors for her prognosis. The poor prognostic factors include all of the following except:
Comorbid schizoid personality
Expressed hostility from family members
Hoarding
Overvalued ideation
Severe avoidance (APT 2007)
All of the following statements about CBT for paranoia are true except:
Clinicians need to be flexible with regard to the length of the sessions
The evidence is strongest for negative symptoms such as apathy
It is an exploratory approach
It reduces recovery time for acute psychosis
Self-help includes testing out suspicious thoughts (APT 2006)
186Which of the following is an ineffective remedy in the treatment of anxiety?
Crataegus oxyacantha
Melissa officinalis
Passiflora incarnate
Piper methysticum
Valeriana officinalis (APT 2007)
The herbal remedy that interacts with phenothiazide to cause epileptic seizures is:
Evening primrose oil
Kava
Lemon balm
St John’s Wort
Valerian (APT 2007)
The herbal remedy that interacts with levodopa to produce extrapyramidal symptoms is:
Evening primrose oil
Kava
Maidenhair tree
St John’s Wort
Valerian (APT 2007)
Which of the following is the symptom with the highest frequency among core manic symptoms in hypomania?
Decreased sleep
Disinhibition
Increased activity
Increased plans or ideas
Increased talkativeness (APT 2006)
187All of the following are substances associated with hypomania except:
Amphetamine
Alcohol
Cannabis
Cocaine
MDMA (APT 2006)
All of the following correlations are true except:
Chronic fatigue syndrome – reduced activity in orbitofrontal cortex
Chronic functional pain – down-regulation of anterior cingulate cortex
Eating disorder – activation of the right amygdala
Functional angina – activation of anterior cingulate cortex
Somatisation – reduced metabolism in bilateral caudate nuclei (APT 2006)
All of the following associations between stroke and mood disorder are true except:
Antidepressants are effective in treating emotionalism irrespective of a diagnosis of depression
Bromocriptine aggravates apathy following a stroke
The standardised mortality rate from suicide following a stroke increases by threefold
There is more evidence of lability of mood in mood disorders associated with a stroke
Tricyclic antidepressants are more effective than SSRIs (APT 2006)
188Which of the following statements about epilepsy is true?
CBT is ineffective in the treatment of non-epileptic seizures
Episodic psychosis is unrelated to prescribed drug use
The lifetime prevalence of panic disorder is 10%
The prevalence of neuropsychiatric disorder in people with epilepsy is 3%
Up to 50% of people who are referred to specialist epilepsy centres have non-epileptic episodes (APT 2006)
Which of the following statements about neuropsychiatric disorders and Parkinson’s disease is true?
Anxiety is common in older patients with Parkinson’s disease
Depression is common among women patients
Delusions are found in 1% of patients with Parkinson’s disease
The prevalence of all psychiatric syndromes among patients with Parkinson’s disease is 30%
Around 5% of patients with Parkinson’s disease with no dementia have cognitive impairment (APT 2006)
All of the following statements about drug treatment and Parkinson’s disease are correct except:
Clozapine at a dose greater than 100 mg/day is the treatment of choice for psychosis
Dopamine agonist treatment is associated with hypomania in pre-existing bipolar affective disorder
Dopaminergic drugs are associated with psychosis
SSRIs exacerbate extrapyramidal symptoms
Tricyclic antidepressants may improve motor symptoms (APT 2006)
189Which of the following statements about smoking cessation treatments is correct?
Bupropion induces weight gain
The gold standard is pharmacotherapy plus individual or group support
Pre-loading with nicotine replacement therapy reduces cessation rates
Nortriptyline is less effective than SSRIs
Varenicline is less effective than bupropion (APT 2008)
Which of the following statements about nicotine replacement therapy (NRT) is correct?
Its nasal spray form is not available in the UK
The risk ratio of abstinence for any form of NRT relative to control is 1.58
The risk ratio is significantly greater for gum than for lozenges
A single form of replacement is more effective than combined forms
Using NRT for short periods before quitting delays abstinence (APT 2008)
Which of the following statements about pharmacological treatments for smoking is true?
Carbamazepine decreases the level of hydroxybupropion
Nortriptyline’s mode of action is independent of its antidepressant effect
Rimonabant is a selective μ-receptor agonist
The most common side-effect of bupropion is sleepiness
Varenicline is a nicotinic receptor antagonist (APT 2008)
190All of the following statements about psychological treatments for smoking are true except:
The evidence of success of brief interventions provided by nurses is weak
Exercise has a positive effect on cigarette cravings
Group therapy is more effective than self-help
Self-help material has an additive effect when used alongside NRT
Simple advice from a physician has a significant odds ratio of 1.74 (APT 2008)
Which of the following statements about smoking and mental illnesses is true?
The daily consumption of 15 or more cigarettes per day is required for the metabolism of mirtazapine
During smoking cessation, doses of clozapine but not of olanzapine need to be reduced to 75% to prevent toxicity
The incremental cost per life-year saved for NRT is £500
The use of both NRT and CBT doubles the cessation rates for patients with depression
Although bupropion reduces relapse rates, it is associated with the worsening of psychotic symptoms (APT 2008)
Which of the following statements about alcohol and EEG is true?
Chronic alcoholism shows similar changes to intoxication
Intoxication is associated with fast activity in the temporal area
Intoxication is associated with decreased beta waves
It takes 6 to 12 months for slow-wave sleep to become normal following abstinence
Withdrawal is associated with slow waves (SBN)
191Which of the following statements about the NICE guidelines for OCD is correct?
Adults who show mild impairment but are unable to engage in low, intense CBT should not be considered for high, intense CBT
Adults with moderate functional impairment should be offered CBT combined with SSRI treatment
Adding an SSRI to CBT is contraindicated for children aged between 8 and 11 years
Initial offers of treatment should include exposure and response prevention
Step 5 involves inpatient treatment ( www.nice.org.uk )
According to the NICE guidelines for OCD, all of the following statements are true except:
Therapists need to advise patients that there is no convincing evidence for the effectiveness of psychoanalysis
Therapists need to consider giving cognitive therapy in addition to exposure and response prevention, to enhance long-term symptom reduction
Therapists need to consider cognitive therapy for patients who refuse to engage in exposure and response prevention
Therapists need to consider using rewards for motivation
Therapists need to discourage patients’ families from using exposure and response prevention should new symptoms emerge ( www.nice.org.uk )
192According to the NICE guidelines, which of the following statements is true?
Therapists need to carry out an ECG before commencing clomipramine
Therapists need to inform patients that it might take up to 12 weeks for an improvement to be noticed
Drug treatment may be continued for up to 12 months if it is effective
SSRI treatment for children should be continued for 6 months after remission if a response is observed
Therapists should offer clomipramine as a first-line drug treatment for adults ( www.nice.org.uk )
All of the following statements about the NICE guidelines for bipolar affective disorder are true except:
If a patient is taking an antidepressant at the onset of manic symptoms, that antidepressant should not be stopped abruptly
If antipsychotics are ineffective in the treatment of mania, augmenting them with valproate should be considered
The guidelines recommend olanzapine for long-term treatment
Patients should not routinely continue antidepressants as a long-term treatment
Risperidone is licensed for the acute treatment of mania ( www.nice.org.uk )
Which of the following does the angular gyrus receive?
Auditory input
Smell input
Somaesthetic input
Taste input
Visual input (TN)
193All of the following are parts of the limbic lobe except the:
Cingulate gyrus
Parahippocampal gyrus
Paraolfactory gyrus
Precuneus
Preterminal gyrus (TN)
Afferent fibres from the thalamus are found in the:
External granular layer
External pyramidal layer
Fusiform layer
Internal pyramidal layer
Molecular layer (TN)
Stellate neurons are found in the:
External granular layer
External pyramidal layer
Fusiform layer
Internal pyramidal layer
Molecular layer (TN)
The right and left amygdalas are connected by the:
Anterior commissure
Genu of corpus callosum
Hippocampal commissure
Posterior commissure
Rostrum of the corpus callosum (TN)
194Mr Bainbridge presents with right hemiparesis, loss of proprioception and loss of his vibratory sense. To which of the following is this due?
The left anterior spinal artery at the medulla
The left anterior spinal artery at the spinal level
A left posterior spinal-artery occlusion
The right anterior spinal artery at the spinal level
A right posterior spinal-artery occlusion (TN)
Which of the following is predominantly released by the pyramidal cells in the cortex?
Acetylcholine
Dopamine
Glutamate
Glycine
Serotonin (TN)
Which of the following is the function of the red nucleus?
Coordination of eye and neck movements
Orientation of the head
The reflex movements of the axial and limb musculature
Sensory modulation
The voluntary movements of the upper limb muscles (TN)
In which of the following are the pyramidal cells that contribute to the corticospinal and corticobulbar tracts situated?
Layer I
Layer II
Layer III
Layer IV
Layer V (TN)
195All of the following statements about the premotor cortex are true except:
Its key function is in the planning phase of motor activity
It involves area 6
It is on the lateral aspect of the frontal lobe
Once an intended activity begins, its activity continues to increase
Its principal function is the control of axial and proximal limb musculature (TN)
Mr Bainbridge presents with a wrinkled forehead, raised eyebrow, drooping eyelid, dilated pupil, and downward and abducted eye on the left half of his face. Which of the following does the lesion involve?
The left abducens nerve
The left oculomotor nerve
The left trochlear nerve
The right facial nerve
The right oculomotor nerve (TN)
Mr Bainbridge presents with a diplopia that becomes very prominent when descending stairs and while reading. It also tilts his head to the right side. This could be due to a lesion involving:
The left trochlear nerve
The left trochlear nucleus
The right abducens nerve
The right facial nerve
The right trochlear nerve (TN)
196Which of the following is mediated by the mesencephalic nucleus of the trigeminal nerve?
The contraction of the muscles of mastication
The jaw-jerk reflex
Pain and thermal sensation from the mandibular division of the nerve
Taste from the anterior two-thirds of the tongue
Touch and pressure sensation from the maxillary division of the nerve (TN)
On eye testing, Mr Bainbridge can gaze to the right with no apparent difficulty. On attempting to gaze to the left, his right eye cannot move inward and his left eye moves outward. He is able to look at a pen placed directly in front of him with no difficulty. The lesion involves the:
Right abducens
Right medial longitudinal fasciculus
Right ophthalmic nerve
Right optic nerve
Right trochlear nerve (TN)
All of the following statements about the taste pathway are true except:
The anterior two-thirds of the tongue are supplied by the facial nerve
The fibres from the ventroposteromedial nucleus end in the parietal operculum
The nodose ganglion receives the fibres from the posterior third of the tongue
Some fibres from the solitary nucleus pass to the parabrachial nucleus
Taste fibres pass through the posterior limb of the internal capsule (TN)
197Which of the following statements about the cytoarchitecture of the cerebral cortex is true?
Aspiny cells release glutamate
The cells of Martinotti are bipolar
Fusiform cells have their dendritic projections to deep cortical layers
The horizontal cells of Cajal are situated in deep cortical layers
Pyramidal cells release aspartate (TN)
All of the following statements about the cell layers of the neocortex are true except:
The external granular layer consists mainly of stellate cells
The internal pyramidal layer is the source of the majority of the corticofugal fibres
Layer IV is the main efferent station of the cerebral cortex
The pyramidal cell axons of the external pyramidal layer are the principal source of the corticocortical fibres
The most numerous cells in the plexiform layer are the horizontal cells of Cajal (TN)
The arcuate fasciculus is part of the:
Inferior longitudinal fibres
Inferior occipitofrontal fasciculus
Short-association fibres
Superior occipitofrontal fasciculus
Superior longitudinal fasciculus (TN)
198All of the following statements about the internal capsule are true except:
Its anterior limb includes corticothalamic radiations
Its genu transmits corticobulbar fibres
It has sub- and retrolenticular limbs
Its posterior limb is between the head of the caudate nucleus and the lentiform nucleus
Its retrolenticular limb carries visual information (TN)
All of the following statements about the motor cortex are true except:
Part of the precentral gyrus controlling the movements of the tongue is located at its inferior aspect
The premotor cortex receives fibres from the cerebellum through the ventral lateral nucleus of the thalamus
Its primary motor area corresponds to Brodmann’s area 4
Its secondary motor cortex is localised exclusively to the frontal lobe
Its supplementary motor area receives input from the basal ganglia (TN)
Which of the following equations regarding the composition of intracellular fluid is accurate?
Na+ = 152 mmol/L
Cl− = 117 mmol/L
HCO3 − = 27 mmol/L
Proteins = 74 mmol/L
Ca2+ = 5 mmol/L (SBN)
199All of the following statements about cell membranes are true except:
They behave as if there were pores
They are permeable to large molecules
They are permeable to lipophilic substances
They are permeable to water
They are selectively permeable to ions (SBN)
Which of the following statements about action potentials is true?
At equilibrium, the electrical force that prevents an efflux of potassium ions is opposed by the concentration gradient that promotes efflux
There are two different types of calcium channels
ECl = −95 mV
Their refractory period is due to the voltage-dependent inactivation of the K+ channels
A sodium pump contributes −127 mV to their resting membrane potential (SBN)
The fibres with the fastest conduction velocity are the:
Aα fibres
Aβ fibres
Aγ fibres
Aδ fibres
C fibres (SBN)
200Which of the following statements about higher-order somatosensory processing is true?
Its large peripheral innervations have a small cortical representation
Its lateral inhibition involves GABA-mediated inhibition by interneurons on adjacent second-order neurons
Its lateral inhibition is a mechanism for limiting the spread of excitation between couples inputs
Its lateral inhibition is one form of feedback inhibition
There are only two different representations of the body’s surface in the cortex (SBN)
All of the following are features of surface dyslexia except:
A breakdown of whole-word reading
Difficulty in reading irregularly spelt words
An inability to read non-words
A lesion in the left temporoparietal region
Making phonologically possible errors
Which of the following is a characteristic feature of peripheral dysgraphia?
Better concrete than abstract spelling
A breakdown of the lexical route for spelling
Oral spelling remaining intact with defective copying
Semantic errors
Being unable to spell non-words (CA)
201All of the following lesions are correctly matched except:
Acalculia – left angular gyrus
Alexia without agraphia – left medial occipital lobe
Dyspraxic dysgraphia – dominant temporal lobe
Lexical dysgraphia – left temporoparietal region
Neglect dysphasia – right hemisphere lesion (CA)
All of the following tests are correctly matched except:
The ability to point to numbers test – dyscalculia
The Cambridge Semantic Battery – visual agnosias
The meaningful and meaningless gesture test – sensory neglect
The single-letter identification test – dyslexia
The spontaneous writing of sentences test – dysgraphia (CA)
Mr Bainbridge presents with a breakdown of fine motor coordination. He has difficulty copying meaningless hand gestures, but can copy meaningful ones. This is:
Conceptual apraxia
Ideational apraxia
Ideomotor apraxia
Limb kinetic apraxia
Oral apraxia (CA)
202Which of the following statements about spasmodic torticollis is true?
Its annual incidence is 1 in 1 000 000
Anticholinergic treatment is effective in more than 50% of patients with this condition
Botulinum toxin is a rare cause of spasmodic torticollis
It is the most common focal dystonia
Remission occurs in 40% of patients with this condition (SBN)
Which of the following statements about neuroleptic-induced movement disorders is true?
α but not β adrenoceptor antagonists are useful in the treatment of akathisia
Dopamine agonists worsen the symptoms of neuroleptic malignant syndrome
The incidence of acute dystonia can be as high as 10% for high-potency neuroleptics
Fewer than 50% of those affected with tardive dyskinesia have symptoms restricted to their face
Tremors are the first feature to develop in drug-induced parkinsonism (SBN)
Mr Bainbridge presents with daytime somnolence associated with hypoxia and recurrent waking during the night. The diagnosis is:
Alzheimer’s dementia
Cataplexy
Kleine–Levin syndrome
Narcolepsy
Pickwickian syndrome (SBN)
203Mr Bainbridge presents with narcolepsy, sleep paralysis and hypnogogic hallucinations. This is:
Ganser syndrome
Gelineau syndrome
Kleine–Levin syndrome
Kluver–Bucy syndrome
None of the above (SBN)
All of the following are disorders of neural-tube defects except:
Chiari malformation
Encephalocele
Holoprosencephaly
Meningocele
Spina bifida (SBN)
Which of the following conditions results from a persistent infection by the measles virus with inclusions in neurons and oligodendrocytes?
Binswanger’s disease
Lacunar disease
Subacute sclerosing panencephalitis
Perivenous encephalomyelitis
Progressive multifocal leukoencephalopathy (SBN)
204All of the following statements about neurosyphilis are true except:
There is dorsal column involvement that leads to loss of proprioception
Optic atrophy may occur
The pupils are small
The pupils respond to light but not accommodation
Its vascular forms may be associated with raised intracranial pressure (SBN)
All of the following statements about neurofibrillary tangles are true except:
They are absent in progressive supranuclear palsy
They can be found in the locus coeruleus
They consist of intracellular paired helical filaments
They are formed by abnormal phosphorylation of the tau protein
They are present in post-encephalitic parkinsonism (SBN)
Swollen cortical pyramidal cells are seen in:
Alzheimer’s disease
Creutzfeldt–Jacob disease
Huntington’s disease
Parkinson’s disease
Pick’s disease (SBN)
205In which of the following is the ‘fried-egg’ appearance seen?
Anaplastic astrocytomas
Astrocytomas
Ependymomas
Glioblastoma multiforme
Oligodendrogliomas (SBN)
The expression of steroid receptors in tumours can be studied using:
Indomethacin
Reboxetine
Riluzole
Tamoxifen
Viloxazine (SBN)
Which of the following is the enzyme that inactivates circulating cortisol in tissues that express mineralocorticoid receptors?
9-hydroxysteroid dehydrogenase
9-cortisol cyclase
11-hydroxysteroid dehydrogenase
11-cortisol cyclase
11-hydroxysteroid decarboxylase (SBN)
All of the following are associated with insulin resistance except:
Acanthosis nigricans
Hypertriglyceridaemia
Lipodystrophy
Polycystic ovaries
Testicular feminisation (SBN)
206All of the following statements about insulin-like growth factor (IGF) binding proteins are true except:
IGF-1 has a 60% homology with proinsulin
IGF-1 mediates the functions of growth hormone
IGF binding protein 1 (IGFBP-1) binds to both IGF-1 and IGF-2
IGFBP-1 shows diurnal variation
IGFBP-1 shows a gradual decline from childhood to puberty (SBN)
Which of the following controls the posterior pituitary?
The ventroposterolateral nucleus
The magnocellular paraventricular nucleus
The preoptic nucleus
The suprachiasmatic nucleus
All of the above (SBN)
All of the following statements about fragile X syndrome are true except:
It is associated with a loss of expression of the FMR2 gene
It is associated with attentional difficulties and hyperactivity
It is the single commonest known inherited cause of mental retardation
Its mutation involves CGG repeats within the first exon of the FMR1 gene
The rate of fragile X syndrome is higher among children with autism than among those with a learning disability (PG)
207As which of the following does the microdeletion of chromosome 7q11 present?
Angelman syndrome
Di George syndrome
Smith–Magenis syndrome
Turner’s syndrome
Williams syndrome (PG)
Which of the syndromes listed below is characterised by a prevalence of 1 to 2 per 2000, males affected by it being characteristically tall and having lower IQs than the general population, and an association with minor criminality?
Klinefelter’s syndrome
Prader–Willi syndrome
Smith–Magenis syndrome
Turner’s syndrome
XYY syndrome (PG)
Bainbridge Junior presents with a mild learning difficulty, a cleft palate, hypocalcaemia, and speech and swallowing difficulties. This is a presentation of:
Angelman syndrome
Di George syndrome
Smith–Magenis syndrome
Turner’s syndrome
Williams syndrome (PG)
208Bainbridge Junior presents with onychotillomania, polyembolokoilamania and self-hugging. This is a presentation of:
Angelman syndrome
Di George syndrome
Smith–Magenis syndrome
Turner’s syndrome
Williams syndrome (PG)
Which of the following statements about excitatory amino acids is true?
Around 20% of all synapses use glutamate as a transmitter
Glutaminase converts glutamate to glutamine
The hippocampal pyramidal cells use glutamate as a transmitter
Glutamate is converted to glutamine in neurons
In rough endoplasmic reticulum, glutamate is formed from glutamine (N)
All of the following statements about inhibitory amino acids are true except:
Cerebellar Purkinje cells use GABA as a neurotransmitter
GABA is synthesised from glutamate by glutamic acid decarboxylase
The glycine receptor is activated by strychnine
The Renshaw cells of the spinal cord use glycine as a neurotransmitter
Vigabatrin inhibits the catabolism of GABA to succinic semialdehyde (N)
209All of the following statements about dopamine are true except:
Around 80% of all dopaminergic neurons are found in the substantia nigra
Aldehyde dehydrogenase metabolises dopamine to homovanillic acid
The amacrine cells of the retina use dopamine as a neurotransmitter
Dopaminergic neurons are unmyelinated
The hydroxylation of tyrosine is the rate-limiting step in the synthesis of dopamine (N)
Which of the following statements about dopamine is true?
D1 receptors are autoreceptors
The D2 family is coupled to Gs
D3 receptors are postsynaptic autoreceptors
Striatum expresses D4 receptors
The vesicular monoamine transporter is blocked by reserpine (N)
Which of the following statements about noradrenaline is true?
Amphetamine increases stores of noradrenaline
DOPEG excretion is used as a measure of noradrenaline turnover
The noradrenaline transporter is a non-saturable Na+/Cl−-dependent transporter
The locus coeruleus contributes to the dorsal noradrenergic bundle
Phenylethanolamine N-methyl transferase is the rate-limiting factor in the synthesis of norepinephrine (N)
210The process that involves two different chromosomes fusing at or near the centromere is called:
Deletion
Duplication
Inversion
Robertsonian translocation
Substitution (PG)
The mechanism by which the variation in the rate at which a gene is expressed can be inherited in the absence of a change in the primary DNA sequence is called:
Anticipation
Epigenetic inheritance
A frame-shift mutation
A trinucleotide repeat
Uniparental isodisomy (PG)
In which of the following is methylation involved?
Angelman syndrome
Rett syndrome
Smith–Magenis syndrome
Turner’s syndrome
Williams syndrome (PG)
In which of the following is anticipation seen?
Angelman syndrome
Fragile X syndrome
Smith–Magenis syndrome
Turner’s syndrome
Williams syndrome (PG)
211In which of the following is uniparental isodisomy involving maternal chromosome 15 seen?
Angelman syndrome
Prader–Willi syndrome
Smith–Magenis syndrome
Turner’s syndrome
Williams syndrome (PG)
Which of the following statements about brain-derived neurotrophic factor (BDNF) and bipolar disorder is true?
The BDNF gene is associated with the early onset of bipolar disorder
GT(n) polymorphism is not associated with rapid cycling disorder
Mania may be caused by under-activity of the central BDNF function
Val66Met polymorphism is associated with susceptibility to bipolar disorder
Val66Met polymorphism is associated with susceptibility to rapid cycling (BJP 2006)
All of the following statements about borderline personality disorder (BPD) are true except:
Around 75% of people with BPD show remission within 6 years after presentation
Individuals with BPD have a hyperactive attachment system
Psychiatrists must take an expert role rather than an inquisitive stance in treating BPD
The recurrence rate of BPD is no more than 10% over 6 years
BPD patients’ relative risk of attempted suicide following treatment with dialectical behaviour therapy is −1.38 (BJP 2006)
212All of the following statements about brain volume in first-episode schizophrenia are true except:
The average volume deficit is less than 3%
The left ventricle is more enlarged than the right ventricle
No significant long-term change has been observed in the volumetric deficits seen at diagnosis involving the insula and the thalamus
It involves a reduction in whole brain volume but not in the volume of the hippocampus
Ventricular volume is increased (BJP 2006)
Which of the following statements about coronary heart disease and severe mental illness (SMI) is true?
Coronary heart disease is second only to suicide when the mortality rates from different causes are compared
Excess coronary heart disease is completely accounted for by a combination of medication and socio-economic circumstances
The mortality rate from coronary heart disease has decreased with the advent of atypical antipsychotics
The odds ratio of the association between SMI and HDLcholesterol is 4.0
There is no significant association between SMI and diabetes (BJP 2006)
213All of the following statements about CBT are true except:
Adjunctive CBT is only of benefit to people who have had fewer than 12 episodes of bipolar affective disorder
A long-term study of the use of CBT for treating comorbid schizophrenia and substance misuse found that it had no effect on the percentage of days of abstinence
CBT can reduce interpersonal difficulty among people at high risk for psychosis
CBT is effective for problems associated with amphetamine use
A reduction in compliance with command hallucination with a reduction in voice activity occurs following CBT for psychosis (BJP 2006)
Which of the following statements about the epidemiology of common mental illnesses is true?
In the UK, household income and geographical localisation have a significant effect on people’s mental health
Quantifying between-place differences using population density alone is the best way of interpreting the role of geographical localisation in mental health
Socioeconomic factors have a greater impact on the duration of episodes of mental illness than the time of their onset
Suicide rates are higher in the urban areas of England but not of Wales
Those living in rural areas have better mental health than those living in non-rural areas (BJP 2006)
214All of the following epidemiological observations are true except:
Agoraphobia occurs at 2 per 100 person-years at risk
Baseline agoraphobia without spontaneous panic disorder does not predict the first incidence of panic disorder
Cluster B disorders are associated with early institutional care
Other phobias predict the incidence of agoraphobia
The prevalence of personality disorder is highest among men (BJP 2006)
Which of the following statements about the psychological impact of stillbirth is true?
The father’s psychological morbidity is not associated with the presence of other children in the family
Stillbirth is a category C event for the development of PTSD in women
Stillbirth is a risk factor for anxiety but not for depression among women during subsequent pregnancies
Stillbirth is associated with prescribed drug use but not with alcohol use among fathers
It involves a significant difference in trait anxiety between mothers and fathers, both antenatally and at follow-up (BJP 2006)
215Which of the following statements about changes in grey matter is true?
A dominant unilateral increase in the volume of putamen takes place in adolescents with Tourette’s syndrome
The dorsal striatum is impaired in the cortico–striatal–thalamic–cortical circuitry implicated in Tourette’s syndrome
Grey matter increases in the left hippocampus of adolescents with Tourette’s syndrome
A number of soft neurological signs are associated with a reduction in grey matter in the prefrontal cortex
A number of soft neurological signs are associated with a reduction in grey matter in the lingual gyrus (BJP 2006)
All of the following statements about group therapies are true except:
Group CBT has a significant impact on schizophrenia relapse rates
Group CBT reduces feelings of hopelessness in patients with schizophrenia
Group CBT reduces low self-esteem among patients with schizophrenia
Group IPT has a significant effect on depression, which is maintained at 6-month follow-up
Group psychoeducational interventions offered to women in primary care reduce depressive symptoms (BJP 2006)
216All of the following statements about a synapse are true except:
Changes in the structure of synapses are mediated by growth factors
Conjoint synapses have both electrical and chemical characteristics
Nitric oxide, but not carbon monoxide, acts as a neurotransmitter in a synapse
The propagation of an action potential along an axon is an all- or-nothing phenomenon
The synaptic compartment represents less than 1% of the brain (KS)
Which of the following types of receptor is involved in seizures?
α1
D1
H1
M1
5-HT1A (KS)
Which of the following is the neurotransmitter in most primary afferent sensory neurons?
Acetylcholine
Corticotropin-releasing factor
Neuropeptide Y
Neurotensin
Substance P (KS)
217All of the following statements about structural neuroimaging techniques are true except:
Areas of the brain with an abnormally high water content appear brighter on a T2 image
Bony structures absorb the largest amount of radiation during a CT scan
CSF is dark on a T1 image
FLAIR is useful for detecting sclerosis of the hippocampus caused by temporal lobe epilepsy
MRI images are obtained in the axial and coronal planes but not in the sagittal plane (KS)
Which of the following statements about magnetic resonance spectroscopy (MRS) is true?
Dopamine cannot be detected using MRS
Just like MRI, MRS detects hydrogen nuclei only
An MRS of hydrogen-1 nuclei is used to detect the pH of the different regions of the brain
An MRS of hydrogen-1 nuclei is used to measure ATP
The resolution of MRS is equal to that of PET (KS)
EEGs show increased alpha activity with the use of which of the following?
Alcohol
Barbiturates
Caffeine
Opioids
Nicotine (KS)
218An EEG pattern of increased alpha activity in the frontal area, but with overall slow alpha activity, is seen with the use of which of the following?
Alcohol
Barbiturates
Cocaine
Opioids
Nicotine (KS)
Which of the following is an EEG feature of cerebrovascular accidents?
A diffuse asynchronous high-voltage slowing
A diffuse generalised slowing of wake frequencies
Focal delta activity
Focal delta slowing
Triphasic waves (KS)
Which of the following is a steroid-like hormone?
ACTH
β-Endorphin
FSH
LH
Thyroxine (KS)
219Which of the following is a research area that uses a range of bioinformatic approaches to analyse the expression and function of proteins within specific systems, cells or organisms?
Epigenetics
Linkage analysis
Multifactorial analysis
Polygenics
Proteomics (KS)
Which of the following statements about the neuropathology of schizophrenia is true?
A blunted prolactin response is seen in association with positive symptoms
The brains of people with schizophrenia show lower levels of phosphomonoester compared with the general population
People with schizophrenia have higher concentrations of n-acetyl aspartate in the hippocampus compared with the general population
The neuropathology of schizophrenia involves increased levels of T-cell interleukin-2 production
Around 25% of people with schizophrenia present with eye-movement dysfunction (KS)
All of the following factors are associated with a good prognosis in schizophrenia except:
Symptoms of depressive disorder
A family history of mood disorders
A history of assaultiveness
Being married
Having positive symptoms (KS)
220Which of the following statements about the comorbidities associated with schizophrenia is true?
People with schizophrenia tend to have higher rates of chronic obstructive pulmonary disease than people in the general population, independent of smoking
An inverse relationship exists between rheumatoid arthritis and schizophrenia
A lack of awareness of a movement disorder is associated with a lack of insight into a primary psychiatric disorder
Patients with schizophrenia are at no higher risk of HIV than the general population
All of the above are true (KS)
All of the following are risk factors for suicide among inpatients with common mental illnesses except:
Involvement with the police
Previous suicidal behaviour
The presence of hallucinations
Suffering a recent bereavement
Engaging in violence against property (BJP 2006)
All of the following are risk factors for suicide among patients discharged from hospital care except:
A lack of continuity of care
The lack of a social network
Suicidal ideation prior to discharge
Unemployment
An unplanned discharge (BJP 2006)
221Which of the following statements about schizoaffective disorder is true?
The depressive type may be more common in young adults
The lifetime prevalence of schizoaffective disorder is less than 0.5%
Lithium is ineffective in the treatment of schizoaffective disorder
Mood disorder dominance is associated with a poor prognosis
The disorder’s prevalence is significantly lower in married men than in women (KS)
Which of the following statements about delusional disorder is true?
Its annual incidence is less than 1 case per 100 000 patients
Its diagnostic criteria include the presence of a non-bizarre delusion for at least 3 months
The mean age of onset is around 40 years
More than 25% of its cases are reclassified as schizophrenia or a mood disorder at follow-up
A slight male preponderance exists (KS)
All of the following statements about the aetiology of delusional disorder are true except:
According to classic psychodynamic theory, the dynamics underlying the formation of delusions are independent of gender
Family history is not significantly associated with delusional disorder
The neurological conditions most commonly associated with delusional disorder involve the basal ganglia
Reaction formation is a primary defence mechanism used by patients with delusional disorder
Sensory isolation is associated with delusional disorder (KS)
222Mr Bainbridge presents with a belief that his wife can assume the guise of strangers. This is called:
Capgras syndrome
Delusional intermetamorphosis
Folie impose
Fregoli’s phenomenon
Illusion de sosies (KS)
All of the following personality disorders involve high susceptibility to developing psychotic symptoms except:
Borderline personality disorder
Antisocial personality disorder
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder (KS)
All of the following statements about genetic factors in affective disorder are true except:
The monozygotic concordance rate for mood disorders is 70–90%
The presence of more severe illnesses in a family conveys a greater risk than other factors
The risk of a child having an affective disorder if one parent is affected is 10–25%
Twin-study findings show that genes account for only 30% of the aetiology of mood disorders
Unipolar disorder is the most common form of disorder in families of bipolar probands (KS)
223The CREB1 locus is located on chromosome:
1
2
18
21
22 (KS)
Which of the following statements about psychosocial factors in affective disorders is true?
The development of depression is associated with losing a parent before the age of 14 years
The environmental stressor that is most strongly associated with the prevention of remission is the loss of a partner
People who are unemployed are three times more likely to report symptoms of an episode of major depression than employed people
People with antisocial personality disorder are more predisposed to depression than people with anankastic personality disorder
People with a histrionic personality trait use projection to protect themselves from their inner rage (KS)
The term used to describe the frustration of the emotional needs and wishes that patients may have in relation to the analyst is:
Analyst as mirror
Counter-transference
The principle of evenly suspended attention
The rule of abstinence
Transference (KS)
224In which stage of psychoanalysis does transference emerge?
1
2
3
4
5 (KS)
The supportive techniques of psychoanalytic therapy include all of the following except the:
Evocative
Relationship-oriented
Repressed
Suggestive
Suppressive (KS)
Which of the following is an indication for insight-oriented psychotherapy?
Meaningful object relations
Poor frustration tolerance
Poor reality testing
Significant ego defects of a long-term nature
A tenuous ability to form a therapeutic alliance (KS)
All of the following statements about brief focal psychotherapy are true except:
Its duration is up to 1 year
Its focus is on internal conflict present since childhood
Its goal is to clarify the nature of the patient’s defence
Its selection criteria include prospective patients having the ability to think in feeling terms
It involves 12 treatment hours (KS)
225Which of the following involves a cognitive profile that includes an inflated view of self, experience and the future?
Anxiety disorder
Conversion disorder
Depressive disorder
Hypomanic disorder
Paranoid personality disorder (KS)
Which of the following is the part of cognitive therapy that involves explaining the cognitive triad, schemas and faulty logic to the patient?
Eliciting automatic thoughts
Didactic aspects
Identifying maladaptive assumptions
Testing automatic thoughts
Testing the validity of maladaptive assumptions (KS)
In hypnosis, which of the following is the ability to reduce peripheral awareness, resulting in greater focal attention?
Absorption
Dissociation
Response attentiveness
Suggestibility
Trance development (KS)
226All of the following are non-verbal behavioural components of social skills training except:
Facial expression
Eye contact
Paralinguistic features
Posture
Proxemics (KS)
Which of the following statements about the phases of interpersonal psychotherapy is true?
Three sessions are dedicated to the initial phase
The initial phase involves the identification of areas and warning signs of anticipated future difficulty
Relating issues about psychiatric symptoms to the interpersonal problem area is part of the intermediate stage
Reviewing significant relationships in the past and present is a component of the intermediate phase
Sessions 10 to 15 constitute the termination phase (KS)
