NEUROSIS QUESTIONS 1.

Regarding neurosis a) The term neurosis was coined by Cullen in 1769 b) Freud coined the term psychoneurosis c) The term is excluded from ICD10 classification d) Females outnumber males at all age groups e) May now be diagnosed using functional neuro-imaging The term is excluded from DSMIV. M>F in childhood. Neuro-imaging may assist in diagnosis. 2. In the epidemiology of neurotic illness in general a) It is commoner in single people than in the widowed b) Increased incidence is found in ethnic minorities c) Twice commoner in social class 4&5 than social class 1 d) There is no geographical variation e) Panic symptoms less common than phobic symptoms There is no racial bias. It is commoner in urban area than rural areas. 3. Good outcome factors in community samples of patients with neurosis include a) Male gender b) Depression symptoms c) Middle age d) Psychotropic medication e) Stable social support T F F F T F F T F T T T F F F

Outcome based on severity of symptoms, it is not illness specific. Young. Medication suggests worse severity. 4. Brown and Harris risk factors for depressive illness include a) Three or more children < 11 years old at home b) Early maternal loss c) Unemployment d) Positive family history e) Lack of confiding relationships F T T F T

Three or more children <14 Positive family history is a risk factor, but not proposed by HB and Harris. 5. Factors associated with neurotic illness include a) Terraced housing F

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b) Length of marital relationship c) Reduced rate of malignancy d) Increased rate of suicide e) Neurotic illness in the spouse

T T T T

High rise flats Longer marriages associated with increased rates 6. The arousal response includes a) Increased heart rate b) Increased finger pulse volume c) Increased EMG response d) Increased alpha pattern on EEG e) Increased habituation on GSR T F T F F

Reduced finger pulse volume. Reduced alpha and increased beta pattern on EEG Reduced habituation on GSR. 7. Regarding childhood and adult neurotic illness a) Male > Female in childhood T b) Most childhood illness persists into adulthood F c) Thumb sucking is associated with childhood illness F d) Childhood schizoid traits usually persist into adulthood T e) High achieving males associated with close paternal relationship T 8. In panic disorder a) There are recurrent predictable attacks of severe anxiety b) There is an association with depersonalisation c) The prevalence is < 1.1% d) Positive family history commoner if onset < 20 years old e) First degree relatives have increased rate of depression Recurrent unpredictable attacks. Prevalence 0.6-1%. First degree relatives have increased rate of panic disorder. F T T T F

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9. The following associations have been found with panic disorder a) Symptoms induced by sodium lactate infusion b) Symptoms induced by raised carbon monoxide levels c) Abnormalities on CT brain scans d) CSF neurotransmitter abnormalities e) Left parahippocampal abnormalities T F F T F

Symptoms induced by raised carbon dioxide levels. PET scans have shown abnormalities of the right parahippocampal region. Nor adrenaline, 5HT and GABA all implicated. 10. With respect to the treatment of panic disorder a) SSRI antidepressants may worsen symptoms b) Benzodiazepines are ineffective c) TCA are more effective than MAOI antidepressants d) Clomipramine is more effective than imipramine e) Psychoeducation may be beneficial T F F F T

SSRI may worsen anxiety when first commenced. Benzodiazepines work rapidly at high dose but induce dependence. Clomiprmine, imipramine and MAOI are of equal efficacy. Cognitive therapy includes education about the cause of symptoms. 11. In Generalised Anxiety disorder a) there is a proven association with mitral valve prolapse b) it is familial in 15-20% of cases c) there is a later age of onset than in panic disorder d) DSM IV diagnosis requires persistent symptoms for 2 weeks e) relationship to irritable heart disorder Mitral valve association is disputed by many researchers. Family history present in 30% cases. Earlier and more gradual onset than other anxiety disorders. DSM IV requires persistent symptoms for 4 weeks. F F F F T

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12. The following tests may be useful in the differential diagnosis of anxiety disorders a) lid lag b) calcium and phosphate c) glucose d) CSF HMMA level e) Echocardiography T T T F T

Lid lag is a clinical sign of thyrotoxicosis. Calcium and phosphate are abnormal in parathyroid disease. Urine HMMA and glucose are elevated in phaeochromocytoma Echocardiography excludes cardiomyopathy and mitral valve disease. 13. Phobic disorders include the following features a) response is out of proportion to the threat b) exposure to anxiety provoking situations c) prevalence rate of 6-10/ 1000 d) increased rate of phobic disorder in relatives e) symptoms under voluntary control T F T T F

avoidance of anxiety is a core feature, exposure is a treatment. symptoms are involuntary. 14. Regarding agoraphobia a) literally means a fear of open spaces b) sufferers are female c) symptoms include fear of closed spaces d) incidence rate is 0.2% e) associated with unstable home background F T T F T

literally means a fear of the market space. symptoms include fear of closed as well as open spaces. incidence rate is 5 13%. 15. The following are correct for social phobia a) commoner in female than male b) rarely has onset after age 20 c) associated with positive family history d) is commonly secondary to generalised anxiety e) sufferers feel persecuted by strangers Equal sex incidence. Rarely begins after age 30. If secondary it is nearly always due to depression. 16. In Obsessive Compulsive Disorder a) females outnumber males T F F T F F

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b) prevalence is 5 10% c) precipitant identified in 30% d) males have earlier age of onset than females e) delayed presentation is typical F:M ratio 1.2 to 2.3:1 prevalence 2-3% no precipitant identified in 30%

F F T T

17. The following association for Obsessive Compulsive Disorder are correct a) positive family history of obsessive compulsive disorder b) positive family history of depression c) 20% sufferers have tics d) increased rate of suicide e) correlation with obsessional features in childhood reduced rate of suicide 18. The following support a biological basis for Obsessive Compulsive Disorder a) reduced platelet serotonin b) reduced function of orbito-frontal cortex c) reduced caudate nucleus volume d) increased sensitivity post synaptic 5HT receptors e) reduced CSF 5 hydroxyindoleacetic acid T T T T T F T T F F

19. Effective treatment of Obsessive Compulsive Disorder includes a) desimipramine b) exploratory psychotherapy c) Electroconvulsive therapy d) response prevention e) vicarious learning F F F T T

desimipramine is said to be ineffective

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20. Somatisation disorder is associated with a) multiple somatic complaint with negative investigation over 2 years b) abrupt onset c) alcohol excess in first degree relatives d) over concern regarding the possibility of underlying disease e) positive family history in 10% slow lifelong illness over concern regarding symptoms positive family history in 20% 21. Regarding hypochondriasis a) delusions are absent b) M>F c) if unilateral, left side predominates d) there is a preoccupation with symptoms e) there is often a family history F F T F F T F T F F

delusions may be present in some forms of the disorder. there is a preoccupation with disease. there is no familial tendency identified. 22. The following are true for conversion disorder a) association with anaesthesia b) globus hystericus is commoner in females c) typical insidious onset d) 60% present with identifiable organic illness e) La belle indifference is a diagnostic feature T T F F F

anaesthesia may be a symptom of conversion disorder typical abrupt onset studies have shown 60% have organic illness in long term follow up 23. Regarding psychogenic amnesia a) it is typically of sudden onset b) associated with clouding of consciousness c) commoner in the elderly d) associated with life events e) generalised amnesia is the commonest presentation clouding of consciousness implies an organic cause commoner in the young generalised amnesia is uncommon 24. Fugue states are associated with a) purposeless wandering F T F F T F

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b) schizophrenia c) generalised amnesia d) primary psychological gain e) mutism

T F T F

purposeful wandering. non generalised amnesia. primary and secondary psychological gain. sufferers can interact with and talk to others. 25. The following statements about compensation neurosis are correct a) It is the faking of disability for financial reward b) It is commoner in lower social classes c) It is commonest in middle aged individuals d) Most show complete recovery after settlement e) Cognitive behaviour therapy is recommended F T T F F

It is said to be an unconscious phenomenon. Recent studies refute previous claims about total resolution after settlement. No specific psychiatric intervention is recommended. 26. Regarding acute stress reaction a) characteristically begins 2-3 days after stressful event b) residual symptoms are present in 10% c) association with deliberate self harm d) commoner in depressed patients e) diagnosis confined to western society F F T F F

characteristically begins within a few hours and resolves completely in 2-3 days. diagnosis cannot be made in those suffering from prior psychiatric illness. 27. The following support a biological basis for post traumatic stress disorder a) reduced caudate nucleus volume b) 5HT receptor hypersensitivity c) reduced hippocampal volume d) increased P300 amplitudes e) increased amygdala activation no association with caudate nucleus size. reduced P300 amplitudes. 28. The following are typical features of post traumatic stress disorder a) delayed onset b) anticipatory anxiety c) hypervigilance d) hypersomnia e) incongruous affect T F T F F F T T F T

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anticipatory anxiety is a feature of phobic disorder. reduced sleep is common. numbed affect may be present. 29. Adjustment disorder a) develops within one week of the stressful event b) includes grief reactions c) is associated with depression d) is associated with amnesia for the event e) usually resolve within three months of event F T T F F

develop within 3 months of the event and may be persistent and prolonged. 30. Depersonalisation symptoms are found in a) Temporal lobe epilepsy b) schizophrenia c) Gansers syndrome d) depersonalisation syndrome e) phobic anxiety T T F T T

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