10 - AIIMS november 2008 psychiatry mcqs

194. type two schizophrenia(tj crow) is characterised by all except?

a. negative symptoms
b. poor response to tt
c. disorganised behaviour
d. CT scan abnormal

answer:

195.according to disabilities act 1995. seventh disability as it is usually referred to is?

a. neurological abnormality
b. mental illness
c. substance abuse
d. disability due to road traffic accident

answer:

196. cognitive model of depression is given by?

a. godfrey
b. beck
c.
d.

answer:

197.most recent marker of ECT is?

a. 5-HIAA
b. CSF dopamine
c. brain derived growth factor
d. thyroxine

answer:

9 - paraphilias - part 7

• Other paraphilias

·

• Autogynephilia describes a man's propensity to be sexually aroused by thoughts or images of himself as a woman (with female attributes).
• 
  
• Asphyxiophilia or hypoxyphilia is when a patient uses hypoxia to achieve sexual excitement; this can be complicated by autoerotic asphyxiation.
• 
  
• Video voyeurs derive sexual gratification from videos, usually of women doing natural acts or women involved in sexual activity.
• 
  
• Infantophilia is a new subcategory of pedophilia in which the victims are younger than 5 years.

8 - paraphilias - part 6

• The Marquis de Sade's life was not an ordinary one. From early on, he was rejected by his parents and moved from one place to another. The Marquis would never gain his father's approval, no matter how hard he worked. His life lacked structure, appropriate discipline, balance, and unconditional love/approval. The young Marquis was exposed to complete self-indulgent behavior lacking any form of discipline while raised by his grandmother, aunts, and uncle. Then he was exposed to extreme corporal punishment while attending prep school with the Jesuits. He was also exposed to deviant sexual behavior in both of these very different settings.
• In theory, one might postulate that exposure to these extreme polarities of behavior, especially during the very crucial formative years, might cause the underdeveloped psyche to integrate the 2. Therefore associating pleasure with pain, hence the deviant masochistic behavior.
• Transvestic fetishism

·

• Over a period of 6 months, heterosexual male patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Typically, patients derive sexual gratification from wearing clothes usually worn by the opposite sex, and patients typically are heterosexual married males (not a DSM-IV-TR criterion).
• Voyeurism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Patients derive sexual gratification from seeing sex organs and sexual acts; scopophilia is a synonym for voyeurism (not a DSM-IV-TR criterion).
• Paraphilia not otherwise specified: This category is included so physicians can code paraphilias that do not meet the criteria for any of the other specific categories.

·

• Scatologia involves making obscene phone calls.
• Necrophilia involves an erotic attraction or sexual interest in corpses. This paraphilia is rare and seldom reported to the police. Patients typically work in mortuaries and funeral parlors. This also involves dangerous situations where the individual could actually acquire infections from the corpse.
• Partialism is sexual interest exclusively focused on a particular body part.
• Zoophilia involves sexual activity with animals (ie, both actual sexual contact and sexual fantasies, higher in psychiatric patients).
• Coprophilia is sexual activity involving feces.
• Klismaphilia is sexual activity involving enemas.
• Urophilia is sexual activity involving urine.
• Masturbation is sexual self-gratification.

7 - paraphilias - part 5

• Donatein was quite young to have been uprooted so many times. He was 10 years old when he was enrolled at the prep school. Although the Jesuits had a remarkable reputation as educators, they were infamous for their practices involving sodomy and corporal punishment. The Jesuits would beat, whip, or flog the young boys in front of an assembled student body to humiliate them. The humility of the beatings, oddly enough, could also be sexually arousing. This practice came to be known as sado-masochistic behavior. As an adult, the Marquis de Sade was unable to be aroused by normal sex, so it appeared that his sexuality was arrested at the infantile anal stage.
• After 4 years with the Jesuits, Donatein was transferred to a military academy upon this father's request. In 1755, shortly following his arrival, Donatein served in the King's light cavalry regiment as a sub leutenant. He was only 15 years old at the time. The young Marquis served in the war and was considered a brave and decisive leader. Unsatisfied with Donatein's success in the cavalry, his father had him placed with a cavalry company commanded by one of the members of the royal family. Donatein's bravery, good looks, and social charm made him a very successful soldier. His superiors were quite impressed by the Marquis; therefore, he was promoted to captain at the young age of 18. Donatein seemed able to impress everyone but his own father. His father never praised his son for his many accomplishments, yet had no difficulty pointing out his shortcomings.
• When the Marquis de Sade returned from the war in 1763, he had his sights set on a particular lady whom he wished to marry. However, his father was opposed to the union. Instead, he arranged for the Marquis to marry her elder sister, Renee-Pelagie de Montrieul. The couple had 3 children, 2 boys and a girl.
• The same year the couple was married, the Marquis de Sade frequently traveled away from home for "business" reasons. While away on his travels, he rented several different maisons around Paris where orgies were held. One particularly disturbing encounter took place between the Marquis and a young prostitute. After he was alone with her, he quizzed the young prostitute about her religious convictions regarding the Roman Catholic Church. When he discovered that she was a faithful Roman Catholic, he began degrading her with inconceivable vile insults.
  
  To the young woman's horror, he proceeded to perform sexually explicit acts on her with the aid of religious objects that were extremely blasphemous and sacrilegious in nature. When the young prostitute refused his request to beat each other with a hot whip, he pleasured himself sexually with a pair of crucifixes. Then he held her at knife point, forcing her to repeat vulgarities in the most blasphemous manner. This resulted in the Marquis de Sade's first imprisonment; however, his lewd and debaucherous behavior would result in numerous other imprisonments during his lifetime. He died in 1814 and was buried in Charenton. Later his skull was removed from the grave for phrenological examination.

6 - paraphilias - part 4

• Donatein's mother was a distant cousin to the Prince de Conde, a junior branch of the royal Bourbon family. She served as a lady in waiting to the Princess de Conde and was a governess to her son, the young Prince de Conde. An early account of Donatein's violent nature involved an altercation between he and his young cousin over a toy. When the young Prince tried to retrieve one of his favorite toys from the grasp of his 4-year-old cousin, Donatein pummeled his cousin with increasing blows of violence. Soon after this incident, the young Marquis was sent to live with his paternal grandmother in Avignon.
• The troubled young boy spent his formative years in Avignon surrounded by female relatives who indulged his every need and enveloped him with sensual affection. Donatein's grandmother and aunts continually doted on the child and indulged every one of his selfish demands. There was no mention of discipline in the boy's upbringing. These actions were only detrimental to the child's development; consequently, his behavior became increasingly unruly. When the Comte de Sade (Donatein's father) received report of his son's unconventional upbringing, the young Marquis was sent to live with his father's brother. The Comte hoped that his brother, Abbe de Sade, would be able to provide a masculine presence and influence that was obviously lacking in Donatein's life.
• Abbe de Sade was a noted author, clergyman, and scholar of his time. He was also very much like his sisters in the sense that he enjoyed the sensual side of life and indulged himself with many pleasures. He was referred to as "sybarite of Saumane" meaning one inordinately attached to pleasure and luxury. Once again the young boy was in an atmosphere that encouraged sexuality and sensual indulgence as an expectation rather that an exception to the rule. During Donatein's stay at his uncle's home, the abbe housed many female companions which included a local prostitute.
• Throughout this period of time in Europe, men and women of the cloth, indulged themselves in various sexual escapades with little remorse. There was rumor of orgies taking place in abbeys and convents, where priests, nuns, prostitutes, and nobles all engaged in debaucherous behavior. Abbe de Sade had a library filled with a genre of literature, and some were pornographic in nature. Donatein was free to read all of the literature in the library at his leisure. After becoming abreast of the ever present debauchery in Donatein's life, his father moved him to Paris where he was enrolled in a Jesuit prep school for young men of nobility.

5 - paraphilias - part 3

• Sometime after this event, he witnessed the Countess and her lover caught in the act by her husband and 2 of his friends. The Count, who was obviously stunned, paused momentarily to plot his course of revenge. In the meantime, the Countess beat all 3 men to a bloody pulp. Leopold had been hiding in the room throughout the encounter, and was discovered by the Countess after gasping in astonishment. Upon discovery, she beat him as well. He made his way out of the room, but was still right outside the door watching should anything else occur. Moments later, the boy witnessed the Count, back in the same room where he had been humiliated earlier, begging for her forgiveness. The Countess looked at her husband and with that same calculating smile, all too familiar to Leopold, gave him a big swift kick.
• Sexual sadists

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the acts in which psychological or physical suffering of the victim is sexually exciting to the patient.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• This variant is named for the activities of the Marquis de Sade (not part of the DSM-IV-TR criterion).

o

• The Marquis de Sade was born in Paris, France on June 2, 1740 and died on December 2, 1814 in Charenton, France. His full name was Donatein Alphonse Francois comte de Sade. The term sadism is a derivative of his name. The Marquis was an aristocrat and an author of violent pornography. The French author's erotic books, mainly written while imprisoned, include Justine, Juliette, and 120 Days of Sodom. The Marquis de Sade regarded criminal/sexually deviant acts as being natural, which was apparent in both his writings and actions. Consequently, his novels were banned into the 20th century.
• The Marquis de Sade's life consisted of numerous acts of cruelty, which were indicative of his total disregard for human life and the law. His acts of extremely violent physical and sexual abuse resulted in numerous imprisonments and consequent escapes. He was also declared insane and admitted to an insane asylum on 2 different occasions. The Marquis was imprisoned or committed to insane asylums for at least 32 years of his life. Most victims of Marquis were young female prostitutes, as well as both male and female employees of his chateau.

4 - paraphilias - part 2

• Sexual masochism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• This variant is named for the activities of Leopold von Sacher-Masoch (not part of the DSM-IV-TR criterion). Sacher-Masoch was born in Lemberg, Austria in 1836. As an author he is most known for his book Venus in Furs. This writing is reportedly based on true events from his life.

o

• Sacher-Masoch's novel is said to be one long masochistic fantasy in which the principle male character desires and encourages his mistress to treat him as a slave. This story appears to parallel his relationship with his wife. He used to plead with her to treat him as a slave, and his outlandish requests would progressively become more demeaning to satisfy his sexual appetite. However, she was not interested in partaking in his deviant self-deprecating fantasies. Eventually they met other partners and parted ways.
• Leopold von Sacher-Masoch was the eldest son of a couple in the town of Galacia, where his father was the Director of Police and his mother was a little Russian lady of noble birth. As an infant, Leopold was very frail and sickly, and not expected to survive. To increase the infant's chances of survival, his parents hired a robust Russian wet nurse who was able to nurse him back to health. Leopold later spoke of the strong bond between the 2 of them. The woman shared strange and melancholy legends about her people with the boy, and he formed a love of the Russians that remained constant throughout his life. He reportedly said that not only did he gain his health from her, but also his soul.
• As a child, Leopold was fascinated by various representations of cruelty. He was especially drawn to pictures of executions, and some of his favorite reading materials pertained to legends of martyrs. At the onset of puberty, he had a recurring dream that he was under the power of a cruel and torturous woman. The term dream is used in this context as opposed to nightmare.
• In the town of Galacia, where Leopold was born, women were said to either rule their husbands or vice versa. At the age of 10, the boy witnessed a sadistic scene that left a permanent impression. The scene involved a female relative from his father's side of the family. This woman was referred to as Countess X. Prior to Leopold witnessing the life-altering event, he was enamored by the Countess and was impressed by her beauty and costly furs. He used to help her with various duties, services, etc. On one occasion, as he was putting on her shoes, he bent down to kiss her feet and she smiled at him and then kicked him. Instead of being hurt, he experienced a perverse sensation of pleasure.

3 - paraphilias - part 1

DSM-IV-TR criteria include the following:

• Exhibitionism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors that involve exposing their genitals to unsuspecting strangers.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Exhibitionism typically involves men exposing themselves to women (not a DSM-IV-TR criterion).
• Fetishism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving nonliving objects.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Patients do not limit the fetish objects to articles of female clothing used in cross-dressing or to devices designated for the purpose of tactile genital stimulation.
• Patients may have a particular pathological displacement of erotic interest and satisfaction for their entire lives (not a DSM-IV-TR criterion).
• Frotteurism

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving rubbing against and touching a nonconsenting person.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Patients typically practice this behavior in crowded places (not a DSM-IV-TR criterion).
• Pedophilia

·

• Over a period of at least 6 months, patients have recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The patient must be aged 16 years or older and at least 5 years older than the child or children involved.

2 - what is oniomania ?

what is oniomania ?

Oniomania is a medical term (from Greek onios = "for sale," mania = insanity^[1]) coined by German psychiatrist Emil Kraepelin, for the compulsive desire to shop, more commonly referred to as shopping addiction or shopaholism. It is not recognized as a disorder by the American Psychiatric Association (APA) manual DSM-IV; however, that may change as more is learned about the brain chemistry of compulsive behavior ^[2]. Kraepplin, along with Swiss psychiatrist Eugen Bleuler, first identified the symptoms associated with oniomania during the late nineteenth century. Oniomania has received increased media attention despite the fact that it does not meet the criteria under the DSM-IV.

Disorder

Psychiatrists often call oniomania a disorder, but it has only been accepted as a disorder by the Deutsche Gesellschaft Zwangserkrankungen (German organization for obsessive-compulsive disorders), for several years.Oniomania is still being studied by psychologists throughout the world, and, in fact, the APA is in the process of possibly including it in the DSM-IV.

Symptoms

Similar to other compulsive behaviors, sufferers often experience the highs and lows associated with addiction. Victims often experience moods of satisfaction when they are in the process of purchasing, which seems to give their life meaning while letting them forget about their sorrows. Once leaving the environment where the purchasing occurred, the feeling of a personal reward has already gone. To compensate, the addicted person goes shopping again. Eventually a feeling of suppression will overcome the person. For example, cases have shown that the bought goods will be hidden or destroyed, because the person concerned feels ashamed of their addiction and tries to conceal it.

Causes

The addicted person gets into a vicious circle that consists of negative emotions like anger and stress, which lead to purchasing something. After the buying is over, the person is either regretful or depressed. In order to cope with the feelings, the addicted person resorts to another purchase.

Shopaholism often begins at an early age. Children who experience parental neglect often grow up with low self-esteem because throughout much of their childhood they experienced that they were not important as a person. As a result, they used toys to compensate for their feelings of loneliness. Adults that have depended on materials for emotional support when they were much younger are more likely to become addicted to shopping because of the ongoing sentiment of deprivation they endured as children. During adulthood, the purchase instead of the toy is substituted for affection. Shopaholics are unable to deal with their everyday problems, especially those that alter their self-esteem. Most of the issues in their lives are repressed by buying something.

Social conditions may also play an important role, especially in capitalist societies that are dominated by a consumerist economy where buying is an important part of daily life. Credit cards facilitate the spending of money as well as mail order via catalogues or the Internet. What differentiates oniomania from healthy shopping is the compulsive, destructive nature of the buying.

Consequences

The consequences of oniomania, which may persist long after a spree, can be devastating. They may include over-indebtedness, theft or defalcation of money, defaulted loans, and general financial trouble. Sufferers often come into conflict with the law.

1 - psychiatry mcqs - 1 to 14

1) Schizopherenia term coined by –

a. Eugene Blueler

b. Kraplein

c. Freud

d. None of the above

Answer (a) Eugene Bleuler

Reference: Kaplan and Sadock’s Synopsis of Psychiatry 9^th Edition Page 471

2) All are First rank symptoms of Schizophrenia except

a. Audible Thoughts

b. Thought Broadcasting

c. Voice arguing or discussing or both

d. Perplexity

Answer (d) Perplexity

Reference: Kaplan and Sadock’s Synopsis of Psychiatry 9^th Edition Page 473

3) Splitting of personality was first described by

a. Blueler

b. Adolf Meyer

c. Harry Stack Sullivan

d. Kraplein

Answer (A) Bleuler

Reference: Kaplan and Sadock’s Synopsis of Psychiatry 9^th Edition Page 471

4) Schizo pherenia is a disorder of

a. Thought

b. Mood

c. Perception

d. None of the above

Answer ( A) Thought

Reference: Kaplan and Sadock’s Synopsis of Psychiatry 9^th Edition Page 471

5) An example of Atypical Antipsychotic drug is

a. Phenothiazines

b. Butyrophenones

c. Clozapine

d. Fluphenazine

Answer (C) CLozapine

Reference: KDTripathi 5^th Edition Page 391

6) Extra pyramidal Symptom are commonly Seen in treatment with

a. Anti psychotic Drugs

b. Diuretics

c. Antibiotics

d. Bronchodialtors

Answer (a) Antipsychotic Drugs

Reference: KDTripathi 5^th Edition Page 397

7) Following are variables enhancing risk of suicide among vulnerable group except

a. Living with parents

b. Homosexuals

c. Increasing agitation

d. Family History of Suicide

Answer (a) Living with parents

Reference: Kaplan and Sadock’s Synopsis of Psychiatry 9^th Edition Page 913

8) Treatment of ADHD involves the following drugs except

a. Amphetamine

b. Antidepressants

c. Barbituarates

d. Lithium carbonate

Answer C) Barbituates

Reference:Nelson 15^th Edition Chapter 30.2

9) The following Delusions are common in depression except

a. Delusion of poverty

b. Delusion of Nihilism

c. Delusion of grandeur

d. Delusion of persecution

Answer c) Delusion of Grandeur

Reference: Ahuja 4^th Edition page 67

10) Disorientation is most commonly seen in

a. Organic Brain damage

b. Schizophrenia

c. Mania

d. None of the above

Answer a) Organic Brain Damage

Reference: Ahuja 4^th Edition page 67

11) Modified ECT is not given frequently in routine practice because of

a. Non availability of anesthetist

b. Myocardial infarction

c. Osteoporosis

d. All of the above

Answer A) Non availability of anaesthetists

Reference

12) About Gille de tourette syndrome

a. Upper limb tics

b. Appears prior to 7 years of age

c. shouting obscene words

d. All of these

Answer d) all of these

Reference: Nelson 15^th Edition Chapter 22

13) Anitdote for methanol

a. Ethanol

b. BAL

c. EDTA

d. None of the above

Answer a) Ethanol

Reference: Tripathi 5^th Edition Page 355

14) All of the following are True about Buspirone except

a. Is a Azapirone

b. Produces severe sedation

c. Antidepressant

d. No anticonvulsant action

Answer : b) Produces severe sedation

Reference: KDTripathi 5^th Edition Page 401