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Sleep Disorders:

1. EEG in sleep shows 3 Hz spikes & waves F
2. EEG in sleep shows Beta waves in the frontal lobes F
3. EEG in sleep shows Delta waves T
4. EEG in sleep shows spikes due to myoclonus T
5. EEG in sleep shows spindles during REM F
6. Hypnopompic Hallucinations are usually visual F
7. Sleep spindles on EEG appear in REM sleep F
8. Somnambulism occur in stage 4 T
9. Paradoxical sleep is one of the parasomnias F
10. Mu waves on EEG are normal T
11. REM sleep is increased in narcolepsy T
12. REM sleep occurs late in the sleep cycle in depression F
13. REM sleep is associated with vivid dreaming T
14. REM sleep has a characteristic EEG T
15. REM sleep is increased with parasympathetic over activity F
16. A decrease in REM latency is associated with relapse of depression T
17. REM sleep is also called slow wave sleep F
18. REM sleep is normally associated with dreaming T
19. REM sleep is associated with cataplexy T
20. REM usually first occur within 30 minutes of sleep onset F
21. REM sleep deprivation is not recovered in subsequent sleeping periods F
22. Studies of sleep rhythm show the subjective day to be 23 hours F
23. None REM sleep is characterised by a wide awake brain in a virtually paralysed body F this REM
24. In REM sleep stimuli from other parts of the body are blocked from entering the brain & there may be no motor out puts T
25. Most of stage 3 & 4 occurs in the first half of the night T
26. Narcolepsy is associated with sleep paralysis T
27. Patients with depression may show decreased REM latency T
28. New-born babies spend the majority of their sleep time in stage 3 & 4 sleep F they spend ½ of the time in REM sleep
29. People waken up from sleep more commonly report dreams T


Miscellaneous ISQs:

1. Reliability is more important than validity F
2. Reliability is higher for neurosis than psychosis F
3. Reliability is improved by structural questionnaires T
4. Reliability is improved by operant definitions T
5. Reliability is higher in clinical psychiatry diagnosis than in scientific diagnosis F
6. Reliability is tested internationally F
7. Reliability is low for dissociative disorders in ICD 10 T
8. Reliability is high for schizophrenia in ICD 10 T
9. Reliability is low for hysterionic PD T
10. Reliability is associated with high validity F
Reliability is important for psychiatry around the world to arrive to the same diagnosis in the same patient. Part of the solution is eliciting the correct information, which is why structural & semi structural interviews are helpful. The other part of the solution is clarifying what constitute a diagnosis, which is why operational classifications are of value (note that just because a test is reliable it is not necessarily valid)

11. Token economy has been used effectively in mentally handicapped patients T

12. Token economy attempts to induce socially acceptable behaviour through the use of tokens T
13. There is a conclusive evidence that improvement by Token economy is maintained outside institutions F
14. Token economy is akin to shaping F
15. Token economy is based on classical conditioning F
16. Male to female incidence is equal in trans-sexualism F
17. Trans-sexualism is associated with low sex drive T
18. Trans-sexualism is associated with sexual arousal during cross dressing F
19. Trans-sexualism is associated with DSH in 40 % T
20. prevalence of Trans-sexualism in females is 1: 110000 T
21. Characteristic age of onset for OCD is Middle age F
22. Characteristic age of onset for simple phobia is during childhood
23. Characteristic age of onset is adolescence for social phobias T
24. Characteristic age of onset is middle age for generalised anxiety disorders F
Characteristic age of onset is lower in men than in women for schizophrenia T
25. Specific learning difficulties are associated with soft neurological signs T
26. Specific learning difficulties are associated with low IQ F
27. Specific learning difficulties are associated with emotional difficulties T
28. Specific learning difficulties are more prevalent in boys T
29. Specific learning difficulties are associated with working class background T
30. Specific learning difficulties are a result of mental retardation in many cases F the difficulties are specific not global
31. Specific learning difficulties are associated with low social class T because the skills are learned & in lower SEC the opportunities for learning may be limited.
32. Specific learning difficulties May be directly related to hearing impairment F

For diagnosis there must be a significant impairment of the specific skills (reading, math etc…). It cannot be blamed on more global problems i.e. mental retardation. The defect need to be developmental i.e. diagnosis can not be made if the child is normal for the first few years at school, then performance of particular skills fall off. The external factors such as absence from school should not explain it. It may not be directly due to vision or hearing impairment.

33. When a patient is aroused & Aggressive, the situation may be helped by moving away from the patient T
34. When a patient is aroused & Aggressive, the situation may be helped by moving to a smaller room T
35. When a patient is aroused & Aggressive, the situation may be helped by decreased eye contact T
36. When a patient is aroused & Aggressive, the situation may be helped by holding open hands out T
37. When a patient is aroused & Aggressive, the situation may be helped by knowing the patient T
38. The relationship between arousal & performance shows that maximal arousal is required in order to perform well F
39. The relationship between arousal & performance is a J shape curve F
40. The relationship between arousal & performance Is independent of the type of arousing stimulus F
41. The relationship between arousal & performance may be measured by physiological indices T
42. The relationship between arousal & performance known as Yerkes-Dodson law T
43. Social differences in health as expressed by mortality rates, have markedly fallen in the last decade
44. Social differences in health can partly be accounted for by social mobility T
45. Social differences in health have been shown for depression T
46. Social differences in health are paralleled by differential accessibility to health services T
47.
48. Social differences in health apply to adult not children F
49. A job loss is always an independent life event F
50. Most severe life events lead to depression F
51. The concept of brought forward time assumes that the illness would have occurred sooner or later F
52. An increase in life events have been reported by relatives of depressed patients compared with controls T
53. There is a significant increase in life events in the 3 weeks preceding a depressive episode
54. The effect of life events depends on the contextual threat of negative impact T
55. Life events can be rate by the social readjustment scale T
56. Loss of mother before 14 predisposes to depression F under 11
57. when rating life events Positive events are included T
The same life event may have different meaning for different people at different points in their lives (the contextual threat) the events are usually thought of as negative, but may be positive i.e. marriage & child birth. The social readjustment scale (Holmes & Rahe 1967) is a self-report questionnaire covering a range of events. The life events & difficulties schedule (LEDS) of Brown & Harris is also used (semi structural interview). Factors in one’s life may be protective or increase vulnerability. Famously summarised in the work of B&H in 1978. Concerning depression vulnerability factors include; loss of mother before 11, no work outside the home, lack of confiding relationship, & 3 or more children under the age of 14 at home. There have been implications of life events with depression, anxiety, schizophrenia, DSH & functional disorders.

58. The Hamilton depression scale is a self administered questionnaire F
59. Montgomery - Asbury rating scale (MADRAS) is a self administered questionnaire F
60. Clinical anxiety scale is a self administered questionnaire F
61. Beck depression inventory is a self administered questionnaire F
62. Michigan alcohol screening test (MAST) is a self administered questionnaire T
Other interviewer rated include; Hamilton anxiety scale, state trait anxiety inventory, Yale Brown OC scale, Positive & negative symptoms of schizophrenia (PANSS), EPS rating scale, Brief psychiatric rating scale (BPRS), General health questionnaire (GHQ) & present state examination PSE
Other self-rated; The Zung depression scale
The maximum possible score for the 21-item HAM-D Hamilton depression scale is 52. In practice very few score above 35. Most people with depression score 14 or more. Scores >= 30 are more typical of severely depressed patients.

63. Concerning risk factors for psychiatric disorders patient’s criminality is included T
64. Being part of a big family is considered as a risk factor for developing psychiatric disorders T
65. maternal psychiatric disorder is a risk factor for developing psychiatric disorders T
66. Concerning risk factors for psychiatric disorders, a single risk factor alone is enough to double chances of having a psychiatric disorder F
67. Concerning risk factors for psychiatric disorders, excessive sociability is a risk factor F
Others include: marital discord & low social class.
Positive factors; sociability, good parenting, good problem solving abilities & network of support (school, church)

68. With respect to psychological measuring instruments criterion validity is independent of reliability F
69. Sources of error in self administered questionnaires include social desirability T
70. Life event scales include daily hassles T
71. In stress research type A behaviour is synonymous with extraversion F
72. In stress research type A behaviour can be modified with cognitive behaviour programmes T
73. The fundamental attribution error explaining causes of behaviour describes a bias towards using stable attribution F
74. Operational criteria for psychiatric diagnosis increase validity & reliability of diagnosis F
75. In MMPI tests, it does not matter whether what the person being tested says is true T this is a criterion keyed method & hence what is important is the fact that he or she says it.
76. Inter-rater reliability is better for thematic appreciation tests than for Rorschach tests T
77. There is good correlation between traits measures on personality test & actual behavioural observation F
78. Pleasurable situations may be stressful T
79. ECT is the treatment of choice in postpartum psychosis T
80. Postpartum psychosis is associated with a complicated delivery F
81. Sensory changes in conversion disorders do not conform to the anatomical neuronal innervation of the affected part T
82. Munchausen’s’ syndrome is commoner in women than in men F > in men
83. Aggressive & violent behaviour is associated with decrease levels of CSF 5-MIAA
84. The squeeze technique is used in treatment of secondary impotence F premature ejaculation.
85. Methylphenidate can cause growth retardation in children T
86. The most important task of the psychiatrist is to give advice F
87. In Somnambulism there is amnesia for the episodes T
88. ECT may be given in pregnancy T
89. CBT has been shown to be helpful in relieving symptoms of chronic fatigue syndrome T
90. People who develop profound deafness at a very young age are more prone to emotional & behavioural disorders than those who develop deafness at a late stage F those who develop it later in life are more prone to emotional & behavioural disorders.
91. Pseudologica fantastica is synonymous with confabulation F
92. Wearing of cloths of the opposite sex does not lead to genital excitement in trans sexualism T
93. Compliance with medications is better if the patient knows the doctor well
94. In negativism the patient has negative views of the future F
95. In stupor there is inability to initiate speech or movements

Psychiatric Interview


1. In standard psychiatric history & MSE occupational history is taken to assess work suitability F
2. In standard psychiatric history & MSE proverb interpretation is a test to demonstrate concrete thinking T
3. In standard psychiatric history & MSE cognitive testing is not indicated if a full clear history is obtained F
4. MSE should always be conducted in the same recommended sequence F
5. In standard psychiatric history & MSE it is possible to draw hypothesis about family dynamics from the family history T
6. Useful interview techniques include Recapitulation T
7. Useful interview techniques include Prompting T
8. Useful interview techniques include asking direct questions T
9. Patients must never be addressed with their Christian names during psychiatric interviews F
10. “Are you happily married” is a closed question T
11. “So did you feel depressed after you lost your job” is a closed question T
12. “How has your health been recently “ is a closed question T
13. “Who is the prime minister “ is a closed question T
14. “How do you get on with your wife “is a closed question T
15. “How are you feeling” is an open question T
16. Disclosure of information in the clinical interview can be facilitated by mild fatigue of the interviewer F
17. Disclosure of information in the clinical interview can be facilitated by considering silence T
18. Disclosure of information in the clinical interview can be facilitated by fluent modelling of speech by the interviewer F
19. Disclosure of information in the clinical interview can be facilitated by addressing the patient by certain names F
20. Disclosure of information in the clinical interview can be facilitated by commenting on the affect of the patient T
21. Direct questions are suitable techniques for psychiatric interviews T
22. Closed questions are suitable techniques for psychiatric interviews T
23. Linking statements are suitable techniques for psychiatric interviews T
24. Recapitulation are suitable techniques for psychiatric interviews T
25. Polythematic questions suitable techniques for psychiatric interviews F
26. During Psychiatric interviews the patient should be let talk of what is more important to him in the beginning T
27. During Psychiatric interviews positive answers to leading question should not be probed further F
28. Depression as a subjective symptom should always be probed further during psychiatric interviews T
29. In a normal psychiatric interview if the patient is allowed to talk freely, clinically relevant material will be offered spontaneously T
30. In a normal psychiatric interview is often wise to discuss major abnormalities first & work to less important issues F
31. In a normal psychiatric interview one should usually start by asking questions about self consciousness F
32. In a normal psychiatric interview silent pauses are as important as questions T
33. In a normal psychiatric interview there is little place for a non directive facilitating style F
34. Useful interview techniques include Rationalisation F
35. Useful interview techniques include paying attention to non verbal cues T
36. Useful interview techniques include Video tape feedback T
37. Useful interview techniques include Restitution F
38. Useful interview techniques include showing emapthy T
39. During initial interview the patient may hide useful information in the presence of a family member T
40. During initial interview it is necessary to take a detailed psychiatric history F
41. During initial interview if the patient is mute the MSE is invalid F
42. During initial interview silences must be avoided F
43. During initial interview questionnaires are extremely useful F
44. Failure to ask direct questions may hinder detection of depression in a clinical interview T
45. Interviewer not using an appropriate scale may hinder detection of depression in a clinical interview F
46. Lack of empathy from interviewer may hinder detection of depression in a clinical interview T
47. Presence of psychosis may hinder detection of depression in a clinical interview T
48. Interviewer not following non verbal cues may hinder detection of depression in a clinical interview T
49. In cognitive assessment if the subject fail to repeat Babcock’s sentence once , impairment immediate memory is a likelihood F
50. In cognitive assessment repeating the months backwards is a good test for attention & concentration T
51. In cognitive assessment failure to recall a name & address at 5 minutes indicates Anterograde amnesia T
52. In cognitive assessment repeating the days of the week backwards may be used to test perseveration T
53. In cognitive assessment poor verbal fluency is suggestive of temporal lobe damage T
54. MMSE has been shown to have poor 24 hour test – retest reliability F
55. Good interviewing includes introducing your self to the patient T
56. Good interviewing is avoiding distress by ignoring tearful outbursts F
57. Good interviewing include using first names early F
58. Good interviewing include reflecting the statement back to the patient T
59. Good interviewing include collecting collateral information T
60. In the first interview with a psychiatric patient history taking will be helped making preliminary transference interpretation F
61. Psychiatric diagnoses are categorical rather than dimensional T
62. The use of video & audio feedback is the most effective way of enabling doctors to develop interviewing skills T
63. Structured interviews like PSE are unsuitable for routine clinical practice T they are inflexible & long
64. The most important task of initial psychiatric interview is to establish a diagnosis F
65. In psychiatric interview it is preferable to obtain a history from a relative before making a formulation T
66. In psychiatric interview it is important t take into account the patient’s view of aetiology of his illness T


- posted by Najat @ 2:47 pm