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Part II ISQ Club - Clinical

37 posts in this topic

Part II ISQs will be posted regularly. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post.

1. Procedural memory is not affected in Korsakoff’s psychosis.

2. Akathisia is a side effect of amphetamines.

3. In the stages of change, the action phase is the right time to start detoxification or acamprosate.

4. In schizophrenic adoptees the biological parents have a higher frequency of delusional disorder than adoptive parents

5. Glutamate receptors are unchanged in number in post mortems of schizophrenics’ brains.

6. Reduced fertility is seen in late onset paraphrenia.

7. Amnesia for the traumatic event is characteristic of PTSD.

8. Emotional blunting is characteristic of PTSD.

9. Repetition of self harm is more likely in antisocial personality disorder.

10. Early onset is a bad prognostic factor for anorexia nervosa.

11. Short time from onset to presentation is a good prognostic factor for anorexia nervosa.

12. Family therapy is more effective than individual CBT for anorexia nervosa in under 18s.

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1. Procedural memory is not affected in Korsakoff’s psychosis.

TRUE

The existence of intact implicit recollection in the absence of explicit memory is found in various conditions including surgical anesthesia, hypnotic amnesia, the adverse effects of some benzodiazepines, neurological conditions such as Korsakoff's syndrome and bilateral hippocampal strokes, divided attention, and childhood amnesia.

KS CTP

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5. GLUTAMATE RECEPTORS ARE UNCHANGED IN NUMBER IN POSTMORTEMS OF SCHIZOPHRENIC'S BRAIN....... FALSE

THEY ARE REDUCED... ref: TREVOR SILVERSTONE.......

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7.AMNESIA FOR THE EVENT IS CHARACTERISTIC IN PTSD.

FALSE

THE PERSON HAS FLASHBACKS OF THE EVENT AND RELATED CUES.

oxford.......

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6.reduced fertility is seen in late onset paraphrenia.....

FALSE....

DO PEOPLE WHO PRESENT WITH PARAPHRENIA HAVE ANY FERTILITY LEFT???

esp.... late paraphrenia?????????

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2. Akathisia is a side effect of amphetamines.

?TRUE

One of the S/E listed is Restlessness

Page 198 - BNF

Causes restlessness in high doses

Synopsis

Page 1168 - Synopsis 9th Edition

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3. In the stages of change, the action phase is the right time to start detoxification or acamprosate.

FALSE

It is the right time to start detoxification. Acamprosate is started following detoxification, which is then the maintenance phase.

PS I changed my mind: Acamprosate CAN be started at the same time as detoxification, ie in the action phase.

Z. M.

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10. Early onset is a bad prognostic factor for anorexia nervosa.

FALSE

Prognostic predictors of outcome

In the long-term Maudsley study a poorer outcome was predicted by an older age of onset, a longer duration of illness, the presence of neurotic traits in childhood, personality problems, and the occurrence of relationship difficulties within the family.111

OTP

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5. GLUTAMATE RECEPTORS ARE UNCHANGED IN NUMBER IN POSTMORTEMS OF SCHIZOPHRENIC'S BRAIN....... FALSE

THEY ARE REDUCED... ref: TREVOR SILVERSTONE.......

FALSE

Agreed; but I found that they are increased:

Postmortem Studies

In general, an increase in glutamate receptors labeled by the neuroexcitatory agonists 3H-aspartate and 3H-kainate is found in frontal cortical areas of schizophrenics, compared with levels in controls.

http://www.acnp.org/g4/GN401000116/CH114.html

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6. Reduced fertility is seen in late onset paraphrenia.

TRUE

Premorbid personality

A consistent theme in descriptions of patients who develop psychoses late in life is the presence of abnormal personality traits—most often schizoid or paranoid personality types.15 Although these patients are known to experience relationship difficulties, reflected by low rates of marriage and reduced numbers of children born to those who do marry, this contrasts with premorbid educational and occupational adjustment which is generally good. Hence abnormalities in pre­morbid personality function have a specificity characterized by unsociability, reticence, suspiciousness, and hostility. Having said all this, the author’s experience of many of these patients is that they can be warm, trusting, and often very lonely individuals whose view of the world has been grotesquely distorted by their psychotic experiences.

OTP

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2. Akathisia is a side effect of amphetamines.

?TRUE

One of the S/E listed is Restlessness

Page 198 - BNF

Causes restlessness in high doses

Synopsis

Page 1168 - Synopsis 9th Edition

I am still bugged by this one. Akathisia is not the same as agitation or restlessness, and both agitation and restlessness are listed as side effects of amphetamines, but I can't find akathisia mentioned anywhere.

Shall we put the question aside with other difficult questions and keep on searching for the correct answer?

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zoran.

Thanks for No.5

Glutamate receptors!!!!!!!! are indeed increased

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2. Akathisia is a side effect of amphetamines.

Akathisia is caused by blockage of D2 and stimulation of alpha1 receptors according to Atlas of Psychopharm. Amphetamines supposedly enhance alpha 1, so this might be TRUE. Also says it causes psychomotor agitation. Is this the same as akathisia?? NOt 100% though...

4. In schizophrenic adoptees the biological parents have a higher frequency of delusional disorder than adoptive parents

Do you have references for this? I haven't read that there is an increase of delusional disorder...

7. Amnesia for the traumatic event is characteristic of PTSD.

FALSE

8. Emotional blunting is characteristic of PTSD.

Another tricky one. Shorter Oxford says' inability to feel emotion - numbness' Is this the same as blunting? . DSM says ' restricted range of affect'. I might guess TRUE

10. Early onset is a bad prognostic factor for anorexia nervosa.

THis is FALSE according to Manchester Course, quoting study by Ratnusuriya 1991. Seems strange because just about everything else is assoc with worse outcome if it occurs earlier!

11. Short time from onset to presentation is a good prognostic factor for anorexia nervosa. TRUE

12. Family therapy is more effective than individual CBT for anorexia nervosa in under 18s.TRUE

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4. In schizophrenic adoptees the biological parents have a higher frequency of delusional disorder than adoptive parents

- true - ox t p - kendler and walsh 1995

specifically schizophrenics spectrum disorders( delusional d, paranoid personality, schizotypal)

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5. Glutamate receptors are unchanged in number in post mortems of schizophrenics’ brains.

false- harrison 2000

increased density of postsynaptic G receptors in frontal area.

reduced expression of non - nmda G receptors in medial temporal area

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8. Emotional blunting is characteristic of PTSD.

- false.

it is not a characteristic feature but a feature of PTSD

'a characteristeristic feature means that it is of diagnostic significance, its absence might make one doubt the diagnosis'.

most charateristic features according to ox short t p are

'reexperiencing symptoms' such as flaskbacks etc.

also emotional blunting present in depression, dementia, chric schizophrenia etc

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12. Family therapy is more effective than individual CBT for anorexia nervosa in under 18s.

for the exam sake i would say true.

'Controlled trials of psychotherapies in anorexia nervosa are few, though benefit has been shown for family therapy in younger patients with shorter duration of illness' kaplan A.S 2002

but no rct or cochrane register comparing CBT and family therapy in adolescents in anorexia show consistent different between effectiveness.

let me know if one of you guys find any other material

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10. Early onset is a bad prognostic factor for anorexia nervosa.  

THis is FALSE according to Manchester Course, quoting study by Ratnusuriya 1991.  Seems strange because just about everything else is assoc with worse outcome if it occurs earlier!

salsababe

Yeah strange but True. The later the onset the worse the prognosis. The other important factor is length of illness (shorter the length the better :-/ )

Palmer 2000 - Shorter Oxford textbook of Psychiatry Edition 4

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12. Family therapy is more effective than individual CBT for anorexia nervosa in under 18s.TRUE

Ref: Russell et al 1987. FT more effective than Individual therapy in pts whose illness was not chronic and had begun before age of 19 years - in group of individuals post-discharge from an inpt unit and followed up 1yr after random allocation to family vs. individual therpay.

BUT... didn't say if it was individual CBT. :lol:

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10. Early onset is a poor prognostic factor for anorexia nervosa.

False.

Good prognostic factor....Kaplan Saddock. Also Kaplan says no relation between prognosis and family probs.

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1. True - Korsakov's psychosis includes chronic impairment of recent memory; remote memory may be impaired. &nbsp:lol:ifficulty learning new material; disturbance of time sense. Immediate recall is preserved; other cognitive functions are usually relatively preserved and consciousness is clear.

Puri&Hall (p.226)

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2. True - akathisia (subjective restlessness) can be a side-effect of amphetamine use.

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3. False - detoxification is part of the action phase.

Acamprosate, in combination with counselling, may be helpful in maintaining abstinence in alcohol-dependent patients. It should be initiated as soon as possible AFTER abstinence has been achieved and should be maintained if the patient relapses, i.e. in the maintenance phase.

BNF

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