• Announcements

    • Gurpal

      New question bank for paper B   05/11/18

      Please see the link below for a new question bank: http://www.superegocafe.com/online-courses/mrcpsych-paper-b-multiple-choice-question-bank/  
Sign in to follow this  
Followers 0
Gurpal

Part 2 ISQ Club - Psychosis

22 posts in this topic

MRCPsych Part 2 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. Posts not following this rule may be removed without warning.

You can download these questions and others on the same topic by clicking here.

1. Psychotic symptoms are a documented side effect of L-dopa.

2. The concentration of non-NMDA receptors in the hippocampus is reduced in schizophrenia.

3. Violent outbursts in a newly admitted excited patient is more likely to be due to schizophrenia than mania.

4. In London, the chance of having a psychotic episode is greater in African immigrants compared with Afro-Caribbean immigrants.

5. There is a 2.7 relative risk increase for psychosis in all first generation immigrants.

6. The diagnosis of delusional disorder requires the presence of persecutory beliefs.

7. Aripiprazole is a partial D2 agonist.

8. Risperidone has been shown to increase the risk of cerebrovascular events in the elderly.

Share this post


Link to post
Share on other sites

6. The diagnosis of delusional disorder requires the presence of persecutory beliefs.

False

Any delusion, not necessarily persecutory

Share this post


Link to post
Share on other sites

8. Risperidone has been shown to increase the risk of cerebrovascular events in the elderly.

True

Share this post


Link to post
Share on other sites

I thought 8 was true, too. Isn't it only Quetiapine that hasn't yet been found to increase  CVA risk in elderly?

The Maudsley Guidelines p306 say 'it has been strongly suggested that neither risperdone nor olanzapine should be used to treat behavioural symptoms in dementia. Both have been linked to an increased rate of cerebrovascular events than placebo.' But it depends what you're comparing against, as they may be lower risk than haloperidol...

Share this post


Link to post
Share on other sites

Number 1: L-dopa and psychosis = TRUE.

'in the majority of patients psychotic symptoms are thought to be secondary to dopaminergic medication' Maudsley p309.

Share this post


Link to post
Share on other sites

For number 3 (excited patient being agressive) ?false, just because I would expect most excited patients to be manic, and more likely to hit out due to disinhibition and lack of insight. Has anyone got any referrences for this one?

Share this post


Link to post
Share on other sites

8. Risperidone has been shown to increase the risk of cerebrovascular events in the elderly.

TRUE, CSM guidelines etc, although newer research is questioning this somewhat - see recent yellow journal. I'd still say TRUE though

Share this post


Link to post
Share on other sites

5. There is a 2.7 relative risk increase for psychosis in all first generation immigrants.

True, SOTP

The relative risk for migrants is 2.7 with a higher risk for the children of migrants (4.5)

Share this post


Link to post
Share on other sites
Number 1: L-dopa and psychosis = TRUE.

'in the majority of patients psychotic symptoms are thought to be secondary to dopaminergic medication' Maudsley p309.

Another reference: NOTP, pg 1148: Psychotic symptoms ('levodopa psychosis') occur at some point in 20 per cent of patients with Parkinson's disease...

Share this post


Link to post
Share on other sites

2. The concentration of non-NMDA receptors in the hippocampus is reduced in schizophrenia.  

 

TRUE. See NOTP, pg 606 (Table 1)

Share this post


Link to post
Share on other sites

For number 3 (excited patient being agressive) ?false, just because I would expect most excited patients to be manic, and more likely to hit out due to disinhibition and lack of insight. Has anyone got any referrences for this one?

I agree with you. See the following reference:

http://www.emedicine.com/med/topic3005.htm

and the following extract from that reference:

Violent behavior in hospitals has also been studied. Violent or threatening behavior is a frequent reason for admission to a psychiatric inpatient facility, and that behavior may continue after the admission. During the first 24 hours after the admission to a psychiatric inpatient unit, 33 (13%) of 253 patients physically attacked another person. Patients who were manic were the most likely diagnostic group to be assaultive during the initial phase of hospitalization, with 12 (26.1%) of 46 patients attacking another person, compared with 9 (10.3%) of 87 diagnosed with schizophrenia and 12 (10%) of 120 diagnosed with mental illness other than schizophrenia or mania. Another group reported that in the first 8 days after hospitalization, 25 (8.7%) of 289 patients who were schizophrenic or schizoaffective assaulted someone at least once.

Share this post


Link to post
Share on other sites
6. The diagnosis of delusional disorder requires the presence of persecutory beliefs.  

False

Any delusion, not necessarily persecutory

Agree. DSM-IV and ICD-10 list subtypes of Delusional Disorder, and Persecutory would be one of those subtypes.

Share this post


Link to post
Share on other sites
7. Aripiprazole is a partial D2 agonist.  

True

Yes, I agree

Share this post


Link to post
Share on other sites
8. Risperidone has been shown to increase the risk of cerebrovascular events in the elderly.

TRUE, CSM guidelines etc, although newer research is questioning this somewhat - see recent yellow journal. I'd still say TRUE though

Yes, I'd say TRUE. Also, see BNF 51 (March 06), pg 187.

Share this post


Link to post
Share on other sites
7. Aripiprazole is a partial D2 agonist.  

True

Yes, I agree

Me too.

From Wikipedia:

Aripiprazole appears to mediate its antipsychotic effects primarily by partial agonism at the D2 receptor. Partial agonism at D2 receptors has been shown to modulate dopaminergic activity in areas where dopamine activity may be high or low, such as the mesolimbic and mesocortical areas of the schizophrenic brain, respectively. In addition to partial agonist activity at the D2 receptor, aripiprazole is also a partial agonist at the 5-HT1A receptor, and like the other atypical antipsychotics, aripiprazole displays an antagonist profile at the 5-HT2A receptor. Aripiprazole has moderate affinity for histamine and alpha adrenergic receptors, and no appreciable affinity for cholinergic muscarinic receptors.

Share this post


Link to post
Share on other sites

Q6) The diagnosis of delusional disorder requires the presence of persecutory beliefs.

FALSE - the beliefs don't even need to be false, any sort of chronic delusion is acceptable.

Share this post


Link to post
Share on other sites

1. Psychotic symptoms are a documented side effect of L-dopa.  T

2. The concentration of non-NMDA receptors in the hippocampus is reduced in schizophrenia.  T

3. Violent outbursts in a newly admitted excited patient is more likely to be due to schizophrenia than mania.   F

4. In London, the chance of having a psychotic episode is greater in African immigrants compared with Afro-Caribbean immigrants.  F

5. There is a 2.7 relative risk increase for psychosis in all first generation immigrants.   T

6. The diagnosis of delusional disorder requires the presence of persecutory beliefs.  F

7. Aripiprazole is a partial D2 agonist.   T

8. Risperidone has been shown to increase the risk of cerebrovascular events in the elderly.  T

Share this post


Link to post
Share on other sites
Sign in to follow this  
Followers 0