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Alzheimers diease affecting the parietal lobe is associated with worse prognosis?


Ref Manchester notes

Reality orientation has lasting beneficial effects when used to treat people with alzheimers.


reference: Seminar series old age

retrograde amnesia is due to retrograde interference


They are two distinct albeit related concepts.

Retroactive interference: Newly learned information hurts memory for old information.

or else:

retroactive inhibition/interference

'Forgetting caused by learning material after the to-be-remembered episode'(Benjamin, Hopkins, & Nation, 1994. p.279)

Related pages: interference theory

retrograde amnesia

A loss of memory for events occurring before the onset of amnesia. Specifically, the word retrograde means moving or tending (to go) backward. (Kurland and

The memory degredation curve starts off gradual and then becomes progressively steeper.


The other way around: memory degradation should refer to the speed of information loss from STM to LTM. According to Psychol basis of Psych pag 164 this starts steeply and then slows down once it is fixed in LTM.

10% of alzheimers is due to variations in the preselinin gene i think FALSE. there are 2 presenelin genes implicated in the aetiology of alzheimers. both are less than 5%. ref:'> <> Early Onset- chromosome 14: Presenelin I (PS-1) <5%. Chromosome 1: Presenelin II (PS-II) <1% Chromosome 21: Amyloid Precursor protein 1-3% Late Onset Chromosome 19: Apolipoprotein E risk factor only 40-50%

in Alzheimers disease there is decreased latency in the evoled responses(evoked potentials?) in EEG


evoked potentials

this invasive technique is justified only under exceptional circumstances. From today's practical point of view, scalp EEG has several uses:

Investigation of epilepsy to confirm the diagnosis and clarify the type of epilepsy

Differentiation of delirium from acute nonorganic psychosis

Recognition of Creutzfeldt-Jakob disease

Distinction of frontotemporal dementia

Kaplan & Sadock's Comprehensive Textbook of Psychiatry

7. presence of birth injury affects the age of onset of SCZ


Byrne et al. (2000) Compared obstetric records of 431 patient–control pairs. Linked with psychiatric case register. Global rate of OCs did not differ between patients and controls. Male patients with a young onset had significantly more OCs than controls.

Rosso et al. (2000) 1955 Finnish birth cohort. 80 patients, 61 unaffected siblings, and 56 matched controls. Hypoxia-associated OCs significantly increase the odds of early-onset schizophrenia (but not of later-onset schizophrenia).  

5.Elderly patient with 1st episode of depression more likely to have large ventricles than someone of the same age with several previous episodes.

True. Old age depression more asscociated with brain pathology and cognitive impairment

Oestrogen HRT is thought to delay the onset of Alzheimers dementia


May double the risk

1.prevalence of mania in older adults is 5% in the community


Mania is a rare disorder in older people. The Epidemiologic Catchment Area Study showed a decrease in the community prevalence of mania with increasing age, from 1.4 per cent in younger adults to 0.1 per cent in the over-65s.

New Oxford Textbook of Psychiatry

1.Retrograde amnesia is due to retrograde interference


(possibly wording just wrong, interferance can be item dependant (proactive and retroactice), or time dependant in which case it is called decay

Delusional disorder in the elderly is associated with auditory hallucinations.

FALSE - delusions but not other psychopathology


In Downs syndrome there is high risk of developing hypothyroidism than general population

TRUE - of course.. much greater occurrence, probably autoimmune, important differential diagnosis with mood disorders in LD

Comp to Psych Stud 542

The genetic risk for Schizophrenia and BPAD are associated with differences in patterns of grey matter volume deficits on MRI


Apparently they could have White matter abnos but no evidence for GM

1: McIntosh AM, Job DE, Moorhead WJ, Harrison LK, Whalley HC, Johnstone EC, Lawrie SM. Related Articles, Links

Genetic liability to schizophrenia or bipolar disorder and its relationship to brain structure.

Am J Med Genet B Neuropsychiatr Genet. 2006 Jan 5;141(1):76-83.

PMID: 16342281 [PubMed - in process]

Women who commit fillinicide(?infanticide) usually have a previous history of admissions to psychiatric units.

F-manch notes

Polymerase chain reaction requires thermostable DNA polymerase


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Neuroleptic malignant syndrome can be treated with a combination of a Ca-blocker and a dopamine agonist


Bromocriptine (Dopamine agonist)

Ca Channel blockers can be used

as long as there is some evidence for use and if the question says 'can be used' I would say the answer is TRUE

I guess this is one of those debatable questions

4. Autism in adults carries an increased risk of schizophrenia. FALSE

Autistic children are not at an increased risk of developing Schz in adult life (Goodman & Scott, 2005, Page 51)

FALSE.....not debatable any longer. all the recent evidence based analysis did not show any linkage.

Sleep deprivation reduces the number of killer cells in the brain



Nk activity is increased by sleep deprivation

The neurological significance of abnormal natural killer cell activity in chronic toxigenic mold exposures.

Anyanwu E, Campbell AW, Jones J, Ehiri JE, Akpan

mentions sleep effects in reference ..

35) The suspicion of cognitive impairment is a contraindication for ECT


No absolute contraindications, relative ones include conditions that may raise i.c. pressure + recent MI

ref NICE guidel/textbooks

Polymerase chain reaction requires thermostable DNA polymerase


women are more suggetible than men under interrogation


this has been discussed elsewhere in the forum...someone gave a reference.

Munchausun by proxy is classified as a factitious disorder in the ICD-10

17. False0

(ref ICD10) Maunchausen by proxy (T74.8

MTHFR gene is a risk for hyperchromocysteinaemia


Nothing to do with it this was the q in the exam i recall?

but MTHFR is a risk for hyperhomocysteinemia which is TRUE


Automatisms usually last for 5 to 15 minutes. - FALSE Automatisms- last from a few seconds to several minutes 80% < 5 min

in severe closed head injury CSF rhinorrhea occurs in more than 10% of cases

FALSE 5% according to Manchester

The heritabilty of cannabis use is 60-80% False The heritability of use and abuse of illicit substances was modest (25% or less), whereas the heritability of tobacco use and nicotine dependence was substantial (40% to 60%) Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:671-677, 2000. © 2000 Wiley-Liss, Inc.


Guys, Bleuler's autism has nothing to do with autism (PDD) as a diagnosis. (although the feature e.g isolative behaviours are common)

That autism is a predecessor of Schizophrenia was an early misconception by Kanner, the guy who described autism.

Note the conclusion of a study in the AJP. Granted, this is a 1991 study.

If the present study group is taken to be representative, it appears that the frequency of schizophrenia among autistic patients (0.6%) is roughly comparable to the frequency of schizophrenia in the general population.

The eldest child in a family has a greater chance of becoming dependent on alcohol.

FALSE (sons are at greater risk, the order does not matter)

Men have a greater prepulse inhibition than females.


Exaggerated gag reflex is a physiological theory for the aetiology of panic disorder.

FALSE - interesting idea though... if anything, the PO2 theory

Vegans can't get nvCJD.


Proposagnosia occurs more often in patients with right sided hemiplegia than left.

FALSE - lesion should be on the tight, therefore hemiplegia on the left

8.Heritability of alcohol dependence depends on the population prevalence

True?(sorry,can`t find a conclusive ref)

A family history of alcohol or drug dependence remains one of the strongest predictors of risk, with heritability estimates for alcohol dependence ranging from 45 to 65 per cent for men and women

7.Genetic linkage studies of BPAD has shown that a suseptiblity gene on chromosome 18 occurs in some families


Berrettini et al first reported linkage of bipolar affective disorder to chromosome 18 DNA markers in a systematic genome survey including 22 families. These authors' results suggest that a susceptibility gene is present in the pericentromeric region of this chromosome.

New Oxford Textbook of Psychiatry

RE: Incidence rates of Schizophrenia in Barbados vs. U.K.

The age-corrected incidence rate for schizophrenia per 10 000 is 2.09 in Jamaica, 2.2 per 1000 in Trinidad, and 2.92 in Barbados. These rates are lower than the incidence rates reported for white British people, and significantly lower that the 6- to 18-fold higher risk ratio incidence reported for African Caribbeans living in Britain.

5.D-Cycloserine enhances the extiction of fear


D-cycloserine (a modulator of the glycine site of the glutamate N-methyl-D-aspartate [NMDA] receptor) may be a particularly effective treatmentin anxiety disorders.


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MCPP is a 5-HT2a antagonist. true

mCPP antagonist with moderate affinity at the 5-HT2A and 5-HT3 receptors, a partial agonist with approximately a ten times lower affinity at the 5-HT1A, 5-HT1B, and 5-HT1D receptors, and a weak partial agonist at the 5-HT2B receptor with an affinity equal to that of the 5-HT2C receptor (Kennett et al.1994).

Duloxetine is a serotonine and NA reuptake inhibitor T

It weakly inhibits dopamine reuptake , with NO significant affinity for histaminergic, dopaminergic, cholinergic and adrenergic receptors. It is extensively metabolised by oxidative enzymes (CYP1A2 and CYP2D6). The half life of duloxetine ranges from 8 to 17 hrs (mean 12 hrs). (and NOT 24 hrs).

Ref: SPC, Cymbalta

4) Acamprosate is an NMDA antagonist TRUE

Neuropharmacology. 2001 May;40(6):749-60. Related Articles, Links

The anti-craving compound acamprosate acts as a weak NMDA-receptor antagonist, but modulates NMDA-receptor subunit expression similar to memantine and MK-801.

Rammes G, Mahal B, Putzke J, Parsons C, Spielmanns P, Pestel E, Spanagel R, Zieglgansberger W, Schadrack J.

5) Carbamazepine is associated with hypothyroidism


1/Long-term treatment of children with epilepsy with valproate or carbamazepine may cause subclinical hypothyroidism.

Eiris-Punal J, Del Rio-Garma M, Del Rio-Garma MC, Lojo-Rocamonde S, Novo-Rodriguez I, Castro-Gago M.

2/Our data suggest that children treated with carbamazepine may have subclinical signs of hypothyroidism, and these changes are more evident if carbamazepine is given in association with valproic acid, while no alteration in thyroid hormones can be found with valproic acid monotherapy. Thyroid-stimulating hormone and thyrotropin-releasing hormone levels do not seem to be affected by these drugs, suggesting that hypothalamic function is not affected in these children.

Pediatr Neurol. 2001 Jul;25(1):43-6.

Thyroid hormones in epileptic children receiving carbamazepine and valproic acid.

6) The Lithium level increases when given with Fluoxetine. FALSE

Lithium concentration is not influenced by cyt p450 as it is not metabolised at all.

.Nicotine receptors in the brain are ion gated TRUE

2.Duloxetine has significant benefit in urgent incontinence TRUE

CONCLUSION: This trial provides evidence for the efficacy and safety of duloxetine as a pharmacologic agent for the treatment of stress urinary incontinence.

3.Duloxetine is serotonine and NA reuptake inhibitor


Duloxetine: a serotonin-noradrenaline re-uptake inhibitor

for the treatment of stress urinary incontinence

4.Duloxetine has a half life of 24 hours FALSE

Pharmacokinetics: The elimination half-life for duloxetine is approximately 12 hours, with a range of 8-17 hours. loxetine.htm

5.Mirtazapine blocks H1 receptors TRUE

Mirtazapine is a presynaptic alpha-2 antagonist that has dual action by increasing noradrenergic and serotonergic neurotransmission. The enhancement of serotonergic neurotransmission is specifically mediated via 5-HT1 receptors because mirtazapine is a postsynaptic serotonergic 5-HT2 and 5-HT3 antagonist. In addition, mirtazapine has only a weak affinity for 5-HT1 receptors and has very weak muscarinic anticholinergic and histamine (H1) antagonist properties. As a consequence of its unique pharmacodynamic properties, mirtazapine is an effective, safe and well-tolerated addition to the antidepressant armamentarium. Mirtazapine is well absorbed from the gastrointestinal tract following oral administration, and it is extensively metabolized in the liver to four metabolites via demethylation and hydroxylation, followed by glucuronide conjugation.

6.Clozapine causes akathisia less than risperidone in any dosage. TRUE

The point-prevalence of akathisia was 7.3% in the clozapine group, 13% in the risperidone group, and 23.8% in the group treated with conventional antipsychotics. &list_uids=9501888&dopt=Abstract

7.duloxetine is an ssri and nari TRUE

see above

8.Grapefruit juice inhibits CYP450 TRUE

cyt P 450 3A4


9.Tinnitus is seen more often in Benzo withdrawal than GAD TRUE

it is common in benzo withdrawal

but only increased by GAD (not caused)

8.MCPP is a 5-HT2a antagonist. - false

mCCP (m-chlorophenylpiperazine) is a metabolite of Trazodone/Nefazodone.

mCCP is a partial 5HT2 agonist


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When a mother remarries, daughters experience more distress than sons. - TRUE

According to goodman and Scott.

so it goes like this:

when parents divorce - boys more distressed

when mother remarries - girls more distressed

100% sure about this one

in psychodynamic psychotherapy interpretations should always be tentative.

F-always is almost always wrong

Group analysis is of the group,by the group ,for the group.F

Gestalt psychology includes law of closure

T-also proximity,similarity,simplicity,continuity. malhi&mitchell1999-pgg5

10) women are more suggetible than men under interrogation

F-as earlier

Group analysis is of the group,by the group ,for the group.

A patient failing to attend a therapy group who have critisized her is what Bion referred to as the basic assumption.

Bion perceived three basic assumption groups: the dependency group, the fight-flight group, and the pairing group. Dependency groups operate on the assumption is that there is a leader (not necessarily the therapist) who can magically gratify the group's need for security and nurture. Another Basic Assumption is that the group must protect itself. It does this by either fighting or running away from something threatening. Naturally enough, Bion called this the 'fight-flight' group. Since it is not unusual (especially in a therapy group) for the Work-Group tasks themselves to feel threatening, it is not uncommon for the nominal leader to be avoided or fought against.

so its not attending the group,

82) If you disagree with the attitude of someone you like you will change your attitude rather than change your opinion of the person


Congruity theory me thinks

8. Gender differences exist in the moral development of children


More recent approaches to explain moral development are the gender-based theories. Carol Gilligan asserts that male and female morality develop along different tracks. Women's moral development ends in compassion and an ethics of caring, whereas men's morality culminates in a moral system that is dominated by the ethics of justice and the assertion of rights

Kaplan & Sadock's

9.A patient failing to attend a therapy group who have critisized her is what Bion referred to as the basic assumption.


Basic assumptions, are dependency, fight or flight, and pairing.

In dependency, the group tries to elicit protection through passive or dependent behaviour. In fight or flight they will attack the therapist or some other issue, or retreat and withdraw. In pairing they may create a group illusion that some magical form of rescue may arise from the dilemmas of group life through charged partnerships.

9.Underlying assumptions are process that belong to the dynamic unconsciousness


personal dynamic unconscious reflects developmental vicissitudes and residues of a life history.

1.Habituation can exacerbate panic avoidance.


Repeated presentation of the same stimulus can have two consequences: sensitization or habituation. The former involves an increase in responding, and the latter involves a decrease. Slow rates of stimulus presentation are relatively more likely to result in sensitization, and rapid rates are more likely to result in habituation.

6.projective identification is a defence mechanism against unconsious anxiety


One member of a couple has an affair, the other, unable to show directly their hurt, may retaliate by themselves sleeping with someone else. Here the initially injured party communicates pain, humiliation, and rage not by direct expression of anger, but by inducing those feelings in the other via PI

2.Negative reinforcement can exacerbate the avoidance in phobic avoidance.

TRUE - Negative reinforcement means that an aversive stimulus is present before a behaviour, so that once the desired behaviour occurs the adversive stimulus stops thus increasing the probability of that desired behaviour reoccurring. This learned response is called avoidance conditioning

Punishment is where an adversive stimulus is appiled after a given behaviour (usually an undesired one) occurs

- Revision notes in Psychiatry

8.Transference phenomena does not effect the therapist

False - it is the reactions that the patient projects pnto the therapist... must affect the therapist in some way (my own interpretation)

4.Rational emotional therapy is of proven benefit for patients with emotionally unstable personality disorder

FALSE - rebt does not have good eidence base

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Child/Learning Disability

maternal deprivation is significantly associated with alcohol dependence

F-not significantly

Irrespective of the childs aggression, peer rejection on its own increases the risk of antisocial behaviour


Reference : Manchester notes

4. Complex partial seizures are usually associated with emotional problems in childhood


ref:The British Journal of Psychiatry 135

8. Truancy is seen with somatisation in children


school refusal maybe seen with somatization, not truancy. In truancy children do not stay at home. Associated with anti social behaviour.

Social emotional repetoire is retained in williams syndrome.


Apparentl it is particularly good

Heritability of conduct disorder is 0.1-0.2 True Ref Superego course

I would go for FALSE - most literature agrees on much higher figures, which also make logical sense.

Women who commit fillinicide(?infanticide) usually have a previous history of admissions to psychiatric units.


'Usually' is wrong: they do in some cases [companion to psych studies 713, ref McGrath 1992]

Sexual offending in LD is more often due to hypersexuality. -false Most sex offences committed by people with LD are associated with lack of sexual knowledge, poor social skills and inability to expess a normal sex drive appropriately. Ref: oxf handbook of psychiatry

23. Young girls are twice as likely as young boys to be targetted by paedophiles. -true

Fragile X shows prepubertal macroorchidism False It is postpubertal macroorchidism Ref Seminar series in LD

Fragile X syndrome affected women show more severe mental retardation than affected men FALSE - mild

Cardiovelofacial syndrome is caused by a deletion on Chromosome 21q11 FALSE 22q11

XYY are taller than average people True

XYY phenotype is associated with low IQ True

prevalance of moderate to severe mental retardation is 3-4/1000 true oxford text book True for moderate & severe LD ;10-11 per 1000 for mild LD

40-70% of cases with tuberous sclerosis have a learning disability TRUE - Intellectual abilities are bimodally distributed, with roughly half of cases having normal IQ and half in he learning disabled range - Joinson Psych Med 2003 33:335-344.

Learning disability is overrepresented in homicide offenders-]False..its true for sexual offences & arson

XYY occurs more often in families with a history of criminal behaviour ...F...itz trasferred sporadically

Those with XYY are more likely to come from a family with a criminal background ...F

An young adult with Downs Syndrome is likely to have epilepsy -?false...2 peaks for Downs epilepsy...chidlhood & in association with Dementia

An young adult with Downs Syndrome is likely to have epilepsy False In people with Down syndrome the frequency of epilepsy is 5 to 10 per cent. There is an age-related bimodal distribution with about 40 per cent of seizures starting before the age of 1 year and another 40 per cent starting after the third decade In Down syndrome or trisomy 21 the bimodal distribution of the frequency of epilepsy between young and older ages is interesting. The fact that more than 75 per cent of adults with Down syndrome develop late-onset epilepsy coincident with the onset of the neuropathological abnormalities in the brain compatible to Alzheimer's disease suggests an aetiological role of these abnormalities Oxford Textbook

8. An young adult with Downs Syndrome is likely to have epilepsy.


Huntingtons chorea usually has more than 35 CAG repeats ...true...

40 to over 100 Parents of children with profound mental retardation are sensitised to bereavement issues ...?my guess T

Fragile X syndrome affected women show more severe mental retardation than affected men ...F..other way are mod-severe

40-70% of cases with tuberous sclerosis have a learning disability..T

Turners syndrome usually causes moderately severe learning difficulties as defined by ICD-10 ...F..have normal I.Q

Williams syndrome is associated with deletion of chromosome 7 ...T..microdeletion of long armof Chr7

Genes can influence your choice of environment ...?probably true..itz one of those'maybe' statements!

Teenagers with social phobia have a higher incidence of shop lifting.


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Turners syndrome usually causes moderately severe learning difficulties as defined by ICD-10?

FALSE - mild learning diff

In Downs syndrome there is high risk of developing hypothyroidism than general population?

'higher' true (1 in 3 before the age of 25

An young adult with Down Syndrome is likely to have epilepsy?

TRUE (5 to 10 % risk, it is higher than for general populaion, 1%

Impaired voice prosody is a feature of Aspergers Syndrome?

TRUE deficits in both prosody and pragmatics

Theory of mind difficulties are found in general population as they are found in people with Autistic spectrum disorders?


4.Social emotional repertoire is retained in williams syndrom

Classic Williams syndrome personality, described as pleasant, unusually friendly, affectionate, loquacious, engaging, and interpersonally sensitive and charming. Such qualities may change over the course of development, with adults being more withdrawn and less overly friendly than children.

XYY phenotype is associated with low IQ


The XYY syndrome is present in 1 in 800 boys. Males with XYY syndrome tend to be tall and to have nodulocystic acne at puberty. XYY males as a group, like XXY males(Klinefelter syndrome), reportedly are somewhat less intelligent than XY males. This may increase their risk of socialization and academic problems

Kelley's Textbook of Internal Medicine

3. XYY occurs more often in families with a history of criminal behaviour.


Cytogenetic and molecular genetic studies have not yet identified specific conditions associated with antisocial behaviour, except for the XYY karyotype where affected individuals show about three times the rate of criminal behaviour than controls or individuals with other chromosomal anomalies such as XXY, even allowing for their reduced IQ.

New Oxford Textbook of Psychiatry

1.Sexually offending in LD is more often due to hypersexuality.


Most offences are crude expressions of sexual frustration

Aspergers syndrome is associated with above average height.


(This is true of XYY though)

Williams syndrome is due to a deletion on chromosome 7.


Small chromosomal deletion on long arm of Chr 7

1.Autistic patients become less socially isolated after childhood.


Autistic patients become less socially isolated after childhood.


Patients with Aspergers syndrome have a narrower repetoire of emotional facial expression


This is part of DSMIV criteria under impairment of non verbal communication (includes poor eye to eye contact, body and facial language

Autistic patients have greater difficulty telling the sex from someones eyes.

FALSE....they can have difficulty but not 'greater difficulty'....

6.Epidemiological studies of adolescents have shown that over 50% of girls are dieting in the US

TRUE - Between 40% and 60% of high school girls in the United States diet to lose weight

Ref: Journal of the American Academy of Child & Adolescent Psychiatry -

1.Parents of Autistic children are usually aware of problems by the age of 12 months. False

' Abnormal development is usually apparent before the age of 3. There are reports that early signs if autism can be detected in infancy'... Shorter OTP

2.Autism and risk of schizophrenia in adults

3.Autistic children become less isolated as they grow older. ....False

Although they try to mix with others but because they have not learnt the social ways they cntinue to behave as small children and amy be rejected and feel isolated..

4.Arson is overrepresented in LD offenders.... True. So is Sexual offences.... Shorter OTP... the section of arson in forensic

Dietary restriction can improve the IQ outcome in children with Tach-says disease ( or was it leash-nyan)

For Tay Sachs - FALSE; and FAlse for lesch

A young adult with down's syndrome is likely to suffer from epileptic siezures.


1. The prevalence of moderate to severe mental retardation is 3-4 per 1000 . T

2. Learning disability is overrepresented in homicide offenders F

3. XYY are taller than average people T

4. XYY phenotype is associated with low IQ T

5. XYY occurs more often in families with a history of criminal behaviour F

6. Those with XYY are more likely to come from a family with a criminal background F

7. Angelman's syndrome is due to paternal deletion in chromosome 15 F

8. An young adult with Downs Syndrome is likely to have epilepsy F

9. Downs syndrome can be suspected if there is hypertonia in the newborn F

10. Huntingtons chorea usually has more than 35 CAG repeats T

11. Parents of children with profound mental retardation are sensitised to bereavement issues T

12. CAG repeats are seen in fragile X F

13. Fragile X shows prepubertal macroorchidism F

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5. In treating dependence, the action stage follows contemplation


Follows ready for action

(Pg 351, Comp to Psych St, 6th Ed, Johnstone et al)

The stage of change that a person can be identified as being at determines the therapeutic approach and type of treatment offered. Thus at the precontemplation stage where there is no recognition of a need for treatment, there is no point in offering intensive treatment interventions. Similarly, at the contemplation stage when treatment is being considered, the appropriate intervention is to help the person clarify their views and build their motivation to change rather than offering active treatment. Indeed, it is only in the decision and action stages that treatment should be actively offered and facilitated.

New Oxford Textbook of Psychiatry

4. Acamprosate is validated for use in alcohol abuse in old people.


Licensed for age18-65yr

1. First born sons are more prone to alcohol dependence.


Just sons, not related to birth order

(Pg 121, Exam Notes in Psych, Basic Sc, Malhi & Mitchell)

1. First born sons are more prone to alcohol dependence.


Just sons, not related to birth order

(Pg 121, Exam Notes in Psych, Basic Sc, Malhi & Mitchell)

9. Alcoholic hallucinations resolves spontaneously in 6 months


(Pg 79, ICD-10, WHO)

halsteid reitan battery test used to assess problem drinkers:false

(test for visuo motor tracking,set shifting&of conceptualisation)

pg 217 :cognitive asst for clinicians(hodges)

7) Regular bingeing more than continous alcohol use has more effect on the socio-economic situation of the patient

True (....I think?)

Oxford Textbook of Psychiatry, 2.17 Alcohol dependence and alcohol problems (via

An individual who drinks in binges will experience different problems compared with someone who drinks the same amount of alcohol spread over a week or a month or a year. The way in which a person behaves while intoxicated is another important factor determining the nature of alcohol related problems. The social consequences of drinking such as job loss, imprisonment, marital and family break-up, and binge drinking have profound effects on the well being of the drinker, their families and society.

26. 'Brewer's droop' is the drowsiness experienced by alcohol brewers


It is the inability to get an erection after alcohol intake

Page 109 Psychology Richard Gross

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1. Female carriers of Fragile-X have a below average IQ

1 true ,30 to 50% of the female carriers show cognitive deficit[oxford page 1954]

It is the 2nd most common single cause of mental retardation. It can range from mild to severe. The intellectual functions seem to decline in the pubertal period. Females are less impaired than males but can be mildly retarded.

Kaplan & Sadock- Synopsis of Psychiatry 9th Edition

2. The Fragile-X fragment occurs on the short arm of the X-chromosome

2false lonng arm Xq 27.3 [ox 1953]

5. Restriction fragment length polymorphisms are inherited in a Mendelian fashion

5 RFLPs are inherited in mendelian pattern true

Gin and Malhi

4. Metachromatic leucodystrophy is an X-linked recessive condition

Q4. False. Metachromatic leucodystrophy is an autosomal recessive metabolic disorder.

12. Symptoms of Angelman’s syndrome include hyperphagia and cognitive impairment

?12. false hyperphagia and cognitive impairment symptoms of prader willi syndrome (the Paternal deletion of same genes) if maternal deletion get angelmans syndrome with midline handflapping and MR. an example of uniparetnal disomy aka imprinting

UPD causes equal amounts of PW and Angelman

13. Uniparental disomy is more a cause of Angelmann’s syndrome than Prader Willi syndrome


Occurs in both, but more in Prader-Willi (25%) cf Angelman (2%)

(Pg 224, Comp to Psych St, 6th Ed, Johnstone et al)

7 Autism has a 90% MZ concordance rate.


2 largest twin studies show 36% MZ vs 0% DZ in one study and 96% MZ vs 27% DZ in second study.Second study, however, zygosity was confirmed in only about half the sample.

Synopsis of Psychiatry, Kaplan and Saddock.


“…the huge disparity in concordance rates for autism between MZ (n = 25) and DZ (n = 20) pairs (60% vs. 5%) confirmed the earlier findings on the strength of the genetic influence. Quantitative analyses indicated a heritability in excess of 90%. term=

“Current heritability estimates for autism are above 90%, which makes autism a strongly genetic disorder.” torial.asp

3. Klinefelter’s syndrome (XXY) is associated with moderate and severe learning difficulties in the majority of patients

3 false mild mental retardation in 47 XXY[may have an IQ in the normal range]severe mental retardation in rarer genoypic variations [puri pg 184]

8. Linkage analysis can be used to study genetic disorders in families

8) Linkage analysis can be used to study genetic disorders in families

True - ref companion page 227

11. Aggression is over-represented in 47XYY


(Pg 205, Exam Notes in Psych, Basic Sc, Malhi & Mitchell)

10. Most people with 47XYY do not have behavioural problems


(Pg 612, Comp to Psych St, 6th Ed, Johnstone et al)

6. Restriction fragment length polymorphisms are the only way to examine genetic linkage


(Pg 95, Oxford Txt of Psych, 3rd Ed, Gelder et al)

9. A gene consists of coding information for intron, codon and mRNA


(Pg 220, Comp to Psych St, 6th Ed, Johnstone et al)

14. An imperforate anus at birth suggests Down’s syndrome

?True .imperforate anus suggestive of downs, as is dudodenal atresia, prolonged meconium ileus, prolonged neonatal jaundince, floppy baby)

6) Fragile X has CAG repeats


Fragile X involves an expansion of the CGG repeats normally in the FMR1 (fragile X mental retardation 1) gene. The CGG repeats are not in a section of the gene that gets edited out (an intron), but rather in a section that is copied and remains after the editing is finished (an exon). Even though the repeat section is part of the finished messenger RNA (mRNA), it doesn't actually get translated into protein.

(Used with permission of

Rob Willemsen, Ph.D., Erasmus University)

Huntingdon's Disease has CAG repeats.

Fragile X due to CGG repeats

Hungtington's disease caused by CAG repeats

Myotonic dystrophy caused by CTG repeats

(Page 210 Exam Notes in Psych, Basic Sciences, Malhi & Mitchell)

1 Phenylketonuria occurs 1 in 20000


Kendell and Zeally put it at 1 in 10000. It is generally accepted to be between 1 in 10000 and 1 in 12000 live births.

Phenylketonuria Prevalence and causes Phenylketonuria is caused by an inborn error of amino acid metabolism which affects approximately 1 in 12 000 people. This condition is inherited in an autosomal recessive manner and often causes severe mental retardation if it remains untreated. Affected subjects have fair hair, fair skin, and blue eyes because of the lack of the skin pigment precursor tyrosine. This metabolic disorder is caused by a deficiency of the hepatic enzyme, phenylalanine hydroxylase, which causes hyperphenylalaninaemia and phenylketonuria.

New Oxford Textbook of Psychiatry

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


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.






2. Akathisia is a side effect of amphetamines.


One of the S/E listed is Restlessness

Page 198 - BNF

Causes restlessness in high doses


Page 1168 - Synopsis 9th Edition

Pseudocyesis is associated with social isolation - TRUE

Int J Psychiatry Med 1990;20(1):97-108 (6 cases where social isolation is one of several common features)

5. Shoplifting is associated with bulimia nervosa

TRUE Comp to Psych Studies pg 523

7.Amenorrhoea is seen in bulimia nervosa

TRUE Comp to Psych Studies pg 524

9. Anorexia nervosa of later onset has higher

mortality..... than that of earlier onset.

TRUE Seminars in Gen Adult Psych pg883

( if ..... than that of very early onset I would answer

false )

18. Self-neglect in the elderly (Diogenes' syndrome) is

likely to be caused by delusions.

FALSE Seminars Old Age Psych pg166

...refers to a syndrome of self-neglect in older

people, unaccompanied by a medical or psychiatric

condition sufficient to account for the situation.

Self neglect in the elderly (Diogenes syndrome) is generally thought to be burnt-out personality disorder


Manchester course notes on old age p11

12. Peripheral CCK(cholecystokinin

) release reduces satiety .false

puri pg 461

(CCK) is a peptide neurotransmitter originally isolated from the gut but abundantly distributed in the CNS. In addition to its presence in pancreas and the gastrointestinal (GI) tract, CCK has been identified in mammalian brain, with high concentrations found in the cerebral cortex, limbic system, and hypothalamus. In animal studies, CCK is involved in the regulation of such behavioral functions as inhibition of intake of solid and liquid food, production of satiety, and pain relief. Of the two identified receptor subtypes, CCK type A (CCK-A) is found primarily in the periphery and in some discrete brain areas, whereas CCK type B (CCK-B) is plentiful in the brain.

13. Approximately 30% of women experience the blues after pregnancy true ans 30 to 80 percent page 557 companion


Medical Complications:

Like all eating disorders bulimics are also at a high risk for dying, especially if they are purging, using laxatives and doing

excessive exercise. Many bulimics have died from cardiac arrest, which is usually caused by low potassium or an electrolyte imbalance. There have also been cases when bulimics have died because of a ruptured oesophagus due to excessive vomiting. Other complications that arise are:

Erosion of tooth enamel because of repeated exposure to acidic gastric contents

Dental cavities, sensitivity to hot or cold food

Swelling and soreness in the salivary glands (from repeated vomiting)

Stomach Ulcers

Ruptures of the stomach and oesophagus

Abnormal build-up of fluid in the intestines

Disruption in the normal bowel release function

Electrolyte imbalance


A greater risk for suicidal behaviour

Decrease in libido

Cathartic colon (caused from laxative abuse)

Edema (swelling of hands and feet)

Low blood pressure

Development of peptic ulcers and pancreatitis (inflammation of the pancreas)

Gastric dilation and rupture

Abrasions on back of hands and knuckles


Cardiac arrest and death


The treatment of bulimia consists of individual psychotherapy and nutritional direction. However, what you have to realise is that you cannot cure a bulimic by trying to control their behaviour or worse shrugging it off. What the patient needs is support. As most of the patients are very hard on themselves and they need support to help understand things better.

15. Adolescent girls who intentionally self harm have a history of parental criticism immediately preceding the episode.

15. TRUE

Ref: Archives of Suicide research, 1995

6.The Eating Disorders Inventory is a self-reported questionnaire


Source- Manchester course

1.Self-induced vomiting and deliberate self harm are associated in adolescent girls


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Really great lad, well done

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5. The EEG shows exaggerated spikes in Huntington’s disease.

false. eeg in huntingtons disease is flattened.the eeg reveals low amplitute waves.[pg389core psychiatry]

5. False - in Huntington's disease a low voltage pattern may be seen.

Puri and Hall (p.403)

.Huntingtons disease is associated with CAG repeats.

TRUE. [pg 55 core psychiatry]

6. True - HD is caused by the expansion of an unstable CAG triplet repeat sequence on Chr. 4p, resulting in a polyglutamine expansion in the resultant abnormal protein 'Huntingtin'.

Manchester Course

12. In transcribing mRNA the exons are spliced out.


RNA splicing is part of post-transcriptional processing along with capping and polyadenylation. It is the introns (non-coding sequences) which are removed by endonucleolytic cleavage at specific splice junctions from the primary transcript by spliceosomes.

12. False - Introns are spliced out in the spliceosome, an assemblage of proteins and snRNPs that recognise terminal intronic sequences.

Companion to Psychiatris Studies (p.153)

11. The globus pallidus is part of the limbic system


Limbic system contains grey matter, part of the amygdaloid nucleus, the limbic lobe (parahippocampal and cingulate gyri), hippocampal formation, hypothalamus (especially mammillary bodies), anterior nucleus of the thalamus, fibre bundles, fornix, mamillothalamic tract, stia terminalis and lots of 5HT

(A-Z of the MRCPsych, Taylor, p195)

The globus pallidus is part of the basal ganglia









1. There is decreased short wave sleep in the elderly.


KS CTP VII Ch 1.19

The amount of time spent in delta sleep (stages 3 and 4) each night peaks in early adolescence and gradually falls with age until it nearly disappears at about the age of 60. Young adults typically spend about 15 to 20 percent of total sleep time in delta sleep. By the age of 60 or 70, few individuals have any delta-wave activity during sleep. Interestingly, men tend to lose delta sleep at an earlier age than women. The loss of delta sleep results more from a reduction in amplitude than from fewer slow (0.5–2 Hz) waves. Some researchers have speculated that this might indicate accelerated aging in men.

. True - normal ageing brings about characteristic changes in sleep architecture, with increased sleep latency, reduced total sleep time, loss of SWS, frequent arousals leading to fragmentation of nocturnal sleep, and an increase in daytime napping.

Companion to Psychiatric Studies (p.788)

2. Old age and Alzheimer’s disease both show neuronal degeneration in layer 2 of the entorhinal cortex.


KS CTP Ch 51.2


The most difficult problem in characterizing the normal aging of the human CNS is identifying a meaningful boundary between normal aging and abnormal neurodegeneration.

Plaques and Tangles

Senile plaques and neurofibrillary tangles are associated with Alzheimer's disease, Down syndrome, and other neurodegenerative diseases. Tangles are fibrous bands of intracytoplasmic inclusions consisting of paired helical filaments that seem to result from abnormal hyperphosphorylation and perhaps glycosylation of the microtubule-associated protein tau. Plaques consist of an b-amyloid core surrounded by microglial processes, dendritic processes, and sometimes neurites that may also contain paired helical filaments. While they are often called 'lesions,' implying pathology, both plaques and tangles occur in the brains of normal aged persons. Plaques may be found, in lower average numbers than in Alzheimer's disease, throughout the neocortex and in the hippocampus. Tangles accumulate with age first in layer II of the entorhinal cortex, later in the hippocampus and nearby temporal lobe areas, and later still in neocortex. There is a rough correlation between plaque counts (especially the neuritic type) and cognitive loss, but there is so much overlap between the counts in elderly adults without cognitive loss and in Alzheimer's patients that conventional neuropathological criteria for Alzheimer's disease require age-adjusted plaque counts. There is a better correlation between tangle counts and cognitive loss.

. False - in a small study comparing ERC in patients with Alzheimer's disease to elderly controls it was found that ERC had 40% volume loss in Alzheimer's disease. Volume of ERC was not dependent on age but degree of volume loss did correlate with disease severity.

Neurobiol. Ageing 1998; 19: 15-22

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9. waxy flexibility occurs in encephalitis

true: if any of you have read or heard the descriptions of encephalitis lethargica which boomed in the 1st world war you will know this is true (was thought to be secondary to influenza but now thought to be secondary to strep) (Oliver Sachs)

other encephalitic conditions can cause encephalitis in association with catatonia (joseph smith library, web)

. True - Mahendra (1981) believes that many of those patients with classical Kraepelinian schizophrenic features and catatonia were actually suffering from a neurological disease, perhaps post-encephalitic, from epidemic and endemic viral infections.

Symptoms in the Mind (p.342)

3. Episodic memory is usually impaired in semantic dementia.

3. False. episodic memory is preserved in semantic dementia

4. Primacy effect is retained in dementia: False????

4. True - in early stages tends only to be episodic (LTM) which is impaired in dementia.

Companion to Psychiatric Studies (p.335)

8. in atypical facial pain temporomandibular dysnction is usually found. false

pain is superficial and may occur in same location as tmj dysfunction

7. The difference between the protein in CJD and new variant CJD is a disulphide bond.

7. False - There are no sequence differences between Prpc and PrpSc. The reduction of a disulphide bond results in change in formation,i.e the structural difference between the normal prion protein and that found in nvCJD is a disulphide bond.

Manchester Course

10. Social judgement decision-making is spared in lesions of the ventromedial frontal cortex.

Think this is FALSE since people with frontal lobe lesions have problems with executive function, including impaired judgement. Any thoughts?

agree too. I wouldn't readily agree if the question was about the dorsolateral frontal cortex, however.

1. Proteomes are collections of proteins in a cell


The proteome is the collection of proteins found in a particular cell type under a particular type of stimulation. It is very roughly the protein equivalent of the genome. lookup.cgi?title=Proteomics

Proteomics is the study of proteomes, which are the collections of proteins expressed in cells. Whereas genomes are essentially invariant in different cells in an organism, proteomes vary from cell to cell, with time and as a function of environmental stimuli and stress

Ref – Published Med - Proteomic approaches to characterize protein modifications: new tools to study the effects of environmental exposures. 2002.

2. Heterozygous autosomal dominance can lead to variable penetrance

TRUE (page 155,companion)

(Pg 222, Comp to Psych St, 6th Ed, Johnstone et al)

4. DHEA opposes the effects of cortisol


“The beneficial effect of DHEA administration in depressed patients might result from its sigma 1 receptor-mediated enhancement of noradrenaline and serotonin neurotransmission, antiglucocorticoid effects, and cognition enhancing effects”

van Broekhoven & Verkes.

Psychopharmacology (Berl). 2003 Jan;165(2):97-110. Epub 2002 Nov 06. &list_uids=12420152&dopt=Abstract

DHEA is a cholesterol-derived hormone secreted by the adrenal glands under control of ACTH. It is the most abundant steroid hormone in the body, circulating primarily in the sulfated form, DHEAS. Blood levels of DHEA and DHEAS are somewhat lower in women, but levels decrease significantly with age in both sexes. DHEAS has a long half-life (20 hours) and serves as a buffer from which DHEA, androgens and estrogens can be derived. DHEA competes with cortisol at the receptor level. For example, DHEA exerted a clear anticortisol effect when administered to immobilization-stressed rats.

17. Nicotine increases attention in non-smokers


(Pg 435, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

3. SPET I123 is used to detect benzodiazepine receptors


pg 455 Table 16.6 Comp to Psych Studies

6. CNV is an EEG evoked potential


(Pg 142, Exam notes in Psych, Basic Sc, Malhi & Mitchell)

CNV = contingent negative variation. It is an evoked potential 'elicited by initially providing a priming stimulus & then one which requires a response...

CNV 'correlates to attention & motivation, and is therefore attenuated by

lack of stimulation or drugs like barbiturates'

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7. The CT scan is usually found to be normal in advanced CJD


CT and MR studies are often normal, even in advanced stages of the disease.

8. In CJD, met/val polymorphism is seen at codon 129


Polymorphism at codon 129 of the prion protein gene (PRNP) is implicated both in susceptibility and phenotype of human prion diseases.

16. Tonsillar biopsy showing prion protein is highly specific for variant CJD


Specificity not proven

“More recently, tonsil biopsy has been used for the presumptive identification of vCJD. Immunohistochemical testing for the prion protein in these tissues has demonstrated that the protein is present in patients with vCJD but not in patients with sCJD (Hill et al., 1999; WHO, 2001a). The postulated reasons for this difference include a strain effect, a species-barrier effect, or the oral route of exposure in vCJD (Hill et al., 1999). There have been too few case series to determine the sensitivity or specificity of this ancillary test.”

Advancing Prion Science: Guidance for the National Prion Research Program -- Interim Report (2003)

9. Sympathetic nerve damage causes hyperaesthesia


'Neuropathic Pain:

Implies damage to nervous tissue either as a primary injury or as a consequence of a disease process (e.g. diabetes). Neuropathic pain results from damage or compression of sensory (or possibly sympathetic) neurones that demonstrate dysfunctional and spontaneous pain signalling'.

“Nerve pain (neuropathic pain, neuralgia). Caused by pressure on or damage to nerves. Often associated with altered sensation or weakness. At first there may be increased sensation in the area of skin the nerve supplies. This is called hyperaesthesia…”

10. In HIV, multinucleate cells are found in the brain


(Pg 370, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

13. Orthopnea suggets cardiac neurosis


cardiac neurosis = Anxiety concerning the state of the heart, as a result of palpitation, chest pain, or other symptoms not due to heart disease; a form of hypochondriasis.

14. Cranial nerve IV palsy prevents the eye looking medially and downwards


innervates superior oblique

(Pg 106, Exam Notes in Psych, Basic Sc, Malhi & Mitchell)

Superior oblique 'depresses the eye in adduction (i.e. medially)'

Inferior rectus 'depresses eye . Laterally rotates eye in adduction'

medial rectus 'adducts eye'

sup. oblique supplied by trochlear (IV)nerve

Lesion of IV nerve will prevent downward medial (adduction) gaze

Inferior rectus supplied by oculomotor nerve

Remember (LR6 SO4)3

11. NMDA activation causes neurotoxicity


(Pg 59, Comp to Psych St, 6th Ed, Johnstone et al)

15. Alexia without agraphia is due to ACA damage


Caused by damage to terminal branch of post cerebral artery (& dominant occipital lobe)

(Pg 208, Sciences Basic to Psych, Puri & Tyrer)

18. Lewy body spectrum disorder includes Parkinson's disease


(Pg 525, Companion to Psych Studies, Johnstone et al, 6th Ed)

1. Protozoal/Mumps/Cytomegalovirus/Recurrent urinary tract infections in pregnancy lead to cognitive impairment


(Pg 1146, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

2. Leukoariosis is significant in a patient with dementia and gait disturbance


(Pg 410, Revision Notes in Psych, Puri & Hall)

3. Shrunken frontal lobes indicates Pick's disease than Alzheimer’s or Fronto-temporal atrophy usually indicates Pick’s disease


(Pg 331, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

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5. Port wine stain is seen in tuberous sclerosis


Port wine seen in Sturge-Weber. Shagreen aka Ash-leaf patches, seen in Tuberous Sclerosis

(Pg 300-1, Exam Notes in Psych, Buckley, Bird & Harrison, 3rd Ed)

STURGE WEBER syndrome -- Encephalo trigeminal angiomata PORTWINE STAIN

6. Hurler's syndrome can be treated by diet


Treatment = Enzyme replacement, bone marrow transplantation


Hurler syndrome is an inherited disease that belongs to a group of diseases called mucopolysaccharidoses. Storage of abnormal quantities of this material (mucopolysaccharide) in different body tissues is responsible for the symptoms and appearance of the disease.

Hurler Syndrome Symptoms & Signs

Short stature

Severe mental retardation

Thick, coarse facial features with low nasal bridge

Full lips with a thick, large tongue

Cloudy corneas

Increased body hair (hirsutism)

Umbilical hernia


Stiffness (in joints)

Shortness of breath

Abnormal bones of spine and claw hand

11. HIV causes Alzheimer’s dememtia


Herpes simplex not HIV

(Pg 332, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

(Pg 409, Revision Notes in Psych, Puri & Hall)

1. HIV enters the brain through infected macrophages


(Pg 303, Comp to Psych St, 6th Ed, Johnstone et al)

HIV targets microglial cells and macrophages within the CNS through CD4 and chemokine cell surface receptors.

Companion to Psychiatric Studies (p. 79)

2. HIV disease progression is measured by CD4 counts


(Pg 366, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

The optimum time for initiation of antiviral treatment will depend primarily on the CD4 count; the plasma viral load and clinical symptoms may also help.


3. Increased sensitivity to neuroleptics is a recognised complication of HIV infection


(Pg 373, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

HIV results in considerable neuronal loss, with evidence of synaptic, dendritic and axonal damage in HIV encephalitis. Due to exposure to proinflammatory cytokines (TNFa and IL-1b). One can only assume that such CNS compromise will render patients more susceptible to the side-effects of neuroleptics.

Companion to Psychiatric Studies (p. 79)

8. In delirium, onset of rigidity and cogwheeling is due to nicotinic acid deficiency

In delirium, onset of rigidity and cogwheeling is due to nicotinic acid deficiency -so possibly true

nicotinic acid deficiency- (merck manual)

CNS symptoms include (1) organic psychosis, characterized by memory impairment, disorientation, confusion, and confabulation (excitement, depression, mania, and delirium predominate in some patients; in others, the reaction is paranoid); and (2) encephalopathic syndrome, characterized by clouding of consciousness, cogwheel rigidity of the extremities, and uncontrollable sucking and grasping reflexes. Differentiating these CNS changes from those in thiamine deficiency is difficult.

wonder if biological psychiatry or organic psychiatry by lishman would have the answer

9. Pantothenic acid deficiency cause dementia/delirium

?A metabolic antagonist of pantothenic acid, pantoyl g-amino butyric acid (called pantoyl-GABA, homopantothenate, or hopantothenate), is widely used in Japan as an anti-dementia drug for treating cognitive impairments in Alzheimer's disease, presumably through increasing cholinergic activity in vivo

10. Vitamin B12 deficiency commonly causes delirium

B12 def causes dementia and not delirium

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10. Delirium may be caused by Wilson’s disease


The most common presentations, in descending order, are neurological, hepatic, psychiatric, orthopedic, ophthalmological, hemolytic anemia, and cardiac. Neurological presentations are protean, but typically begin with basal ganglia signs of tremor or rigidity. The classic 'wingbeating' tremor is localized to the arms, usually absent at rest, and is elicited by extension. Parkinsonian or intention tremors may also be seen. Parkinsonian rigidity, dystonic postures, and occasionally choreo-athetotic movements are seen. Dystonia and rigidity of laryngeal, pharyngeal, and facial musculature may result in dysarthria, dysphagia, hoarseness, drooling, and the classic vacuous or fixed open-mouthed smile. The tendency for motor disorders to predominate in the bulbar musculature contrasts with parkinsonism. Loss of coordination, convulsions, coma, and delirium may occur. ...

KSCTP Ch 2.6

7- SSRIs cause 10% of dementia cases to improve.

False. Manchester course.

4. Met-Val allele in new variant CJD is present on region 129 True For a brilliantly overly detailed summary of prion disease(bit late in the day ) 4. True - Mutations in the PrP gene, best known at codons 102, 178 and 210, are important factors in inherited prion diseases, but no mutation is present in sporadic or variant CJD. The natural val/met polymorphism at codon 129 influences the phenotype of the disease as well as having an apparent effect on vulnerability. All patients with vCJD have been met homozygotes up to the present time. Companion to Psychiatric Studies (p.79)

2. Korsakoff?s syndrome affects implicit memory FALSE working memory and long-term memory, (implicit) are intact - transfer and therefore memory acquisiton is impaired 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 (Kaplan and Saddock CTP) Korsakoff's is characterised by impairment of STM with a tendency to confabulate

5. The EEG in Huntington's disease is characteristic 5. True loss of alpha rhythms, generalised low voltage fast activity which may disappear as the disease progresses, though a normal EEG can be obtained (Lishman p 470) Characteristic diffuse flattening with low amolitude theta and delta waves (Examination notes in psych- Basic sciences p141

10. In dementia associated with Huntington?s disease, the amnesia is similar for all decades of life TRUE according to Lishman ' the retrograde amnesia is usually severe and generalised, being equally impaired across the decades and not showing the temporal gradient of Korsakoff's syndrome.' p 469

3. New variant CJD is characterised by positive tonsillar biopsy of prion protein FALSE ? There are no available, completely reliable diagnostic tests for use before the onset of clinical symptoms. However, magnetic resonance scans, tonsillar biopsy and cerebrospinal fluid tests are useful diagnostic tests. ?WHO website

1. An inter-ictal EEG in automatisms is of limited value 1. True - the EEG is insensitive: a single interictal EEG will only detect clearly epileptiform abnormalities in about 30% of patients with epilepsy. Companion to Psychiatric Studies (p.353)

7. Stimulation of 5HT receptors in ventromedial hypothalamus leads to satiety(?correct) 7. True - Stimulation of VM hypothalamus results in satiety. SSRIs which increase available 5HT can have anorexia as a side-effect.

8. Genes consist of introns, extrons & tRNA 8. False - Genes consist of DNA Companion to Psychiatric Studies (p.152)

11. In dementia associated with Alzheimer?s disease, the amnesia is similar for all decades of life 11. False - Ribot's Law of Memory Regression states that recent memories are lost first, with long-term memory relatively intact until latter stages of illness

13. Delusions of persecution commonly precedes dementia


Not common

(Pg 296, Comp to Psych St, 6th Ed, Johnstone et al)

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14. Stepwise cognitive decline is a recognised feature of lewy body dementia


Vascular dementia

(Pg 524-5, Oxford Txt of Psych, 3rd Ed, Gelder et al)

15. Determining Apoprotein E genotype is useful for counselling relatives of the risk of Alzheimer’s disease


(Pg 728, Comp to Psych St, 6th Ed, Johnstone et al)

while it seems likely that possession of ApoEe4 hastens the onset of AD in individuals who are susceptible for other reasons, it is not necessarily predictive for AD.

9. Myasthenia Gravis is associated with panic disorder leads to increased mortality 9. True Lishman p 712 - says that anxiety attacks appear to be of particularly grave significance (in myasthaenia gravis) and increases the mortality to almost 50% in 14years (39% with emotional or psychiatric disturbance vs 17% without)

7. Primary generalized epilepsy is usually associated with an aura


Secondary generalised

(Pg 335-6, Oxford Txt of Psych, 3rd Ed, Gelder et al)

7. False - Primary generalised epilepsy usually causes tonic-clonic seizures without an aura, or less often, classical absences.

Davidson's Principles and Practice of Medicine (17th Ed.)


8. Suggestibility is increased in complex partial seizures


Increased suggestibility in pseudoseizures

(Pg 357, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

9. A seizure lasting longer the 30 minutes is more indicative of pseudo-seizure than epilepsy


Status epilepticus

(Pg 335 & 339, Oxford Txt of Psych, 3rd Ed, Gelder et al)

12. Disorders of praxis are associated with Pick’s disease


(Pg 323, Oxford Txt of Psych, 3rd Ed, Gelder et al)

Pick's disease is a fronto-temporal dementia and so would not present with apraxia which would suggest a parietal lobe lesion.

5. Hypothyroidism causes bone pain


Causes joint & muscle pain

while hypothyroidism can present with muscular aches and pains, bone pain is not described. Primary hyperparathyroidism can result in osteitis fibrosa, in which there is increased bone resorption by osteoclasts with fibrous replacement in the lacunae and cystic expansion. These changes may present clinically as bone pain, fracture and deformity.

Davidson's Principles and Practice of Medicine, 17th Edition (p.702)

6. Hirsuitism can be caused by hypothyroidism


Causes hair loss

11. If a healthy couple have a baby with phenylketonuria, the chances of the next baby having the same condition are less than 1%


25%. Autosomal recessive condition.

(Pg 179, Sciences Basic to Psych, Puri & Tyrer)

PKU is autosomal recessive and so requires the presence of homozygosity to be manifest. This couple must both carry one PKU gene each and so have a 25% chance of having a further affected child.

4. The suicide rate in HIV is 10% higher than expected . false

studies based on coroners reports suggest that patients with advanced HIV disease have a thirtyfold risk of commiting suicide compared to seronegative persons matched for age and sex.... page 332 Comp textbook Kap and SAd

1 The negative symptoms of schizophrenia are thought to be related to hypofunction of the pre-frontal cortex. TRUE Revision notes in psychiatry, Puri and Hall p259-260 - Functional brain abnormalities in schizophrenia - studies have found hypofrontality: associated with the presence of negative symptoms and autism. - Combining functional imaging with task activation: impaired performance by schizophrenics was mirrored by smaller increase in blood flow to prefrontal cortex.

2 The anterior thalamus is affected in Huntington's disease. 2 false The main histological abnormality is found in the caudate and putamen, where there is extensive loss of small neurones, leading to shrinkage, and a false impression of gliosis, although such changes are found elsewhere. ( oxford textbk of medicine)

3 Lesch-Nyan syndrome can be successfully treated by diet. 3 false Most children affected by Lesch-Nyhan syndrome show verbal and physical aggression. However, more characteristic problems, which are resistant to management, are self-injurious behaviours which affect over 85 per cent of these children( ox TxBk of psy)

6 Lewy bodies are found in Parkinson's disease. lewy bodies presence is one of the pathological hallmarks in parkinson's disease. ref,shorter oxford textbook of psychiatry page 421.

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4 Patients with Parkinson's disease are impaired in set-shifting tasks. Q 4 True re Impaired set shifting in parkinsons read from the web Tests which assess the ability to shift cognitive set modelled after the Wisconsin Card Sorting Test are particularly sensitive to impairments in patients with Parkinson's disease as well as in patients with frontal lobe damage. However, the underlying mechanisms responsible for the similar deficits observed in the two patient groups are not well understood and may not be identical. For example, an apparent deficit in set-shifting ability may reflect either an impairment in the ability to shift from a perceptual dimension which has previously commanded attention (i.e. 'perseveration'), or in the ability to shift to an alternative perceptual dimension which has previously been irrelevant (i.e. 'learned irrelevance'). In this study, the performance of both medicated and non-medicated patients with Parkinson's disease were compared with a group of neurosurgical patients with localized excisions of the frontal lobes on a novel task designed to assess the relative contribution of 'perseveration' and 'learned irrelevance' to impaired set-shifting ability. Patients with frontal lobe damage were worse than controls in their ability to shift attention from a previously relevant stimulus dimension. Medicated patients with Parkinson's disease were worse at shifting to a previously irrelevant dimension. In contrast to both groups, nonmedicated patients with Parkinson's disease were impaired in both conditions. These results suggest that the gross set-shifting deficits reported in both frontal lobe patients and patients with Parkinson's disease may involve fundamentally different, though related, cognitive processes, and that these may be differentially affected by medication. Specifically, L-dopa therapy may protect Parkinson's disease patients from preservation of attention to a formerly relevant stimulus dimension. PMID: 8221053 [PubMed - indexed for MEDLINE]

5 Lewy bodies are found in 40% of patients with dementia. 5 false, 15 --30% of cases ox txbk of psychiatry

9 In Alzheimer's disease there is decreased latency in the evoked responses on EEG. q.9- F- P300 abnormalities have been reported in patients with dementia (delayed response and reduced amplitude). ref-core psychiatry 10 OCD is associated with increased blood flow in the prefrontal cortex and basal ganglia.

10 OCD is associated with increased blood flow in the prefrontal cortex and basal ganglia.


7 There is usually a greater fall of cortisol following dexamethasone in depressed individuals than in normal volunteers. ans- F- a proportion of depressed pts -non suppression of cortisol with dxmethasone (positive test-nonspecific) ref-core psychiatry

Q8 an interictal eeg in automatisms typically shows 8 and 14 HZ spikes? False ref: Core Psychiatry: automatisms are associated with initial unilateral low voltage theta (4-8Hz waves) and subsequent bilateral delta(<4Hz waves) waves on the EED. Also question refers to spikes!

angleman syndrome has a paternal cause


angelman is due to deletion at 15q11-13 on maternal derived chromosome, Prader-Willi in contrast occurs due to deletion of paternal orgin.

companion to psychiatric studies p224

1 ) false The syndrome is characterized by severe mental retardation, jerky limb movements associated with abnormal gait, and inappropriate bouts of laughter, features which give the syndrome its name. This is a rare condition which affects between 1 in 20 000 and 1 in 30 000 people. In around 60 to 75 per cent of cases a deletion in the long arm of chromosome 15 (q11q13) could be detected. In the case of Angelman syndrome it is derived from the maternal source

question 2 - the brain in CJD shows spongiform changes without plaque formation


CJD is assoc with '' insoluable protien accumulation causing cell death and other pathological changes including spongiform changes , astrocyte proliferation and ON OCCASION amyloid plaque deposition''

vCJD - ''all at autopsy had spongiform changes and plaque formation''

Companion to psychiatric studies p306

Q3- Most patients with CJD have abnormalities on CT


'structural neuroimaging may reveal cerebral atrophy' while in vCJD ' neuroimaging was usually normal or revealed non specific changes'

core psychiatry p386-7

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Q4- early CJD is associated with definite EEG changes


'the EEG of up to 90% shows a reduced backround rhythm with characteristic triphasic sharp wave complexes at 1-2 HZ, these may not be present initally and repeat recordings are necessary'

p386 core psychiatry

10. Acute intermittent porphyria can lead to hallucinations.


Clinical Medicine - Kumar & Clark.

17. Prominent cortical atrophy is seen in Wilson's disease.


Subcortical (OTP)

28. Narcolepsy is associated with sudden onset REM sleep.


5. Hachinski score is used to differentiate between Alzheimer's disease & vascular dementia.

Not 100% certain but think this may be TRUE.

Seminars in Old age psychiatry (Gaskell) explains the Hachinski score and its components and says that a score over 6 is highly suggestive of vascular dementia. Also says it is incorporated into other old age scales and is not uncommonly used.

9. Paraventricular 5HT (or histamine) nuclei are responsible for satiety


supraoptic, paraventricular are associaited with adh secretion and oxytocin

ventromedial nucleus is responsable for satiety

lewy bodies are present in 40% of dementias.



(Pg 300, Companion to Psych studies, 6th Ed, Johnstone et al)

29. SPET I123 IBZ is used to detect 5HT2 receptors


Used for dopamine receptors

(Pg 455, Comp to Psych St, 6th Ed, Johnstone et al)

30. Up to 5 cells/mm is normal in CSF


(Pg 359 & 750,Oxford Handbook of Clinical Medicine)

14. Proteomes are collections of proteins in a cell

14 true. A proteome is a cell’s repertoire of proteins; it dictates the cell’s function. It is generated by translation, the process of converting the information in RNA molecules into proteins

19. After a five year follow-up in penetrating head injury to the right cerebral cortex, there is strong evidence that apathy is a significant association true according to lishman ,refer to table9 page 181 3rd edition

15. White matter hyperintensities are most commonly periventricular

true, lishman, page459-460, in MRI they are hyperintensities, in CT they are radiolucent

18. Leukoariosis is associated with cognitive decline

TRUE. Leukoariosis seen in 33% sdat

38%mixed dementia, 5 with multi infarct and 11% nondemented elderly

13. Nicotinic receptors are ion-gated

13 true pg 164 Gin S Mahli

Q21. Somnambulism is most likely to occur in stage III and IV sleep.

True according to Core psychiatry page 399.

Sleep walking is a common familial disease that occurs during non-REM (stage III and IV) sleep and is largely confined to childhood.

12, tau proteins interfere with microtubule formation


tau is involved with maintaining the stability of microtubules (institute of molecular and cell biology web site)

27) Introversion is thought to be due to excessve sympathetic lability.

?False - Psychology 4th ed. Gross. p 616.

This refers to Neuroticism (N) as described by Eysenck. Extroversion/Introversion thought to be detemined by 'balance' of ascending reticular activating system (ARAS).


“Intravert is highly aroused - any stimulation is over stimulation

Extravert is low on arousal - stimulus hunger - low threshold for boredom”

“Eysenck (1957, 1967) argued that levels of cortical activity contribute to the level of a person’s extroversion. His idea was that people have different levels of need for external activity based on their levels of internal activity.

Extroverts have little internal arousal and thus seek external stimulation.

Introverts generally have sufficient internal arousal and thus avoid external activity that would yield too much arousal.

Extending Eysenck’s argument, Gray (1973, 197)described extroverts as having emotional deficits resulting from low levels of arousal, which causes them to seek interaction with others to stimulate cortical arousal.”

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6. Vascular dementia is associated with gait disturbance


(Pg 1295, Synopsis of Psychiatry, 8th Ed, Kaplan & Sadock)

7. Difficulties with spatial recognition are more likely from lesions with right-sided hemiplegia than left-sided


(Pg 284, Comp to Psych St, 6th Ed, Johnstone et al)

Right-sided hemiplegia caused by left cerebral damage

“Patients with lesions of the parietal lobe of the right hemisphere have the most pronounced spatial processing deficits.”

22. Metabolic disorders often cause increased alpha waves on the EEG


reduced alpha, increased ­delta and theta

(Pg 140, Exam Notes in Psych, Basic Sc, Malhi & Mitchell)

25. A penetrating right sided head injury is likely to produce prosopagnosia


'It is generally accepted that there is right hemisphere superiority in face processing

•In the past it was believed that bilateral damage to the brain was necessary for Prosopagnosia to exist.

•Recent studies suggest that right hemispheric damage will cause Prosopagnosia, and specifically unilateral damage to the right temporo-occipital region' omy.htm

20. Imaging studies have shown increased blood flow to prefrontal cortex in post-traumatic stress disorder ??

ox txtbk of psy

Consistent with possible deficits in cortical control, positron emission tomography studies have shown a relative decrease in middle temporal blood flow (and several adjacent medial prefrontal areas) in patients with PTSD relative to controls when they imagined the traumatic event or were presented with reminders of it. The middle temporal cortex plays a role in the extinction of fear through inhibition of amygdala function.

At the same time, PTSD patients showed increased blood flow in the limbic regions (parahippocampus and cingulate).

8. Phrase length is shortened in Brocas Aphasia


23. 80% of depressed children have a positive dexamthesone suppression test


The DST in children and adolescents with major depressive disorder

CD Casat, GW Arana and K Powell

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425.

The authors analyzed dexamethasone suppression test (DST) results from 13 prospective studies on the use of the DST in children and adolescents with psychiatric disorders. Sensitivity of the DST was significantly higher among the children than among the adolescents with major depressive disorder (69.6% and 47.1%, respectively), and specificity was significantly lower (69.7% and 80.2%). Significantly more adolescents with major depressive disorder than with other psychiatric diagnoses, especially conduct disorder, were nonsuppressors. The authors discuss possible explanations for the high DST sensitivity among the children and point out the potential usefulness of the DST in

differentiating major depressive disorder from conduct disorder.

3. Cytomegalovirus infection in pregnancy leads to cognitive impairment


ref: oxford handbook of specialties

TERATOGENIC: May cause IUGR, microcephaly, periventricular calcifications,sensorineural deafness, blindness with chorioretinitis, mental retardation, hepatosplenomegaly, thrombocytopenic purpura, hemolytic anemia

Incidence of sequelae is 25% for primary infection, and 8% with recurrent infection [1]

1.Protozoal infections in pregnancy lead to cognitive impairment


ref same as above

TERATOGENIC: 3/4 of infants are asymptomatic at birth. Infection may cause chorioretinitis, hydrocephaly,microcephaly, aqueductal stenosis, agenesis of corpus callosum, cerebral calcifications, nonimmune hydrops

The EEG trace has exaggerated spikes in Huntington's disease



8. Port wine stain is seen in tuberous sclerosis



seen in sturge weber syndrome

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2. Mumps in pregnancy leads to cognitive impairment


Although mumps virus is capable of infecting the placenta and fetus, several studies have failed to demonstrate an association between gestational mumps and fetal malformation.[3,4].

4. Recurrent urinary tract infections in pregnancy lead to cognitive impairment.


“Maternal UTI has few direct fetal sequelae because fetal septicemia is rare; however, uterine hypoperfusion due to maternal dehydration, maternal anemia, and direct bacterial endotoxin damage to the placental vasculature may cause fetal cerebral hypoperfusion”

PJ Woodman. Urinary Tract Infections in Pregnancy

5. Leukoariosis is significant in a patient with dementia and gait disturbance


Suggests vascular dementia

(Pg 410, Rev Notes in Psych, Puri & Hall) .


Ref: Puri and Hall says it is seen in non-dementing subjects as well as those with degenerative and vascular disease. page 410

Therefore it is 'not significant'

Seems more like a English testing exam rather than testing knowledge in Psychiatry......... Frustrating isn't it??

6. Shrunken frontal lobes indicates Pick's disease than Alzheimer’s


BBH - p 180, 3rd edition

9. Hurler's syndrome can be treated by diet


mucopolysaccharidoses along with hunter and sanphillipos syndromes. no treatment. bone marrow transplant is still being considered.

11. In delirium, onset of rigidity and cogwheeling is due to nicotinic acid deficiency

??false no evidence

19. Being demented nullifies testamentary capacity

false many patients do write thier will after the onset of dementia.

(Pg 1313, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

26. Memantine is useful in vascular dementia

27. Memantine is useful in Alzheimer’s dementia

both true

systemic review of cochrane database

Reference: Areosa-Sastre, A. and Sheriff F. The Cochrane Database of Svstematic Reviews: Memantine for dementia, Cochrane Library (3), May 28, 2003.

28. Neuroleptics cause lethal side effects in Lewy Body disease


increased incidence of NMS

24. Decreased somatostatin levels are seen in Alzheimer’s disease

true including decreased gaba and ck

p 176- BBH

(Pg 330, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

12. Pantothenic acid deficiency cause dementia/delirium

13. Vitamin B12 deficiency commonly causes delirium

both false;

Pantothenic acid is widespread in foods, making deficiency very rare except for those with a highly processed diet since much of the vitamin B-5 activity is lost during the refinement process. Additionally, pantothenic acid is produced by beneficial bacterial in the digestive system. A reduction or destruction of intestinal flora, most commonly by antibiotic use, can contribute to vitamin B-5 deficiency.

There are claims that pantothenic acid can prevent graying and even restore hair to its natural color, but this is based on animal research that showed increased graying of the fur, decreased growth, progressing to hemorrhage and destruction of the adrenal glands.

In humans, pantothenic acid deficiency results in diminished adrenal gland function. A variety of metabolic problems will also manifest themselves. Fatigue is common along with depression, and problems associated with the digestive system. There will also be loss of nerve function and problems with blood sugar metabolism, with hypoglycemia being the most common.

Pantothenic acid deficiency can reduce immune system responses, increasing the risk of infection. Other symptoms of B-5 deficiency include skin problems, insomnia, lack of coordination, muscle cramps and worsening of allergy symptoms.

14. HIV causes Alzheimer’s dememtia


Herpes simplex not HIV

(Pg 332, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

(Pg 409, Revision Notes in Psych, Puri & Hall)

15. Fronto-temporal atrophy usually indicates Pick’s disease


(Pg 331, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

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16. In Alzheimer’s disease, the recency effect is preserved when reading a list


“…Primacy effect is impaired for immediate and delayed recall in dementia of the Alzheimer type. By contrast, immediate recall recency effect and possibly also long-term recency effect are preserved.”

Martin Burkart, Reinhard Heun, Otto Benkert Serial Position Effects in Dementia of the Alzheimer Type

Dementia and Geriatric Cognitive Disorders 1998;9:130-136 p;ProduktNr=224226&Ausgabe=225514&ArtikelNr=17036

17. Diogene’s syndrome is treated by psychotherapy and in-patient treatment


(Pg 423, Revision Notes in Psych, Puri & Hall)

20. Dementia is seen more often in women not prescribed HRT


(Pg 343, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

21. Psychosis in temporal lobe epilepsy is mainly associated with a non-dominant focus


Dominant focus associated with psychosis

Non-dominant lesions associated with mood disorder symptoms

(Pg 356 -7, Synopsis of Psy, 8th Ed, Kaplan & Sadock)

1. Determining Apoprotein E genotype is useful for counselling relatives of the risk of Alzheimer’s disease

I would put FALSE.

Did read a paper, some-time, someplace which dscrbied why it was not useful. ALthough risks increased they are non-quantifiable for the individual person (unlike Huntingdon's) and there are other factors (as yet unknown - ?vascular risk factors et al) which are also operating.

2.The suicide rate in HIV is 10% higher than expected


10. SSRIs cause 10% of dementia cases to improve

ANy IDEA's? I'd be inclined to put TRUE - but an extensive search on pubmed was even unhelpful. There was suggestion that up to 30% of patients with DAT have behavioural disturbances that might improve with SSRI's and loads of other stuff which didn't give any percentages. Please let me know your thoughts!

I think this exam is doing my head in!

5. Alzheimer’s disease affecting the parietal lobe is associated with a worse prognosis


Other indicators of poor prognosis = “significant language impairment; poor cognitive functioning & reduced density of left parietal region evident on CT scan”

(Pg 410, Revision Notes in Psych, Puri & Hall)

17. Death occurs early if parietal lobe is affected in Alzheimer’s disease


Other indicators of poor prognosis = “significant language impairment; poor cognitive functioning & reduced density of left parietal region evident on CT scan”

(Pg 410, Revision Notes in Psych, Puri & Hall)

Dementia with myoclonus occurs in CJD


(Pg 306, Companion to Psych studies, 6th Ed, Johnstone et al)

Old people with dementia are at significant risk of non-accidental injury by their carer


(Pg 427, Revision Notes in Psych, Puri & Hall)

6. There are specific histological changes to the brain in alcohol dementia


Hemorrhages in 3rd & 4th ventricular gray matter, mamillary bodies, inferior colliculi

(Pg 308, Companion to Psych studies, 6th Ed, Johnstone et al)

9. An abnormal gait is more suggestive of early Alzheimer’s disease than vascular dementia


(Pg 299, Companion to Psych studies, 6th Ed, Johnstone et al)

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10. Cognitive impairment is seen in chronic multiple sclerosis


(Pg 320, Companion to Psych studies, 6th Ed, Johnstone et al)

11. Emotional lability is more common in Alzheimer’s disease than Vascular dementia


(Pg 299, Companion to Psych studies, 6th Ed, Johnstone et al)

(Pg 410, Revision Notes in Psych, Puri & Hall)

12. Emotional lability in a patient with dementia indicates vascular dementia rather than Alzheimer’s disease


(Pg 299, Companion to Psych studies, 6th Ed, Johnstone et al)

(Pg 410, Revision Notes in Psych, Puri & Hall)

16. Gait disorder suggests vascular dementia than Alzheimer’s disease


(Pg 299, Companion to Psych studies, 6th Ed, Johnstone et al)

Alzheimer’s disease can be caused by HIV infection


HIV causes a subcortical dementia

Herpes simplex causes Alzheimer’s

(Pg 332 & 369, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

(Pg 409, Revision Notes in Psych, Puri & Hall)

8. Vitamin B12 deficiency can cause dementia


(Pg 329, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

15. Early onset of apraxia indicates Pick’s disease rather than Alzheimer's


(Pg 323, Oxford Txt of Psych, 3rd Ed, Gelder et al)

19. Longstanding multiple sclerosis can cause dementia


(Pg 320, Companion to Psych studies, 6th Ed, Johnstone et al)

A similarity between impaired cognition in old age and Alzheimer’s disease is impaired visuo-spatial scratch pad.


Low scores on visual perceptual/spatial tasks often suggest Alzheimers disease or other conditions (eg right hemispheric stroke) that interfere with right parietal lobe functioning (p3028, Kaplan and Sadock, 7th ed)

14. The prolactin level is normal 20 minutes after a pseudoseizure


“A prolactin level drawn within 20 minutes of a seizure would be markedly elevated (above 1000) in a generalized tonic clonic seizure, and will be above 500 in a partial complex seizure, but in a pseudoseizure will be within normal limits.”

12. Emotional lability in a patient with dementia indicates vascular dementia rather than AD


This is one of the basic symptoms required in ICD-10 for a general diagnosis of dementia, and not specific to any subtype.

(Table 10.3-9 [item G4], Page 336, Kaplan & sadock's synopsis of Psych)

?True. Emotional incontinence addes one point to Hachiniski Ischemic score, which is, when more than 5 indicates vascular rather than degenerative.

9. Cognitive impairment is seen in chronic multiple sclerosis


(Page 320, Companion to Psych Studies, Johnstone et al)

However, the severity of memory impairment is NOT related to the duration of illness or severity of neurological symptoms (Page 360, Kaplan & Sadock's Synopsis of Psych)

8. An abnormal gait is more suggestive of early Alzheimer[ch8217]s disease than vascular dementia

False. In ICD-10, one of the criterias of VD is clinical evidence of focal brain damage which may be e.g a unilateral spastic weekness of the limb!

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11. 5%of elderly schizophrenics have a family history of schizophrenia in the first degree relatives

?False. ''Genetically, patients with late paraphrenia occupy an intermediate position between the unaffected population and those with schizophrenia of earlier onset. In one study{Kay 1972}, the risk in first degree relatives was found to be 3.4% in late paraphrenics compared with 5.8% in young schizophrenics and less than 1% in the general population''


08 The mesocortical dopamine system is generally intact in Parkinson's disease. F

09 Parkinson's disease patients perform poorly on attention set-shifting. T

True, Lishman p 654 - impaired on wisconsin card sorting test and verbal fluency compared to age matched controls.

13. Orthopnea suggets cardiac neurosis


Orthopnoea is a physical sign that is caused by heart failure. Cardicac neurosis is a functional illness that would not have such clear, objective symptomatology.

8.. In Alzheimer[ch8217]s disease there is decreased latency in the evoked responses on EEG False

increased latency on evoked responses in eeg in alzheimers disease.

malhi and mitchell pg 142

1. The plenum temporale is situated on the anterior part of inferior temporal lobe


Certain brain functions, such as language, are localized to one hemisphere . The structural bases for the lateralization of function have not been determined, but some anatomical differences between the cerebral hemispheres have been observed. For example, a portion of the superior temporal cortex, called the planum temporale (infolded cortex in the posterior portion of the sylvian fissure) , is generally larger in the left hemisphere than in the right hemisphere. That cortical area, which is located close to the primary auditory cortex and includes the region known as Wernicke's area appears to be involved in receptive language functions that are localized to the left hemisphere. In addition, Brodmann's area 44 in the left inferior frontal cortex contains larger pyramidal neurons than the homotopic region of the right hemisphere, a difference that may contribute to the specialization of Broca's area for motor speech function.

Kaplan & Sadock's Comprehensive Textbook of Psychiatry

Editor(s): Sadock, Benjamin J., Sadock, Virginia A.

8th Edition © 2005 Lippincott Williams & Wilkins

6) Alexia without agraphia occurs in anterior cerebral artery lesions


Also known as pure word blindness/agnosic alexia

the patient can speak normally and has no difficulty with comprehension of the spoken word. His difficulties with language are entirely restricted to his understanding of what he reads.


usual cause is occlusion of


Ref: lishman, organic psychiatry

The difference between prion protein and scrapie prion protein is a disulphide bond

false single sulphide bond

manchester notes

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Thanks Lad. Much appreciated.

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lad from pakistan you have done a great deed helping the others you don't even know .i am pregnant with two little kids and i didn't know wher to start the preparation .you have given me some thing to work for .

can you recommend a good book for psychology

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