Symptoms and Clinical Manifestations in Psychiatry MCQs

There are four main conditions to be aware of that result from problems with the basal ganglia: Huntington's chorea (caudate nucleus) Wilson's disease (copper deposition in the basal ganglia) Parkinson's disease (substantia nigra) Hemiballismus (sub thalamic nucleus) Multiple sclerosis is a demyelinating disease of CNS. Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11 th Edition, Page Number-8.

The Papez circuit consists of the hippocampus → fornix → mammillary bodies → mammillothalamic tract → anterior thalamic nucleus → genu of the internal capsule → cingulate gyrus → Para hippocampal gyrus → entorhinal cortex → perforant pathway → back to hippocampus The boundaries of the limbic system were subsequently expanded outside of the Papez circuit to include the amygdala, septum, basal forebrain, nucleus accumbens, and orbitofrontal cortex. The limbic system is thought to be involved in various functions such as mediation of emotional responses (through amygdala), influencing neuroendocrine responses (via hypothalamus) and reward system regulation (via nucleus accumbens). Reference: Kaplan and Sadock’s Synopsis of Psychiatry, 11 th edition, Chapter 1.2 Functional Neuroanatomy, Page number 13.

Criteria for Tension type headache: At least 10 episodes of headache occurring on 1-14 days per month on average for >3 months and, 1 attack lasting from 30 mins-7 days. 2/4 of following b/l, non-pulsatile (non-throbbing quality), mild to moderate, not aggravated by routine activities None of following Nausea or vomiting, either photo or phono-phobia. Reference: Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 10 th edition, Chapter 2.11 Neuropsychiatric aspects of headache, Page number 1647.

Deliberate self-harm means willful self-inflicting of painful, destructive, or injurious acts without intent to die ( OPTION A ) Parasuicide is a term used to describe patients who injure themselves by self-mutilation (e.g., cutting the skin), but who usually do not wish to die. ( OPTION B ) Hence, in the above clinical scenario, since intention to die is absent, the self-harming behavior by cutting skin superficially is suggestive of deliberate self-harm/ Para-suicide. ( CORRECT OPTION D ) Reference : Kaplan and Sadock's Synopsis of Psychiatry, 11th edition, Chapter 23.1 Suicide, Page number 763.

Tryptophan hydroxylase (TPH) is an enzyme involved in the biosynthesis of serotonin. A polymorphism in the human TPH gene has been identified, with two alleles -U and L. Because low concentrations of 5-HIAA ( OPTION A ) in CSF are associated with suicidal behavior, it was hypothesized that such individuals may have alterations in genes controlling serotonin synthesis and metabolism. It was found that the presence of the L allele (OPTION C) was associated with an increased risk of suicide attempts . The presence of one TPH*L allele may indicate a reduced capacity to hydroxylate tryptophan to 5-hydroxytryptophan in the synthesis of serotonin, producing low central serotonin turnover and, thus, a low concentration of 5-HIAA in CSF. Reference : Kaplan and Sadock's Synopsis of Psychiatry, 11th edition, Chapter 23 Emergency Psychiatric Medicine, Page number 767.

Advanced age, marital status (divorced), Occupation status (unemployed), Socio-economic status (Low socio-economic status), living alone are all important predictors of suicide. ( OPTION A, B, D ) However, time of the day has least clinical correlation to suicide ( CORRECT ANSWER -C) Reference : Kaplan and Sadock's Synopsis of Psychiatry, 11th edition, Chapter 23.1 Suicide, Page number 763.

Boundaries of doctor-patient relationship are violated if the physician has sexual or business relations with the patient. Breaching of confidentiality is allowed in some situations like when the patient is a minor , when the patient is homicidal or suicidal or in legal matters. Reference : Kaplan and Sadock's Synopsis of Psychiatry, 11th edition, Chapter 36.2 Ethics in Psychiatry, Page number 1393.

Fluvoxamine, when used with naproxen, increases the risk of bleeding. ( CORRECT OPTION D) In addition, it should be used with caution when given together with lithium(or non-steroidal anti-inflammatory drugs[NSAIDs]), St John's wort, tryptophan or warfarin. Fluvoxamine inhibits the cytochrome P450 CYPIA2/2CG/3A4. Reference: Synopsis of Psychiatry, Eleventh edition, Chapter 29th, Page no. 1021.