PSYCHIATRY

Mr. A, 40 years old man, admitted to a psychiatric unit after having been brought to the
emergency department by police. He grabbed and smashed other’s person camera on the
ground (the other person was standing on the sidewalk about to take the picture of a
building accross the street). He explained that his actions would be used to control other
person to take illegal photograph. He felt being monitored by hidden cameras and
microphones everywhere he goes in the city.
Mr. A has a history of multiple hospitalizations since he was 25 years old. During the
hospitalizations, his symptoms have been well controlled with a variety of typical and
atypical antipsychotic medications. But after discharged, he neglects and stops his
medications, because he feels that he doesn’t need medications at all.

1. Which of the following is the most likely diagnosis for the case described above?
A. Schizophrenia catatonic type
B. Schizophrenia undifferentiated type
C. Schizophrenia paranoid type
D. Delusional disorder
E. Schizoaffective disorder

2. Which of the following interventions is most likely to prevent relapse in the case above?
A. Vocational rehabilitation
B. Increased socialization
C. Use of a long term depot antipsychotic
D. Use of an atypical antipsychotic
E. Alcohol counseling

3. Which of the following Mr. A’s insight of illness?

A. Type 1
B. Type 2
C. Type 3
D. Type 4
E. Type 5

4. The negative symptoms of Schizophrenia include all of the following except

A. Alogia
B. Affective flattening
C. Avolition
D. Aggressivity
E. Inattentiveness

5. Which of the following is not typically associated with catatonia?

A. Mutism
B. Verbigeration
C. Stereotypies
D. Mannerisms
E. Waxy flexibility
6. Prefrontal cortex and limbic system hypotheses are the predominant neuroanatomical
theories of Schizophrenia because of the demonstration of
A. Decreased volume of prefrontal gray or white matter
B. Prefrontal cortical interneuron abnormalities
C. Disturbed prefrontal metabolisme and blood flow
D. Disarrayor abnormal migration of hippocampal neurons
E. All of the above

7. The rationale for the role of excess dopamine in Schizophrenia is based on observations that
A. Dopaminergic drugs can induce paranoid psychosis
B. Drugs that block postsynaptic dopamine receptorsreduce symptoms of Schizophrenia
C. Metabolic alteration in limbic anatomy are consistent with a disturbance in dopamine
metabolism
D. Increased concentrations of dopamine have been found in the amygdalas in postmortem
brains of Schizophrenic patients.
E. All of the above

8. MRI studies of Schizophrenics have found evidence for

A. Increased cortical gray matter
B. Increased volume of the amygdala
C. Increased volume of basal ganglia nuclei
D. Increased temporal cortex gray matter
E. Increased volume of the hippocampus

9. Mr. B, 40 years old man is referred by his primary care physician because of repeated
consultations related to his complaint of hair loss. Multiple dermatologist had evaluated the
patient, found no pathology, and told him that the minimal hair loss was normal. But he
refused to accept their judgment and demanded further consultations. He believed that
there was a problem with his hair.
The most likely diagnosis in this man is :
A. Hypochondriasis
B. Psychotic depression
C. Paranoid Schizophrenia
D. Body dysmorphic disorder
E. Delusional disorder, somatic type

10. Of the following somatic treatment for delusional disorder, which is considered the least
likely to be successful?
A. Dopamine receptor antagonists
B. Serotonin dopamine antagonists
C. SSRI
D. Electroconvulsive treatment
E. All of the above are considered equally effective

11. In Schizoaffective disorder, all of the following variabels indicate a poor prognosis except
A. Early onset
B. Bipolar type
C. Depressive type
D. No precipitating factor
E. A predominance of psychotic symptoms
12. True statements about hypothesized neurobiological models of Schizophrenia include :
A. Genes funtion in part by increasing vulnerability to enviromental factors
B. Enviromental factors increase risk by producing subtle brain damage
C. The apparent lack of gliosis in postmortem studies implicates in utero factors
D. As the prefrontal cortex matures, behavioral and cognitive sequelae of subtle structural
deficits become manifest
E. All of the above

13. Features weighing toward a good prognosis in schizophrenia include all of the following
except
A. Depression
B. Paranoid feature
C. An undulating course
D. A family history of mood disorders
E. Undifferentiated or disorganized features

14. Which of the following classified patients as being afflicted with manic-depressive psychoses,
dementia precox, or paranoia
A. Eugen Bleuler
B. Emil Kraepelin
C. Sigmund Freud
D. Erik Ericson
E. Jean Piaget

15. Which of the following criteria of Schneider’s first rank of Schizophrenia

A. Perplexity
B. Audible thoughts
C. Sudden delusional ideas
D. Depressive and euphoric mood changes
E. Feelings of emotional impoverishment