Question 66#

Which of the following is an early developmental temperament noted to precede the onset of social phobia in some cases?

A. Behavioural familiarity

C. Behavioural inhibition to the unfamiliar is a temperamental construct that refers to a characteristic propensity to react to both social and non-social novelty with inhibition. In contrast, shyness refers to feelings of discomfort in social situations but not non-social situations. Extreme behavioural inhibition is also denoted as neophobia. Some children have a consistent pattern of behavioural inhibition, especially if parents have an anxiety disorder themselves. This may grow into social phobia in at least some. 

Reference:

1. Van Ameringen M et al. The relationship of behavioral inhibition and shyness to anxiety disorder. Journal of Nervous and Mental Disease 1998; 186: 425–431. 

Question 67#

Which of the following describes the two peaks often noted in the age distribution of panic disorder?

A. Around age 20 and 50

A. Panic disorder has higher prevalence in females than males at a ratio of 3:2 in community samples and 3:1 in clinical samples. The onset of panic disorder falls into two peaks – the first occurs in the early to mid-twenties (15–24 years) with a second peak at around 50 (45–54 years). The onset of panic disorder for the first time in elderly people is extremely rare.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 811.

Question 68#

Which one of the following suggests depression rather than a grief reaction?

A. Early morning awakening

D. The phenomenology of grief is very similar to depression, but some important differentiating features exist. For example though all features of somatic syndrome, guilt regarding the death, and preoccupation with the unfortunate event occurs in normal grief, recurrent suicidal ideas, psychomotor retardation, inappropriate guilt not pertaining to the loss, and psychotic symptoms other than transient visual hallucination of the loved one are unusual. These symptoms, if present, warrant a diagnosis of abnormal grief/ major depressive episode.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 1144.

Question 69#

According to Brown and Harris, all of the following predispose to depression following a stressful life event EXCEPT:

A. Early parental loss

E. Brown and Harris, in a landmark study, established the high risk of depression in urban-living women with early maternal loss, lack of a confiding relationship, greater than three children under the age of 14 at home, and unemployment. Though urban living is not quoted as one of the four identified factors, it is important to note that the study was carried out in Camberwell, an inner city area with high deprivation rates.

Reference:

1. Patten SB. Are the Brown and Harris vulnerability factors risk factors for depression? Journal of Psychiatry and Neuroscience 1991; 16: 267–271.

Question 70#

A woman suffers from recurrent, intrusive flashbacks of a fire accident that she had in the past, accompanied by irritability and sleeplessness.

In order to diagnose PTSD, when should the fire accident have happened?

A. Within the last 6 months

A. According to ICD-10 criteria for PTSD to be diagnosed the cluster of hyperarousal, flashbacks, irritability and intrusive memories must occur within 6 months of the traumatic event. A diagnosis of probable PTSD can be made after 6 month’s interval. This is largely an arbitrary cut off without much difference in clinical features of the two groups.

Reference:

1. World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders; Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization, 1992, p. 148.