Question 46#

Which of the following is noted through longitudinal observation of recurrent depressive disorder?

A. Life events precede onset of each relapse

C. Life events are strong predictors of onset of depression. It is suggested that the association of life events and depression is stronger for the first episode than recurrences of depression. This may be because a kindling effect underlies depression. In other words, depression begets depression once the initial damage is done by a life event. It is not necessary that life events must precede the onset of depression in every patient.

Reference:

1. Johnstone EC et al., eds. Companion to Psychiatric Studies, 7th edn. Churchill Livingstone, 2004, p. 433.

Question 47#

Which of the following endocrine abnormalities is suspected to be associated with rapid cycling bipolar disorder?

A. Hypercortisolaemia

C. In DSM-IV rapid cycling disorder is a course specifier while ICD-10 does not include this as a separate category or specifier. It can occur in both bipolar type I and bipolar type II disorders. Rapid cycling is diagnosed if there are at least four episodes fulfilling the criteria of major depression, mania, hypomania, or mixed mood disorder in the previous 12 months. Hypothyroidism is associated with rapid cycling bipolar disorder. Other causes of rapid cycling in a bipolar patient include the use of antidepressants that can induce switching, excessive use of stimulants including caffeine, non-compliance with medications, and presence of temporal lobe arrythmias in EEG. It is more common in women, in those with bipolar II, and can have a familial tendency to occur. Of bipolar patients, 5–15% can have rapid cycling at some point in their lifetime.

Reference:

1. Kupka RW, Luckenbaugh DA, Post RM, et al. Rapid and non-rapid cycling bipolar disorder: A meta-analysis of clinical studies. Journal of Clinical Psychiatry 2003; 64: 1483–1494.

Question 48#

Which of the following is NOT a predictor of good outcome in schizophrenia? 

A. Florid positive symptoms at onset

E. Good outcome in schizophrenia can be predicted by the presence of prominent affective symptoms during first presentation, acute onset, significant stressor at the onset, absence of family history of schizophrenia, good premorbid adjustment, having a family history of mood disorder, being female and living in a developing country.

Reference:

1. Johnstone EC et al., eds. Companion to Psychiatric Studies, 7th edn. Churchill Livingstone, 2004, p. 406; Box 19.6. 

Question 49#

Which of the following is NOT a characteristic feature of atypical depression?

A. Leaden paralysis

E. In atypical depression mood is depressed but affect remains reactive. Vegetative signs may be characteristically reversed with hypersomnia, hyperphagia, reversed diurnal mood variation, leaden paralysis (a peculiar heaviness in the limbs), and hypersensitivity to rejection. Cognitive distortions of typical depression may be absent. The characterization of this subgroup of depression is owed largely to an observation that the effects of MAO inhibitors such as phenelzine are better than other antidepressants in this population.

Reference:

1. Semple DM et al., eds. Oxford Handbook of Psychiatry, 1st edn. Oxford University Press, 2005, p. 268.

Question 50#

Which of the following is a good estimate of heritability of bipolar disorder?

A. 10%

C. Heritability of bipolar disorder was estimated as 85% by McGuffi n et al. Variable rates are reported in other studies. Currently, it is generally accepted that bipolar disorder is one of the most heritable psychiatric disorders.

Reference:

1. McGuffi n P, Rijsdijk F, Andrew M, et al. The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of General Psychiatry 2003; 60: 497–502.