All of the following are characteristic features of a depression-prone individual except:
C. If negative events are ascribed to external, unstable, and specific causes, one may come to believe that they are modifiable; this will also induce less self-blame and guilt and will not induce feelings of helplessness or hopelessness. In contrast, individuals whose locus of control for negative events is internal, global, and non-specific show a higher degree of self-blame and depression-prone attitude. These individuals possess a high degree of information-processing biases characterized by the perception of a higher than possible probability for aversive events and belief that such events are uncontrollable (fatalistic). They also have a fragile self-esteem.
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Anti-obesity drug rimonabant is associated with significant psychiatric adverse effects.
Which of the following correctly describes the mechanism of action of rimonabant?
A. Rimonabant was approved in Europe as an anti-obesity agent in 2006. Rimonabant is a selective antagonist of the cannabinoid type 1 receptor, and it is the first member of a new class of compounds that targets the endocannabinoid system. But concerns have been raised regarding the psychiatric adverse effects of this drug. A meta-analysis by the American Food and Drug Administration showed that 26% of people given rimonabant 20 mg versus 14% of those given placebo had a psychiatric symptom reported as an adverse event. The side-effects range from depressed mood to anxiety and often led to co-prescription of a psychotropic or withdrawal of the drug. The relative risk for psychiatric adverse events in the rimonabant group was twice higher than the placebo group.
Which of the following neurotransmitters is proposed to be involved in increasing the significance (salience) of external stimuli in patients with schizophrenia?
D. Kapur proposed that in the normal individual, the role of mesolimbic dopamine is to attach significance or ‘salience’ to an external stimulus or an internal thought. This converts a neutral piece of information into attention-grabbing information. In acute psychosis where a hyper-dopaminergic state is noted in the mesolimbic system, insignificant events and perceptions receive inappropriate salience. For example, an innocuous smile of a stranger may be given a high degree of ‘aberrant salience’ leading to delusional elaborations. On a similar note, when such aberrant salience is attached to internally generated self-speech, hallucinations may be experienced. Antipsychotics are claimed to ‘dampen the salience’ of these abnormal experiences rather than erase the symptoms, and provide the platform for a process of psychological resolution.
References:
All of the following are diagnostic features of neuroleptic malignant syndrome (NMS) except:
C. DSM-IV-TR research criteria require both severe muscle rigidity and elevated temperature to be present following recent administration of an antipsychotic. In addition, at least two associated signs, symptoms, or laboratory findings must be present. The associated symptoms listed in DSM research criteria include diaphoresis, dysphagia, tremors, incontinence, mutism, tachycardia, elevated blood pressure, leucocytosis, changes in the level of consciousness, and laboratory evidence of muscle injury. NMS must be distinguished from serotonin syndrome. NMS is an idiosyncratic reaction to therapeutic dosages of neuroleptic agents, whereas serotonin syndrome is a toxic reaction due to overstimulation of 5-HT2a receptors; distinguishing features include bradykinesia and lead pipe rigidity in NMS, whereas hyperkinesia and myoclonus are evident in serotonin syndrome.
The most common phase of sleep when nocturnal panic attacks appear is:
A. Nocturnal panic refers to waking from sleep with an abrupt and discrete sense of intense fear accompanied by cognitive and physical symptoms of arousal. It does not differ significantly from panic attacks that occur during wakeful states. Most patients with nocturnal panic experience panic attacks during wakeful states too. But a small subset with predominantly circumscribed nocturnal panic has been described. Most patients report that nocturnal panic occurs between 1 and 3 hours after sleep onset. It is a non-REM event, usually occurring in late Stage II or early Stage III sleep. It is not accompanied by any electroencephalographic abnormalities.
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