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Psychiatry Question Bank – 65 Multiple Choice Questions on “Psychiatry in India”

1. One Indian psychiatrist who was interested in rehabilita­tion of mentally handicapped children and who was re­sponsible for the formation of an association of the men­tally handicapped at Bangalore is:

A. Dr Chennabasavanna

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B. Dr Murthy Rao

C. Dr R L Kapur

D. Dr N N Wig

2. Who described the concept of Guru-chela relationship?

A. Dr Mahal

B. Dr JSNeki

C. Dr Varma

D. Dr Carstairs

3. A psychiatrist who pioneered idea of involving family members in the treatment of his patients by providing a number of tents in the compound of the hospital is:

A. Dr Murthy Rao

B. Dr Vidyasagar

C. Dr J S Neki

D. Dr N N Wig

4. Who published the first series of leucotomies in India?

A. Ramamurthy and Ravi

B. Govindasamy and Rao

C. Kalyanaraman and Dharmaraj

5. The psychiatrist who was first to start electro encephalo- graph in this country in 1948, who was the first psychia­trist to practice psychosurgery at Ranchi and an Indian psychiatric society was formed on 7th Jan 1947, because of his efforts and who was awarded Padmashree is:

A. Dr Murthy Rao

B. Dr Vidyasagar

C. Dr Robert Brocklesby Davis

D. Dr N N Wig

6. The two centers in south India other than Amritsar where family ward therapy was introduced:

A. Madurai and Salem

B. Vellore and Bangalore

C. Kottayam and Trivandrum

D. Hyderabad and Vishakhapatanam

7. The model primary health center chosen for the study of decentralization of mental health services is:

A. RajpurRani

B. Piranmalai

C. Kallakurichi

D. Avadi

8. The prevalence of mental disorders in elderly in India was studied by the following:

A. Dube

B. Nandi

C. V Ramachandran

D. A V Rao

E. Sethi

9. The following psychiatrists studied about the family struc­ture and mental illness:

A. Dube, Sethi V

B. V Ramachandran

C. Vergheze

D. A V Rao

E. Channabasavanna

10. The following Indian psychiatrists described the posses­sion syndrome:

A. H S Narayanan and A S Mahal

B. JS Teja

C. LP Varma

D. Carstairs and Kapur

E. J K Trivedi

11. The correctly paired Indian psychiatrists who studied the psychosomatic illnesses are:

A. Bagadia – Diabetes

B. Ramachandran and Desai – Bronchial asthma

C. Srivastava – Skin disorders

D. Moudgil and Pershad – Pulmonary tuberculosis

12. The Indian psychiatrists who have done research on in­digenous healers or shamans are the following:

A. BB Sethi

B. JK Trivedi

C. Chopra

13. The Indian psychiatrists who have studied hysteria are the following:

A. Marfatia

B. Lai and Sethi

C. Trivedi

D. Mahal

14. The following psychiatrists who have studied psycho­therapy in Indian setting:

A. JS Neki

B. VK Varma

C. B B Sethi and A V Rao

D. Nandi

E. Surya and Jayaram

15. The Indian psychiatrist who developed a stressful event scale for use in India:

A. Neki

B. Wig

C. Gurmeetsingh

D. Nandi

16. The stimulatory response of the pineal gland to lithium is christened “Tilak effect” by one of the following:

A. BB Sethi

B. S Parvathi Devi

C. Neki

D. Varma

17. The following Indian psychiatrists reported Koro- a cul­ture bound syndrome:

A. Shukla

B. Chakravarthy

C. Dutta

D. C R Subramanian

18. The following Indian psychiatrists have reported on the use of behaviour modification techniques in the treat­ment of male sexual dysfunctions:

A. Bagadia

B. Venkoba Rao

C. Nandi

D. A K Agarwal

E. Kuruvilla

19. The following Indian psychiatrist studied about the mi­gration and mental illness:

A. Shekar Saxena

B. Bhaskaran

C. Sethi

D. Nandi

E. AV Rao

20. The following Indian psychiatrists who have reported that the point prevalence rate of schizophrenia is about 2-3 per 1000:

A. Dube

B. Sethi

C. A V Rao

D. Vergheze

21. In India the following psychiatrists stressed the need for rehabilitation in schizophrenia:

A. Bhaskaran

B. Sarada menon

C. Ramachandran

D. Holkar

E. Jacob John

22. The Indian psychiatric interview schedule was developed in1974 by:

A. AV Rao

B. Vergheze

C. Kapur

D. Sethi

23. An epidemiological study of drug dependence in India is by:

A. Dube and Handa (1971)

B. Mohan (1978)

C. Sethi and Trivedi (1979)

D. Lai and Sing (1979)

E. Sachdev et al (1986)

F. Kuruvilla (1980)

24. Psychosocial aspects of smoking were studied by the fol­lowing Indian psychiatrists:

A. A K Tandon (1990)

B. A K Gupta and B B Sethi (1977)

C. Lai and Sing (1979)

25. The study about psychoimmunology in India is by the:

A. Sethi

B. Pandey

C. Tiwari

D. Venkoba Rao

26. The one who conducted the first epidemiological study on mental morbidity in India is:

A. Dr N C Surya

B. Dr N N Wig

C. Dr Vrgheze

D. Dr Sethi

27. The one who talked much about the ethics in psychiatry in India is:

A. Kuruvilla

B. A K Agarwal

C. BB Sethi

D. O Somasundaram

28. In anxiety scale which consists of 100 items, used in India for quick estimation of anxiety in various areas such as physical, psychological, social, and economical is:

A. Hamilton depression rating scale (HDRS)

B. Sinha’s anxiety scale (SAS)

C. State anxiety Scale

29. The one who reported clozapine induced agranulocyto­sis in India and it was reversed with the use of cytokines like granulocyte-colony stimulating factor is:

A. Suresh Kumar

B. Srinivasan

C. Jayakar

D. Murugappan

30. The one Indian psychiatrist who wrote his monumental paper on history of psychiatry in India and Pakistan is:

A. Dr N N Wig

B. Dr L P Varma

C. Dr Murthy Rao

D. Dr N C Surya

31. The following dates are important for Indian psychiatrists:

A. World no tobacco day – My 31st

B. World de-addiction day – June 26th

C. Global mental health day – October 10th

D. World Alzheimer’s day – September 21st

32. Culture bound syndrome seen in India are the following:

A. Dhat, Jiryan

B. Koro (Jnjinia Bemar)

C. Possession syndrome

D. Ascetic syndrome

E. Jhin-jhini

33. The suicide rate in India is expressed as:

A. 3 to 4/10,000

B. 5 to 6/10,000

C. 6 to 7/10,000

34. Lithiumology a new discipline devoted to the study of various aspects of lithium was introduced in India by:

A. B B Sethi

B. A Venkoba Rao

C. JSNeki

35. The studies on Mongolism were carried out in India by:

A. Vergheze and Murthy Rao (1961)

B. Rao (1973)

C. Rafi and Marimuthu (1977)

D. O Somasundaram and Pappakumari (1978)

E. Subbe Gowda (1987)

Psychological Therapies:

Sigmund Freud– Psychoanalysis and Free association
Carl C Rogers– Client oriented psychotherapy
Frederich Perls– Gestalt therapy
Eric Berne– Transactional analysis
Victor E Frankl– Existential logo therapy
James Braid– Neuro-hypnotism
Albert Ellis– Rational emotive therapy
William Glasser– Reality therapy
Arthur Janov– Primal therapy
J L Moreno– Psychodrama
Assagioli– Psycho synthesis
Maslow– Self actualization
Pietro Pisani– Millieu therapy
Aaron Beak– Cognitive therapy (in depression)
T F Main and– Therapeutic communities
Maxwell Jones
John Watson– Behaviorism
Ivan Pavlov– Classical conditioning
Joseph Wolpe– Systematic desensitization
B F Skinner– Operant conditioning
Joint Commission of Mental Illness (in USA)– Deinstitutionalization

Syndromes in Psychiatry:

Abstinence Syndrome (withdrawal syndrome):

In the area of alcohol or drug dependence, being without the substance on which the subject is dependence. It is equivalent to withdrawal symptoms and its appearance suggests the presence of physiologic dependence or addiction.

Ascetic Syndrome:

A syndrome, which appears in adolescents and adults, leading to psychosocial withdrawal, severe sexual abstinence, practice of religious austerities, lack of concern with personal appearance, and considerable loss of weight (J S Neki 1972)

Ataque or Puerto Rican Syndrome:

Often characterized by anxiety, hyperventilation, confusion, and pseudoepileptic movements while. There may also be hallucinations, screaming, some violence to others or the self, and mutism. Generally the episode is self-limited and may last only minutes. At other times, it is severe and extends to a few days, thereby causing difficulty in differentiating from acute schizophrenic episode or atypical psychosis.

Capgras’s syndrome (Delusion of doubles):

Belief that a person known to the patient has been replaced by an exact double. Usually the person implicated is a close relative, particularly spouse. The common causes are functional psychiatric disorders (schizophrenia, paranoid states, affective disorder, etc.) and organic illness (temporal lobe epilepsy, brain tumor, delirium, etc.)

Charles Bonnet Syndrome:

It was named in 1938 by Morsier, after the man who first described and later himself developed the condition. It is characterized by vivid and complex visual hallucinations that are recognized as unreal and occur in the absence of any other psychiatric symptoms. The syndrome has most frequently been described in elderly people and is commonly associated with visual impairment.

Cotard’s Syndrome (Nihilistic delusions):

Delusions of negative to a varying degree. May have their body or self has disappeared and they no longer exist, even that the whole universe no longer exists. Frequently depressive symptoms but many have a basis in organic brain disease.

De Clerambault’s syndrome (Pure erotomania):

Delusional belief that another person (the object) often of unattainably higher social status loves the patient (the subject, usually a female) intensely. ‘Primary or pure’ erotomania, is an isolated phenomenon whereas ‘secondary’ type is much common in the setting of paranoid, manic, or other disorder.

De lange syndrome:

It is characterized by subnormality, excessive facial and skeletal abnormalities, dwarfism, and excessive body hair.

Ekbom’s Syndrome (Delusion of infestation):

Delusion that body and/or surrounding are infested with insects, parasites, etc. Evidence of this is fathered. Often paranoid or depressive or something organic brain disorder may cause it.

Frontal Lobe Syndrome:

Organic mental disorder characterized by a marked change in personality, with development of certain relatively characteristic patterns of relating to the environment that have been associated with damage to the frontal lobes. Such patterns include emotional liability, impairment in impulse control and social judgement, and marked apathy and indifference. Also called organic personality syndrome.

Ganser Syndrome:

Ganser in 1897, described two persons who developed brief bouts of mental illness characterized by disturbed consciousness, hallucinations, sensory changes of a hysterical kind and characteristic answers to questions.

These episodes terminated abruptly with subsequent amnesia for the episode and complete recovery. Enoth and Trethowan (1979) listed the four essential diagnosis features as approximate answers, clouding of consciousness, somatic conversing and visual and/or auditory hallucination (psudohallucination).

The condition is not confined to prisoners. The causes have been listed as schizophrenia, neurosyphilis, alcoholism, Korsakoff’s psychosis, cerebra vascular disease, depression, mental retardation, trauma, and artefactual illness.

General Adaptation Syndrome (GAS):

Hans Selye’s term for the responses of the body of major stress, passing through the alarm reaction, resistance, and finally, exhaustion.

Gray-out Syndrome:

A psychosis that occurs in pilots plying the stratosphere, out of sight of the horizon.

Meige’s Syndrome:

(Meige, 1910) An idiopathic disorder consisting of blepharospasm and oromandibular dystonia; first depicted by the Flemish painter Pieter Breughel the Elder (1526 – 1569). Most common in women and persons above 40 years of age.

Dyskinesia fluctuates from day to day; common aggravating factors are fatigue, stress and certain activities like talking, regarding or walking, and like other syskinesias it improves with sedation and disappears during sleep; occasionally it extends to extremities and may then develop torticollis, anti-or retrocollis, writer’s cramps, flexorspasms of the body.

No intellectual deterioration and no pyramidal, cerebeller or sensory deficiency. It is alleviated with anticholiner­gics, narcoleptics, GABA agonists, benzodiazepines, scopolamine, and others which exert action on dopaminergic system.

Munchausen’s Syndrome:

It is rare condition, characterized by patients who reportedly seek admission to hospital in a state of mental or physical distress, give plausible histories to support their complaints and submit themselves to painful or even dangerous investigations and therapies but then abruptly discharge themselves when discovered to have fabricated their stores and physical signs.

Othello Syndrome (Morbid jealously):

Delusion of infidelity on part of the sexual partner. Normal phenomena are interpreted to fit in with conviction. The common causes are alcoholism, organic psychosis, schizophrenia, obsessional personality, etc.

Pickwickian Syndrome:

Condition characterized by obesity, hypoventilation, and hypersomnia. Pisa syndrome:

A dystonic syndrome characterized by tonic, flexion of the trunk to one side, accompanied by its slight rotation, in the absence of other concomitant dystonic symptoms. First described by Ekbom, Lindholm, and Ljunberg in 1972 as a side-effect of treatment with butrophenones. Treatment includes anticholinergic medication, tetrabenazine, carbamazepine, clonazepam, propranolol, and even electroconvulsive therapy.

Prader Willi Syndrome:

The patient has goes obesity, hypogonadism, mild to severe sub normality and outbursts of anger. Possibly hypothalamic disorder.

19. White-out Syndrome:

A psychosis that occurs in Arctic explorers and mountaineers who are exposed to a lack of diverse stimuli in the snow-clad environment.

Important Points to be remembered:

1. Average prevalence of mental disorders in India is 15 to 20/1000.

2. Neuroses are the commonest group of disorders.

3. In India depressive neurosis is the- commonest mental disorder followed by anxiety neurosis.

4. Acute delirium is the commonest type of organic mental disorder whereas psychotic depression is the commonest type of functional psychosis.

5. Most common hallucination is schizophrenia is auditory whereas in organic disorders it is visual.

6. Alcohol dependence is the commonest type of drug dependence (excluding nicotine and Caffeine). In Korsakoff psychosis, pathological lesions are most often seen in mamillary bodies.

7. Opiates produce the strongest physical dependence whereas cocaine produces no physical dependence and cannabis produces low or no physical dependence.

8. Tactile hallucinosis (Magnan’s symptom) is seen in cocaine dependence “Cocaine bugs”.

9. Depression is the commonest cause of suicide followed by alcoholism.

10. In purperium, “postpartum blues” (transient depressive neurosis) is the commonest psychiatric disorder.

11. Schneider’s first rank symptoms of schizophrenia may not be seen in 20 to 30 percent of schizophrenics or they may be found in 20 to 30 percent of other psychiatric disorders (mood disorders).

12. Word “psychiatry” was coined by Johann Reil. Whereas word “psychology” was coined by Gockel.

13. Simon Porta gave first description of anorexia nervosa whereas Leo Kanner gave first description of autistic disorder in children (childhood autism).

14. Termites are children with I Q more than 150.

15. Sex chromosomes ‘X’ belongs to “C” group while ‘Y’ belongs to ‘G’ group.

16. Anorexia nervosa is almost always seen in young women.

17. Alzheimer’s disease is the most common cause of the presenile dementias.

18. Thioridazine may cause retinitus pigmentosa if does exceed 800 mg/day.

a. Schizophrenia occurs most commonly in adolescence and early adulthood (except: paranoid which occurs in late twenties).

19. Clozapine has the side-effects of agranulocytosis, seizure, and increased salivation.

20. Most common chromosomal abnormality causing mental retardation is trisomy 21.

21. Transference – counter transference is important in psychoanalysis.

22. The most common adverse renal effect of lithium is polyuria with secondary polydipsia.

23. Pimozide has shown promising results m monosymptomatic delusion.

24. Tardive dyskinesia is first noticed in perioral muscles.

25. Rigidity of narcoleptic malignant syndrome responds rapidly to bromocriptine.

26. Premature ejaculation is most commonly due to anxiety.

27. Most common postpartum disorder is depression.

28. The commonest from of focal epilepsy is temporal lobe epilepsy.

29. Parkinsonism most commonly present with depression

30. The commonest psychiatric illness found Cushing’s syndrome and Hypothyroidism is depression.

31. Xanthopisa or micropsia is most often seen in lesions of temporal lobe.

32. Thyrotoxicosis is most commonly associated with anxiety.

33. The most common menstrual disturbance seen in anorexia nervosa is amenorrhea.

34. In most instances, school phobias are a form of separation anxiety.

35. Enuresis in children is usually occurs with the onset of the first REM period.

36. Mitral value prolapse syndrome is most often confused with panic attacks.

37. The “Start-stop technique” and the ‘Squeeze technique” are useful in the treatment of premature ejaculation.

38. Pseudocyesis is often a form of conversion hysteria.

39. Myxoedema madness resembles paranoid psychosis.

40. Dhat syndrome, a term, was first used by, N.N. Wig in 1960.

a. Nihilistic delusions (delusions of negation) are most commonly seen in severe depression.

41. Colored visual disturbances are most commonly caused by digitalis.

42. The commonest form of an obsession seen in clinical setting is thoughts (doubts).

43. Pseudohallucinations are a type of mental imagery.

44. Coprolalia is a feature of Tourette’s syndrome.

45. First neurotransmitter to be discovered was acetylcholine (now found be deficient in Alzheimer’s disease)

a. Derealization is a disorder of perception.

46. Confabulation is most characteristic in Korsakoff’s psychosis.

a. Floccillaion is characteristically seen in delirium.

47. Patients with Down’s syndrome are at high risk of developing Alzheimer’s disease.

48. Dementia in Alzheimer’s disease in irreversible.

49. ‘Rum fits’ or alcoholic convulsions occur in chronic alcoholics after 12 to 48 hours of heavy drinking.

50. Delirium tremens (DT) represents by far the most serious of the alcohol withdrawal phenomena with a mortality of upto 55

51. DT usually lasts less than 3 days in the majority of cases and typically it terminates in a prolonged sleep.

52. Peripheral neuropathy, the most common neurological complication, apparently results from multiple vitamin B deficiency in alcoholics.

53. Korsakoff’s psychosis consists of short-term memory loss (anterograde amnesia) with confabulations.

54. Commonest form of compulsive ritual is washing.

55. The commonest type of dissociative hysteria described in prisoners is amnesia.

56. The mental mechanisms of isolation and undoing are found chiefly in obsessive-compulsive reaction.

57. In phobic neurosis, main ego defense used by the patient is avoidance and displacement.

58. ‘la belle indifference’ is most often associated with hysteria.

59. Inhalation of C02, hyperventilation and lactate infusion provoke panic attacks in panic disorder patients.

60. Obsessive-compulsive neurosis is relatively equally common in both sexes.

61. Most phobic disorders are more common in women than in men.

62. Synesthesias occur with the use of LSD.

63. Degeneration of nasal septum is most often associated with cocaine abuse.

64. Amotivational syndrome has been reported with the chronic use of marijuana.

65. Recent intake of heroin (amok) is clinically judged by pin point pupil.

66. The average duration of untreated manic episode is 6 months; whereas untreated depressive episode is 9 months.

67. Bipolar disorder most often starts with mania or hypo- mania.

68. Diencephalic and temporal lobe tumors are particularly associated with depressive syndromes.

69. Learned helplessness is typically seen in depression.

70. Dexamethasone suppression test (DST) is most useful in correct identification of those who don’t have major depression.

71. The typical presentation of ‘masked depression’ is with somatic complaints.

72. Schizophrenia which is superimposed or grafted onto mental deficiency is known as pfropf’s schizophrenia.

73. Defect of conation is typically seen in catatonic schizophrenia.

74. Most common lithium induced ECG changes is T-wave flattening.

75. Amoxapine is a newer antidepressant with dopamine reuptake blocking property also.

76. Drugs useful in narcoleptic malignant syndrome are dantrolene and bromocriptine.

77. ECT in schizophrenia was first used by Cerletti and Bini whereas in depression, it was by Jarvie. Unilateral ECT was devised by Friedman & Wilcox.

Drug of Choice:

i. Antidepressant induced tremors… Propranolol.

ii. Oro facial dyskinesia … Trihexyphenidyl.

iii. Acute dystonic reaction … Intravenous diazepam.

iv. Acute overdose with pentazocine … Naloxone.

v. Neuroleptic induced urinary retention … Bethanecol.

vi. Spinal spasticity including multiple sclerosis…… Baclofen.

vii. Excitement associated with epilepsy or alcohol or drug withdrawal … intravenous diazepam.

viii. Alcohol hallucinosis… Diazepam.

ix. Drug induced Parkinsonism … Trihexyphenidyl.

x. Schizomania … Haloperidol.

xi. Schizodepression … Loxapine/Amoxapine.

xii. Phenothiazine induced severe hypotension… Mephenteramine.

xiii. Lithium induced tremors … Beta blockers.

xiv. Lithium induced hypothyroidism … Thyroxine.

xv. LSD overdose … Chlorpromazine.

xvi. Intractable hiccoughs … Chlorpromazine.

xvii. Akathisia … Propranolol.

xviii. MNO inhibitors induced hypertensive crisis … Phentolamine.

xix. Alcohol withdrawal symptoms … Chlormethizazole.

xx. Recurrent febrile seizures (infants) … Phenobarbitone.

xxi. Attention deficit disorder with epilepsy (in child) … Carbamazepine.

xxii. Myoclonic jerks and atypical absence seizures … Valproate

xxiii. Atypical depression … Tranyl cypromine.

xxiv. Enuresis – Imipramine, Desmopressin.

xxv. Lithium induced diabetes insipidus … Thiazides.

xxvi. Sleep walking with complex and at times violent behaviours … Carbamazepine.

xxvii. Nocturnal bruxism … Diazepam.

xxviii. Narcolepsy (sleep attacks) …Amphetamines.

xxix. Hyperkinitic syndrome (Strauss syndrome) …Amphetamines.

xxx. Atypical depression and phobic neurosis … Phenelzine

xxxi. Obsessive compulsive neurosis… Fluoxetine Clomipramine, Fluvoxamine, Paroxetine, Citalopram, Sertraline.

xxxii. Acute panic attack … Intravenous diazepam.

xxxiii. Amphetamine Psychosis … Haloperidol.

xxxiv. Prophylaxis of MDP … Lithium, Carbamazepine.

Answer

1.B 2.B 3.B 4.B 5.C 6.B 7.A 8.A,B,C,D 9.A,B,C,D 10.A,B,C,D 11.A,B,C,D 12.A,B, 13.A,B,C, 14.A,B,C,E 15.C 16.B 17.A,B,C 18.A,B,D,E 19.A,B,C,D 20.A,B,C 21.A,B,C,D 20.A,B,D 21.A,B,C,D 22.C 23.A,B,C,D,E 24.A,B 25.A,B,C 26.A 27.B 28.B 29.B 30.B 31.A,B,C,D 32. A,B,C,D,E 33.C 34.B 35. A,B,C,D,E

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