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Arab Board Psychiatry Final Written study materials
Arab Board Psychiatry Final Written study resources

Arab Board Psychiatry Final Written practice questions

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Question 1Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which neurotransmitter is most consistently reduced in the brains of patients with Alzheimer disease, forming the basis for cholinesterase inhibitor therapy?

  1. GABA
  2. Serotonin
  3. Dopamine
  4. Acetylcholine Correct answer.

Explanation

The cholinergic hypothesis links Alzheimer disease to degeneration of basal forebrain cholinergic neurons, especially in the nucleus basalis of Meynert, with reduced cortical acetylcholine. This deficit underlies the rationale for cholinesterase inhibitors such as donepezil.

Question 2Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

A 28-year-old man develops severe rigidity, tremor, and hyperthermia after abruptly stopping his antipsychotic. Which syndrome is most likely?

  1. Neuroleptic malignant syndrome Correct answer.
  2. Acute dystonia
  3. Serotonin syndrome
  4. Tardive dyskinesia

Explanation

Neuroleptic malignant syndrome follows dopamine blockade or abrupt withdrawal of dopaminergic drugs and presents with rigidity, hyperthermia, autonomic instability, and altered consciousness. Serotonin syndrome instead features hyperreflexia and clonus.

Question 3Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which structure connects the two cerebral hemispheres and is the largest commissural tract?

  1. Fornix
  2. Corpus callosum Correct answer.
  3. Mammillary body
  4. Internal capsule

Explanation

The corpus callosum is the largest commissural bundle, connecting homologous cortical regions of the two hemispheres. Its division can produce disconnection syndromes such as split-brain phenomena.

Question 4Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which enzyme is the primary target of typical antipsychotic drugs such as haloperidol?

  1. Dopamine D2 receptor Correct answer.
  2. Monoamine oxidase
  3. Acetylcholinesterase
  4. Serotonin reuptake transporter

Explanation

Typical antipsychotics act mainly by blocking dopamine D2 receptors in the mesolimbic pathway, which reduces positive symptoms. This same blockade in the nigrostriatal pathway explains extrapyramidal side effects.

Question 5Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Lithium is largely eliminated unchanged by the kidney. Which change most increases the risk of lithium toxicity?

  1. High dietary potassium
  2. Alkaline urine
  3. Volume depletion with reduced renal clearance Correct answer.
  4. Increased glomerular filtration rate

Explanation

Lithium is reabsorbed in the proximal tubule alongside sodium; when sodium and volume are depleted, lithium reabsorption rises and clearance falls. This is why dehydration, diuretics, and NSAIDs precipitate toxicity.

Question 6Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which brain region is most central to fear conditioning and is implicated in panic disorder?

  1. Cerebellum
  2. Wernicke area
  3. Basal ganglia
  4. Amygdala Correct answer.

Explanation

The amygdala integrates threat detection and fear learning, and its hyperactivity is implicated in anxiety and panic. The central nucleus coordinates autonomic fear responses.

Question 7Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

A patient on an SSRI develops agitation, diaphoresis, hyperreflexia, and inducible clonus after receiving tramadol. Which mechanism best explains this?

  1. Dopamine D2 blockade
  2. GABA-A potentiation
  3. Excess serotonergic activity Correct answer.
  4. Muscarinic receptor blockade

Explanation

Combining serotonergic agents such as an SSRI with tramadol can produce serotonin syndrome through excessive synaptic serotonin. Clonus and hyperreflexia distinguish it from neuroleptic malignant syndrome.

Question 8Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which cranial nerve carries parasympathetic fibers that constrict the pupil?

  1. Trigeminal nerve
  2. Oculomotor nerve Correct answer.
  3. Optic nerve
  4. Facial nerve

Explanation

The oculomotor nerve carries parasympathetic fibers from the Edinger-Westphal nucleus to the ciliary ganglion, which innervate the pupillary constrictor. Loss of this supply produces a dilated, unreactive pupil.

Question 9Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which is the rate-limiting enzyme in the synthesis of catecholamines?

  1. Dopamine beta-hydroxylase
  2. Dopa decarboxylase
  3. Tyrosine hydroxylase Correct answer.
  4. Catechol-O-methyltransferase

Explanation

Tyrosine hydroxylase converts tyrosine to L-DOPA and is the rate-limiting step in catecholamine synthesis, regulated by feedback inhibition. Subsequent steps are comparatively fast.

Question 10Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

A 45-year-old woman has a first-degree relative with bipolar disorder. Which statement about heritability of bipolar disorder is most accurate?

  1. It is entirely environmental with no genetic contribution
  2. Twin studies show substantial heritability, estimated around 60-80% Correct answer.
  3. Heritability is identical to that of Huntington disease
  4. It follows simple Mendelian dominant inheritance

Explanation

Family, twin, and adoption studies indicate that bipolar disorder is highly heritable, with twin estimates commonly around 60-80%. Inheritance is polygenic and does not follow a single-gene pattern.

Question 11Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which dopamine pathway is most implicated in the positive symptoms of schizophrenia and is the target of antipsychotic efficacy?

  1. Mesocortical pathway
  2. Mesolimbic pathway Correct answer.
  3. Tuberoinfundibular pathway
  4. Nigrostriatal pathway

Explanation

Overactivity of dopamine transmission in the mesolimbic pathway is linked to positive symptoms, and D2 blockade there reduces hallucinations and delusions. The mesocortical pathway is more associated with negative and cognitive symptoms.

Question 12Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

A patient develops hyperprolactinemia and galactorrhea while taking risperidone. Which pathway explains this effect?

  1. Mesolimbic pathway
  2. Mesocortical pathway
  3. Tuberoinfundibular pathway Correct answer.
  4. Nigrostriatal pathway

Explanation

Dopamine tonically inhibits prolactin release via the tuberoinfundibular pathway. Blockade of D2 receptors here removes that inhibition and raises prolactin.

Question 13Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which statement best describes the mechanism of action of benzodiazepines?

  1. Direct activation of GABA-A receptors in the absence of GABA
  2. Blockade of glutamate NMDA receptors
  3. Positive allosteric modulation increasing GABA-A chloride current frequency Correct answer.
  4. Inhibition of GABA transaminase

Explanation

Benzodiazepines bind an allosteric site on GABA-A receptors and increase the frequency of chloride channel opening in the presence of GABA. They require endogenous GABA and have a ceiling effect, unlike barbiturates.

Question 14Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which brainstem structure regulates the sleep-wake cycle and contains the locus coeruleus?

  1. Pineal stalk
  2. Optic chiasm
  3. Medulla oblongata
  4. Pons Correct answer.

Explanation

The locus coeruleus is a noradrenergic nucleus located in the pons, and pontine structures including the raphe and cholinergic nuclei regulate arousal and REM sleep. The medulla mainly controls vital autonomic reflexes.

Question 15Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which finding would most suggest that a depressed patient is a poor candidate for a tricyclic antidepressant?

  1. Low body weight
  2. Mild insomnia
  3. A history of ischemic heart disease with conduction delay Correct answer.
  4. A family history of depression

Explanation

Tricyclics block cardiac sodium channels and can prolong conduction, causing arrhythmias, so pre-existing conduction disease is a major contraindication. Their anticholinergic and cardiotoxic profile makes SSRIs safer in cardiac disease.

Question 16Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which structure is the primary output of the basal ganglia and inhibits the thalamus?

  1. Globus pallidus internus Correct answer.
  2. Subthalamic nucleus
  3. Putamen
  4. Caudate nucleus

Explanation

The globus pallidus internus and substantia nigra pars reticulata are the main basal ganglia outputs and tonically inhibit the thalamus. Reduced inhibition after dopaminergic modulation permits movement.

Question 17Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

A patient on clozapine develops fever and sore throat. Which is the most appropriate immediate step?

  1. Reassure and continue monitoring monthly
  2. Add an SSRI
  3. Stop clozapine and obtain a full blood count urgently Correct answer.
  4. Increase the clozapine dose

Explanation

Fever and sore throat raise concern for neutropenia or agranulocytosis, a serious clozapine adverse effect. The drug should be withheld and an urgent full blood count obtained.

Question 18Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which neurotransmitter is the principal inhibitory transmitter in the mammalian central nervous system?

  1. Substance P
  2. Glutamate
  3. Dopamine
  4. GABA Correct answer.

Explanation

GABA is the predominant inhibitory neurotransmitter in the adult brain, acting largely through GABA-A chloride channels. Glutamate is the principal excitatory transmitter.

Question 19Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

Which genetic phenomenon explains why the same genotype can produce different phenotypes in monozygotic twins with schizophrenia?

  1. Simple autosomal dominance
  2. Anticipation
  3. Codominance
  4. Incomplete penetrance and environmental interaction Correct answer.

Explanation

Monozygotic twins share a genotype but often differ in phenotype because of incomplete penetrance, epigenetic variation, and environmental exposures. Discordance reflects gene-environment interaction rather than a monogenic rule.

Question 20Basic sciences relevant to psychiatry (neuroanatomy, neurophysiology, psychopharmacology, genetics)

A patient taking an MAO inhibitor eats aged cheese and develops a severe occipital headache and hypertension. Which mechanism explains this reaction?

  1. Reduced tyramine breakdown causing noradrenergic surge Correct answer.
  2. Enhanced GABA release
  3. Direct vagal stimulation
  4. Serotonin receptor blockade

Explanation

MAO inhibitors reduce gut and hepatic breakdown of dietary tyramine, which then displaces stored catecholamines and causes a hypertensive crisis. This is the classic cheese reaction.

Question 21Psychopathology and diagnostic classification

According to ICD-11, which symptom is required for the diagnosis of a depressive episode in addition to depressed mood or diminished interest?

  1. Flight of ideas
  2. Grandiose delusions
  3. Reduced energy or increased fatigability Correct answer.
  4. Psychomotor agitation only

Explanation

ICD-11 requires at least two of three core symptoms for a depressive episode: depressed mood, diminished interest or pleasure, and reduced energy or increased fatigability. The other listed features are not core depressive symptoms.

Question 22Psychopathology and diagnostic classification

A patient has persistent low mood for 2 years with poor appetite, low energy, and low self-esteem, never meeting criteria for a full depressive episode. What is the most likely diagnosis?

  1. Adjustment disorder
  2. Bipolar II disorder
  3. Cyclothymic disorder
  4. Persistent depressive disorder (dysthymia) Correct answer.

Explanation

Persistent depressive disorder requires chronic depressed mood for at least 2 years (1 year in youth) with associated symptoms that do not reach the threshold for a full episode. The chronicity and subthreshold severity distinguish it from episodic disorders.

Question 23Psychopathology and diagnostic classification

Which feature best distinguishes a manic episode from a hypomanic episode?

  1. Presence of elevated mood
  2. Duration of at least 4 days
  3. Marked impairment or need for hospitalisation Correct answer.
  4. Increased goal-directed activity

Explanation

Mania is differentiated from hypomania by severity: marked impairment in functioning, need for hospitalisation, or psychotic features. Duration and symptom type overlap, so severity determines the distinction.

Question 24Psychopathology and diagnostic classification

A patient reports hearing voices discussing him in the third person and believes his thoughts are being broadcast to others. These are best classified as:

  1. Cognitive symptoms
  2. Affective symptoms
  3. First-rank (Schneiderian) symptoms Correct answer.
  4. Negative symptoms

Explanation

Third-person auditory hallucinations and thought broadcasting are classic first-rank (Schneiderian) symptoms of schizophrenia. They reflect disturbed self-monitoring and boundary of self.

Question 25Psychopathology and diagnostic classification

For a diagnosis of schizophrenia under ICD-11, symptoms must persist for at least what minimum duration?

  1. 1 month Correct answer.
  2. 6 months
  3. 1 week
  4. 2 weeks

Explanation

ICD-11 requires core psychotic symptoms to be present for at least 1 month for schizophrenia. A 6-month requirement is a DSM-style duration used for schizophreniform versus schizophrenia distinctions.

Question 26Psychopathology and diagnostic classification

A woman develops delusions and hallucinations 3 weeks after childbirth, with mood fluctuating rapidly. What is the most appropriate diagnosis?

  1. Schizoaffective disorder
  2. Postpartum depression
  3. Puerperal psychosis Correct answer.
  4. Brief psychotic disorder

Explanation

Puerperal (postpartum) psychosis typically begins within 2 to 4 weeks of delivery with delusions, hallucinations, and mood lability. The temporal relationship to childbirth defines the diagnosis.

Question 27Psychopathology and diagnostic classification

Which symptom is characteristic of a panic attack rather than generalised anxiety disorder?

  1. Abrupt surge of intense fear peaking within minutes Correct answer.
  2. Sleep disturbance over weeks
  3. Muscle tension lasting months
  4. Chronic worry about multiple domains

Explanation

Panic attacks are characterised by an abrupt surge of intense fear that peaks within minutes, with prominent autonomic symptoms. Generalised anxiety is chronic and diffuse rather than paroxysmal.

Question 28Psychopathology and diagnostic classification

A person fears social situations, avoids them, and recognizes the fear as excessive, present for 8 months. The most likely diagnosis is:

  1. Specific phobia
  2. Agoraphobia
  3. Social anxiety disorder Correct answer.
  4. Avoidant personality disorder

Explanation

Social anxiety disorder involves marked fear of social scrutiny with avoidance lasting 6 months or more. Recognition of excessiveness and fear of negative evaluation distinguish it.

Question 29Psychopathology and diagnostic classification

Which feature is required for the diagnosis of obsessive-compulsive disorder?

  1. Presence of obsessions, compulsions, or both Correct answer.
  2. Presence of a tic disorder
  3. Onset before age 18
  4. Presence of delusional conviction

Explanation

OCD requires the presence of obsessions, compulsions, or both that are time-consuming or cause distress. Insight may vary, and neither early onset nor tics are required.

Question 30Psychopathology and diagnostic classification

A patient re-experiences a traumatic event through flashbacks, avoids reminders, and is hypervigilant 2 months after the event. The most likely diagnosis is:

  1. Generalised anxiety disorder
  2. Acute stress disorder
  3. Adjustment disorder
  4. Post-traumatic stress disorder Correct answer.

Explanation

PTSD requires symptoms persisting beyond 1 month after trauma, including re-experiencing, avoidance, and hyperarousal. Symptoms lasting less than 1 month suggest acute stress disorder.

Question 31Psychopathology and diagnostic classification

Which core feature defines dissociative amnesia?

  1. Confabulation with false memories
  2. Gradual decline in memory with age
  3. Impaired memory due to substance intoxication
  4. Inability to recall personal information, usually traumatic, not due to ordinary forgetting Correct answer.

Explanation

Dissociative amnesia is an inability to recall important autobiographical information, often related to trauma, that is inconsistent with ordinary forgetting. It is not due to a substance or neurological condition.

Question 32Psychopathology and diagnostic classification

A patient presents with sudden onset of blindness in both eyes; examination and investigations reveal no organic cause, and the patient appears unconcerned. This presentation is most consistent with:

  1. Illness anxiety disorder
  2. Malingering
  3. Conversion disorder (functional neurological symptom disorder) Correct answer.
  4. Somatic symptom disorder

Explanation

Conversion disorder involves neurological symptoms incompatible with recognised disease, often with la belle indifférence. Absence of organic findings and incongruent concern support the diagnosis.

Question 33Psychopathology and diagnostic classification

Which symptom is a negative symptom of schizophrenia?

  1. Delusions of persecution
  2. Formal thought disorder
  3. Avolition Correct answer.
  4. Auditory hallucinations

Explanation

Negative symptoms reflect loss of normal function and include avolition, blunted affect, alogia, and anhedonia. Delusions, hallucinations, and thought disorder are positive symptoms.

Question 34Psychopathology and diagnostic classification

A patient meets criteria for schizophrenia and also has a full major depressive episode that is present for most of the illness. Which diagnosis is most appropriate?

  1. Schizoaffective disorder Correct answer.
  2. Schizophrenia
  3. Major depressive disorder with psychotic features
  4. Bipolar I disorder

Explanation

Schizoaffective disorder requires psychotic symptoms meeting schizophrenia criteria plus a major mood episode present for the majority of the illness. When mood symptoms dominate the course, schizoaffective disorder is preferred.

Question 35Psychopathology and diagnostic classification

Which feature is most characteristic of delirium as opposed to dementia?

  1. Insidious onset over years
  2. Acute onset with fluctuating attention Correct answer.
  3. Preserved attention with stable cognition
  4. Progressive memory loss over months

Explanation

Delirium is characterised by acute onset, fluctuating course, and impaired attention. Dementia is typically insidious and progressive with relatively preserved attention until late.

Question 36Psychopathology and diagnostic classification

A patient has excessive anxiety about having a serious illness despite normal investigations, with preoccupation lasting 7 months. The most likely diagnosis is:

  1. Somatic symptom disorder
  2. Illness anxiety disorder Correct answer.
  3. Body dysmorphic disorder
  4. Panic disorder

Explanation

Illness anxiety disorder is preoccupation with having or acquiring a serious illness with minimal or absent somatic symptoms. It persists for at least 6 months and is not better explained by another disorder.

Question 37Psychopathology and diagnostic classification

Which eating disorder is characterised by recurrent episodes of binge eating without compensatory behaviours, in a person of normal or above-normal weight?

  1. Avoidant/restrictive food intake disorder
  2. Anorexia nervosa
  3. Bulimia nervosa
  4. Binge eating disorder Correct answer.

Explanation

Binge eating disorder involves recurrent binge episodes without regular compensatory behaviours, often with weight gain. The absence of purging distinguishes it from bulimia nervosa.

Question 38Psychopathology and diagnostic classification

A 10-year-old has persistent defiance, arguing with adults, and deliberately annoying others for 8 months. The most likely diagnosis is:

  1. Disruptive mood dysregulation disorder
  2. Attention-deficit/hyperactivity disorder
  3. Conduct disorder
  4. Oppositional defiant disorder Correct answer.

Explanation

Oppositional defiant disorder involves a persistent pattern of angry, defiant, and vindictive behaviour without serious violation of others' rights. Conduct disorder requires aggression or violation of rights.

Question 39Psychopathology and diagnostic classification

Which feature is most consistent with a diagnosis of autism spectrum disorder rather than social anxiety disorder?

  1. Onset in adolescence after a stressful event
  2. Fear of negative evaluation by peers
  3. Desire for social contact with avoidance due to fear
  4. Deficits in social communication present from early development Correct answer.

Explanation

Autism spectrum disorder involves early developmental deficits in social communication and interaction, often with restricted interests. Social anxiety typically emerges later and centres on fear of evaluation.

Question 40Psychopathology and diagnostic classification

A patient has recurrent, intrusive, unwanted thoughts of harming others and performs mental rituals to neutralise them, with good insight and no psychosis. The most likely diagnosis is:

  1. Obsessive-compulsive disorder Correct answer.
  2. Schizophrenia
  3. Generalised anxiety disorder
  4. Body dysmorphic disorder

Explanation

OCD involves intrusive obsessions and repetitive compulsions performed to reduce distress, with variable insight. The presence of ego-dystonic intrusive thoughts and neutralising rituals supports OCD.

Question 41Clinical assessment, interviewing and psychiatric examination

During a standard psychiatric interview, which component is assessed primarily through open-ended questioning rather than structured checklists?

  1. The current dose of prescribed medication
  2. The number of prior hospital admissions
  3. The frequency of panic attacks in the past month
  4. The patient's subjective experience of distress Correct answer.

Explanation

Open-ended questions elicit the patient's own narrative, allowing the subjective, meaning-laden aspects of experience to emerge. Enumerative clinical facts such as attack counts, admission numbers and medication doses are better captured by structured, closed questioning.

Question 42Clinical assessment, interviewing and psychiatric examination

A patient answers every question with a single word and volunteers nothing further. Which interviewing technique is most appropriate to broaden the dialogue?

  1. Repetition of the same closed question
  2. Immediate confrontation of the patient
  3. Abrupt change to a checklist format
  4. Use of open-ended facilitation prompts Correct answer.

Explanation

Open-ended facilitation prompts invite elaboration and shift the initiative to the patient without pressure. Repeating closed questions, confronting early, or forcing a checklist tends to increase defensiveness and further restrict output.

Question 43Clinical assessment, interviewing and psychiatric examination

In the mental state examination, which item is assessed under 'insight'?

  1. The patient's recognition that their symptoms are abnormal Correct answer.
  2. The patient's ability to recall three objects after five minutes
  3. The patient's orientation to person, place and time
  4. The patient's capacity to copy a pentagon figure

Explanation

Insight concerns the patient's awareness and understanding of their own illness and its symptoms. Recall, visuospatial copying and orientation are cognitive or orientation items, not measures of insight.

Question 44Clinical assessment, interviewing and psychiatric examination

A patient describes hearing voices that comment on their actions in the third person. Under which mental state examination heading is this recorded?

  1. Perception Correct answer.
  2. Content of thought
  3. Cognition
  4. Form of thought

Explanation

Hallucinations are disorders of perception, as they are sensory experiences without an external stimulus. Thought form, thought content and cognition refer to the organisation, beliefs and intellectual functions respectively.

Question 45Clinical assessment, interviewing and psychiatric examination

Which finding on cognitive screening most strongly suggests a delirium rather than a stable dementia?

  1. Intact orientation to place and person
  2. Fluctuating attention with an acute onset Correct answer.
  3. A Mini-Mental State Examination score of 22/30
  4. A stable score on repeat testing one month later

Explanation

Delirium is characterised by an acute onset and a fluctuating course with impaired attention. A stable, non-fluctuating score, even if low, is more consistent with a chronic process such as dementia.

Question 46Clinical assessment, interviewing and psychiatric examination

During an interview a patient suddenly becomes mute and unresponsive for two minutes and then resumes talking. What is the most appropriate immediate action?

  1. Ask the patient to sign a consent form for admission
  2. Observe closely, note the duration and reassure the patient Correct answer.
  3. Immediately administer an intramuscular antipsychotic
  4. Terminate the interview and discharge the patient

Explanation

Brief episodes of mutism or unresponsiveness require careful observation and documentation, including duration and any associated features, before any intervention. Reassurance maintains the therapeutic alliance while information is gathered.

Question 47Clinical assessment, interviewing and psychiatric examination

Which feature best distinguishes a delusion from an overvalued idea?

  1. The belief is culturally shared by the patient's community
  2. The belief is held with less conviction than an overvalued idea
  3. The belief is firmly held despite contrary evidence and is not shared by the patient's culture Correct answer.
  4. The belief is always accompanied by a hallucination

Explanation

A delusion is a fixed, false belief held with strong conviction despite evidence to the contrary and outside the person's cultural context. An overvalued idea is an understandable, affect-laden conviction that is less rigid and more open to reason.

Question 48Clinical assessment, interviewing and psychiatric examination

A patient reports that their thoughts are being removed by an external agency and that their body movements are controlled by others. These symptoms are best classified as:

  1. Depersonalisation
  2. Flight of ideas
  3. Obsessions
  4. Passivity phenomena Correct answer.

Explanation

Passivity phenomena describe the experience that one's thoughts, feelings or actions are controlled or replaced by an external force. Obsessions are intrusive thoughts recognised as one's own, depersonalisation is a sense of unreality, and flight of ideas is a disorder of thought form.

Question 49Clinical assessment, interviewing and psychiatric examination

In assessing suicide risk, which feature most increases the immediate level of concern?

  1. A specific plan with access to lethal means Correct answer.
  2. A family history of depression
  3. A reported feeling of hopelessness without a plan
  4. A history of a suicide attempt two years ago

Explanation

A specific plan combined with access to lethal means indicates high immediate intent and capability, warranting urgent intervention. Historical and background factors raise risk but do not alone signal imminent danger.

Question 50Clinical assessment, interviewing and psychiatric examination

A patient's speech is rapid, with ideas that jump between topics linked by rhymes and puns. This abnormality is best described as:

  1. Thought blocking
  2. Circumstantiality
  3. Perseveration
  4. Flight of ideas Correct answer.

Explanation

Flight of ideas is a rapid flow of thought with loose associations and incidental links such as rhymes or puns. Circumstantiality is over-inclusive but goal-directed speech, perseveration is repetition of a response, and thought blocking is abrupt interruption of thought.