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Iraqi Board Psychiatry study materials
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Iraqi Board Psychiatry practice questions

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

A 28-year-old man develops severe rigidity, hyperthermia, and autonomic instability after starting an antipsychotic. Which neurotransmitter system's blockade in the nigrostriatal and hypothalamic pathways best explains the rigidity and thermoregulatory failure of neuroleptic malignant syndrome?

  1. Dopamine D2 receptors Correct answer.
  2. Serotonin 5-HT2A receptors
  3. Muscarinic acetylcholine receptors
  4. GABA-A receptors

Explanation

Neuroleptic malignant syndrome is attributed to abrupt central dopamine D2 blockade, which disrupts striatal motor regulation (rigidity) and hypothalamic thermoregulation (hyperthermia). The syndrome is classically linked to high-potency D2 antagonists and to rapid dose changes. Serotonergic, cholinergic and GABAergic mechanisms do not account for this characteristic triad.

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

Destruction of dopaminergic neurons projecting from the substantia nigra pars compacta to the dorsal striatum produces the cardinal motor features of Parkinson disease. Which pathway is affected in this degeneration?

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

Explanation

The nigrostriatal pathway runs from the substantia nigra pars compacta to the caudate and putamen and regulates movement; its degeneration causes bradykinesia, rigidity and tremor. The other three dopaminergic pathways arise from the ventral tegmental area or arcuate nucleus and subserve reward, cognition and prolactin control.

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

A patient on clozapine develops fever, confusion, and a raised creatine kinase. Which receptor-binding property of clozapine most contributes to its low liability for extrapyramidal symptoms compared with haloperidol?

  1. Low striatal D2 occupancy with prominent 5-HT2A antagonism Correct answer.
  2. Potent dopamine transporter inhibition
  3. Selective D1 agonist activity
  4. High-affinity D2 blockade with slow dissociation

Explanation

Atypical antipsychotics such as clozapine produce extrapyramidal symptoms infrequently because they occupy striatal D2 receptors only transiently and at lower levels, aided by strong 5-HT2A antagonism that modulates dopamine release. Haloperidol, by contrast, sustains high D2 occupancy. This pharmacological difference underlies the atypical profile.

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

A 34-year-old woman on fluoxetine for depression is started on tramadol for back pain and presents with agitation, clonus, hyperreflexia and fever. Which mechanism best explains this presentation?

  1. Excess synaptic serotonin from combined serotonergic agents Correct answer.
  2. Dopamine D2 receptor supersensitivity
  3. Increased GABA-A receptor conductance
  4. Blockade of norepinephrine reuptake alone

Explanation

Serotonin syndrome results from excessive serotonergic neurotransmission, typically when two agents that increase synaptic serotonin (an SSRI plus a serotonergic opioid such as tramadol) are combined. The triad of mental status change, autonomic hyperactivity and neuromuscular hyperactivity (clonus, hyperreflexia) is characteristic. Treatment is withdrawal of the offending agents plus supportive care and, in severe cases, cyproheptadine.

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

Which enzyme is the principal target of valproate and is also inhibited by the mood stabiliser's action on GABA metabolism, contributing to its broad-spectrum antiepileptic and mood-stabilising effects?

  1. Catechol-O-methyltransferase
  2. Acetylcholinesterase
  3. Succinic semialdehyde dehydrogenase and GABA transaminase Correct answer.
  4. Monoamine oxidase A

Explanation

Valproate inhibits GABA transaminase and succinic semialdehyde dehydrogenase, reducing GABA breakdown and raising GABAergic tone; it also blocks voltage-gated sodium channels. These combined actions explain its use in epilepsy, mania and migraine prophylaxis. The other enzymes listed are not its primary targets.

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

A 45-year-old man develops a hypertensive crisis with headache and sweating after eating aged cheese while taking an irreversible monoamine oxidase inhibitor. Which mechanism explains this reaction?

  1. Loss of monoamine oxidase A-mediated degradation of dietary tyramine Correct answer.
  2. Direct agonism of tyramine at dopamine D2 receptors
  3. Increased hepatic conjugation of tyramine
  4. Reduced presynaptic reuptake of tyramine

Explanation

Irreversible MAOIs inhibit monoamine oxidase A in the gut and liver, abolishing first-pass degradation of dietary tyramine. Tyramine then reaches noradrenergic nerve terminals, displaces stored noradrenaline and triggers a hypertensive crisis, the classic cheese reaction. Avoiding tyramine-rich foods is therefore essential with these agents.

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

Benzodiazepines such as diazepam enhance GABA-A receptor function. Which statement best describes their mechanism at the receptor level?

  1. They directly open the chloride channel in the absence of GABA
  2. They block the GABA binding site competitively
  3. They increase the duration of chloride channel opening in the presence of GABA
  4. They increase the frequency of chloride channel opening in the presence of GABA Correct answer.

Explanation

Benzodiazepines bind an allosteric site on the GABA-A receptor and increase the frequency of chloride channel opening when GABA is present, enhancing inhibitory neurotransmission. Barbiturates prolong channel opening duration and can open the channel directly at high doses, which explains their narrower safety margin. This distinction is a classic pharmacology point.

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

A patient with schizophrenia is started on haloperidol and develops a sustained upward rolling of the eyes and neck spasm within hours. Which pathway and receptor change best explain this acute dystonic reaction?

  1. Mesolimbic D2 blockade producing limbic hyperdopaminergia
  2. Nigrostriatal D2 blockade producing striatal cholinergic excess Correct answer.
  3. Tuberoinfundibular blockade producing hyperprolactinaemia
  4. Blockade of muscarinic receptors in the striatum

Explanation

Acute dystonia arises from sudden D2 blockade in the nigrostriatal pathway, which unmasks striatal cholinergic activity and produces sustained muscle contractions. It responds rapidly to anticholinergics such as benztropine or to diphenhydramine. The other pathways do not mediate this acute motor effect.

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

Which change in the dopamine hypothesis best accounts for the observation that antipsychotic efficacy typically requires several days to weeks despite immediate D2 occupancy?

  1. Immediate complete elimination of dopamine synthesis
  2. Selective destruction of ventral tegmental area neurons
  3. Progressive depolarisation block of mesolimbic dopamine neurons after sustained D2 antagonism Correct answer.
  4. Rapid upregulation of postsynaptic D2 receptors

Explanation

Sustained D2 antagonism leads over days to depolarisation block and inactivation of mesolimbic dopamine neurons, a delayed effect that parallels the clinical latency of antipsychotic response. Immediate receptor occupancy alone does not produce symptom relief. This temporal dissociation supports the delayed-onset component of the dopamine hypothesis.

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

A 60-year-old woman on lithium develops coarse tremor, ataxia and confusion after starting a thiazide diuretic. Which renal mechanism best explains the lithium rise?

  1. Reduced distal tubular sodium reabsorption leading to compensatory increased proximal lithium reabsorption Correct answer.
  2. Increased glomerular filtration of lithium
  3. Enhanced proximal tubular secretion of lithium
  4. Induction of hepatic lithium metabolism

Explanation

Lithium is handled like sodium in the kidney. Thiazides cause natriuresis in the distal tubule, leading to volume depletion and compensatory increased proximal sodium and lithium reabsorption, raising serum lithium. This is why thiazides are a classic precipitant of lithium toxicity, whereas loop diuretics have a smaller effect.

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

Clozapine requires regular full blood count monitoring because of agranulocytosis. Which mechanism is most implicated in this idiosyncratic reaction?

  1. Direct bone marrow suppression by high-affinity D2 blockade
  2. Complement-mediated destruction of circulating erythrocytes
  3. Depletion of folate stores by hepatic enzyme induction
  4. Immune-mediated and toxic effects on granulocyte precursors in genetically susceptible individuals Correct answer.

Explanation

Clozapine-induced agranulocytosis is thought to involve a combination of toxic and immune-mediated damage to granulocyte precursors, with genetic susceptibility contributing. It is not dose-dependent and is not explained by the drug's dopamine blockade. Mandatory blood monitoring allows early detection and drug withdrawal.

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

Tricyclic antidepressants such as amitriptyline are dangerous in overdose. Which pharmacological action accounts for the potentially fatal cardiac conduction delay and arrhythmia?

  1. Blockade of cardiac potassium channels shortening the QT interval
  2. Selective beta-1 adrenergic agonism
  3. Increased calcium influx through L-type channels
  4. Blockade of cardiac sodium channels slowing phase 0 depolarisation Correct answer.

Explanation

Tricyclics block cardiac fast sodium channels, slowing phase 0 depolarisation and widening the QRS complex, which predisposes to ventricular arrhythmias. This quinidine-like membrane-stabilising effect, together with anticholinergic and alpha-1 blocking effects, makes overdose hazardous. Sodium bicarbonate is the treatment for cardiotoxicity.

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

Which structure connects the hippocampus to the mamillary bodies and is the principal site of pathology in Wernicke encephalopathy?

  1. Uncinate fasciculus
  2. Arcuate fasciculus
  3. Cingulum bundle
  4. Fornix and mamillothalamic tract Correct answer.

Explanation

The fornix carries output from the hippocampus to the mamillary bodies, which project via the mamillothalamic tract to the anterior thalamus, forming the Papez circuit. Thiamine deficiency damages mamillary bodies, medial thalamus and periaqueductal grey, producing the Wernicke triad. The other tracts serve different association functions.

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

A patient with a lesion of the right parietal lobe shows neglect of the left side of space and of his own body. Which cortical region is most likely damaged?

  1. Right posterior parietal cortex, particularly the inferior parietal lobule Correct answer.
  2. Right inferior frontal gyrus
  3. Left occipital pole
  4. Left primary motor cortex

Explanation

Contralateral hemispatial neglect most often follows damage to the right posterior parietal cortex, especially the inferior parietal lobule and temporoparietal junction. The right hemisphere attends to both sides of space, so its loss leaves left-sided stimuli unattended. Frontal lesions can cause neglect but the parietal focus is classic.

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

Bilateral damage to the amygdala in a patient with Urbach-Wiethe disease abolishes which function most specifically?

  1. Procedural motor learning
  2. Conditioned fear learning and recognition of fearful facial expressions Correct answer.
  3. Declarative memory consolidation
  4. Spatial working memory

Explanation

The amygdala is essential for attaching emotional significance to stimuli, particularly for conditioned fear acquisition and for recognising fear in facial expressions. Bilateral amygdala lesions impair fear conditioning while leaving declarative memory and motor skill learning largely intact. This dissociation illustrates the separation of emotional and cognitive memory systems.

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

A patient with alcohol dependence develops acute confusion, ataxia and ophthalmoplegia. Which neurochemical deficit underlies this presentation?

  1. Vitamin C deficiency impairing collagen synthesis
  2. Vitamin B12 deficiency impairing myelin synthesis
  3. Thiamine deficiency impairing pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase Correct answer.
  4. Niacin deficiency impairing NAD synthesis

Explanation

Thiamine is a cofactor for pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase and transketolase. Deficiency in alcohol dependence impairs cerebral energy metabolism and causes Wernicke encephalopathy with confusion, ataxia and ophthalmoplegia. Untreated, it can progress to Korsakoff syndrome with persistent amnesia.

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

A 25-year-old man has a first episode of psychosis, and his father also has schizophrenia. Which genetic finding best supports the heritability of schizophrenia?

  1. A single Mendelian mutation explains most cases
  2. The disorder is equally common in all first-degree relatives regardless of degree of sharing
  3. Monozygotic twins show higher concordance than dizygotic twins Correct answer.
  4. Adopted children of affected parents have no increased risk

Explanation

Schizophrenia is polygenic with high heritability, and the higher concordance in monozygotic than dizygotic twins is classic evidence for genetic contribution. Adoption studies showing increased risk in biological relatives of affected individuals further support heritability while indicating environmental contributions. No single Mendelian mutation accounts for most cases.

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

A patient with treatment-resistant depression is started on phenelzine. Which dietary instruction is most important to prevent a hypertensive crisis?

  1. Avoid foods rich in potassium
  2. Avoid green leafy vegetables because of vitamin K
  3. Avoid all dairy products because of lactose
  4. Avoid aged cheese, cured meats and fermented products containing tyramine Correct answer.

Explanation

Irreversible MAOIs prevent gut and hepatic breakdown of tyramine, so tyramine-rich foods such as aged cheese, cured meats and fermented soy products can trigger a hypertensive crisis. Patients need a written list of foods to avoid. This is the best-established dietary precaution with these drugs.

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

Ketamine produces rapid antidepressant effects. Which mechanism is most supported as the basis of this action?

  1. Blockade of the serotonin transporter
  2. Irreversible inhibition of monoamine oxidase
  3. Direct agonism of 5-HT1A receptors
  4. Blockade of NMDA receptors on GABAergic interneurons leading to a glutamate surge and increased AMPA-mediated BDNF signalling Correct answer.

Explanation

Ketamine is an NMDA antagonist that preferentially blocks receptors on inhibitory interneurons, disinhibiting glutamate release and enhancing AMPA receptor signalling and BDNF-mediated synaptic plasticity. This rapid plasticity mechanism contrasts with the slower monoamine-based actions of conventional antidepressants. It explains the rapid onset of antidepressant effect.

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

A patient with bipolar disorder on lithium develops polyuria and polydipsia with dilute urine. Which renal mechanism explains lithium-induced nephrogenic diabetes insipidus?

  1. Reduced vasopressin-stimulated cAMP and aquaporin-2 expression in collecting duct cells Correct answer.
  2. Increased sodium reabsorption in the ascending loop of Henle
  3. Excessive ADH secretion from the posterior pituitary
  4. Increased aquaporin-2 insertion in the collecting duct

Explanation

Lithium enters collecting duct cells and interferes with vasopressin signalling, reducing cAMP generation and aquaporin-2 channel expression, so the kidney cannot concentrate urine. This causes nephrogenic diabetes insipidus with polyuria and polydipsia. Amiloride can reduce lithium entry and is sometimes used.

Question 21Psychopathology and psychiatric interviewing/mental state examination

A 34-year-old man is brought to the clinic. He speaks rapidly, jumps from topic to topic, and the interviewer cannot redirect him; the connections between successive ideas are understandable only when the interviewer infers the linking theme. Which formal thought disorder is best described?

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

Explanation

Flight of ideas is accelerated, pressured speech in which successive ideas are linked by understandable but loose associations, often with distractibility and rhyming or punning. The key feature is that the listener can still reconstruct the connecting theme, which distinguishes it from true incoherence.

Question 22Psychopathology and psychiatric interviewing/mental state examination

During the mental state examination, a patient states with full conviction that his neighbours have installed a device that is transmitting his thoughts to the government. He has no supporting evidence and cannot be persuaded otherwise. This belief is best classified as:

  1. An obsession
  2. An overvalued idea
  3. A hallucination
  4. A delusion Correct answer.

Explanation

A delusion is a fixed, false belief that is held with extraordinary conviction, is not shared by the patient's culture, and is not amenable to reason or contrary evidence. The persecutory content and the absence of any basis make this a delusion rather than an overvalued idea.

Question 23Psychopathology and psychiatric interviewing/mental state examination

A patient reports hearing two voices discussing him in the third person, which he experiences as coming from outside his head. Which term describes this phenomenon?

  1. Depersonalisation
  2. Pseudohallucination
  3. Illusion
  4. Auditory hallucination Correct answer.

Explanation

A hallucination is a perception experienced in the absence of an external stimulus, and third-person auditory voices are a classic example, particularly in schizophrenia. Because the experience is perceived as external and real, it is a true hallucination rather than a pseudohallucination.

Question 24Psychopathology and psychiatric interviewing/mental state examination

Which feature most reliably distinguishes a true hallucination from a vivid mental image or pseudohallucination?

  1. The patient's emotional reaction to the experience
  2. The experience being located in external space with the quality of real perception Correct answer.
  3. The content being frightening or persecutory
  4. The symptom occurring mainly at night

Explanation

True hallucinations are experienced as originating in objective, external space and carry the full sensory quality of real perception, as if the person were actually seeing or hearing it. Pseudohallucinations and vivid imagery are located in inner subjective space and lack that sense of external reality.

Question 25Psychopathology and psychiatric interviewing/mental state examination

A patient describes feeling that his thoughts are being removed from his head and that his own actions are being controlled by an outside force. These experiences are best described as:

  1. Obsessive-compulsive symptoms
  2. Negative symptoms
  3. Passivity phenomena Correct answer.
  4. Conversion symptoms

Explanation

Passivity phenomena (made phenomena) are experiences in which the patient feels that thoughts, feelings, impulses, or bodily actions are controlled or replaced by an external agency. Thought withdrawal combined with made actions is characteristic of this first-rank-type experience.

Question 26Psychopathology and psychiatric interviewing/mental state examination

In assessing a patient's insight, which description best reflects partial insight?

  1. Agreement that symptoms are due to an external persecutor
  2. Complete denial that any problem exists
  3. Full understanding of the illness with agreement to treatment
  4. Acceptance that he is unwell but attribution of symptoms to a physical cause Correct answer.

Explanation

Partial insight typically involves acknowledging that something is wrong while retaining an incorrect explanation, such as attributing psychiatric symptoms to a physical illness. Full insight requires recognising the nature of the illness and the need for appropriate treatment.

Question 27Psychopathology and psychiatric interviewing/mental state examination

A patient's speech is described as incoherent: words are strung together without grammatical connection and the listener cannot follow any meaning. This is most consistent with:

  1. Echolalia
  2. Clanging
  3. Derailment
  4. Word salad Correct answer.

Explanation

Word salad (incoherence) is speech in which words and phrases are juxtaposed without logical or grammatical links, so no coherent meaning can be extracted. It represents a severe disorder of the form of thought.

Question 28Psychopathology and psychiatric interviewing/mental state examination

During the interview a patient suddenly stops speaking mid-sentence, stares blankly for several seconds, and then resumes on a different topic, saying his mind had gone empty. This is best termed:

  1. Thought blocking Correct answer.
  2. Thought broadcasting
  3. Thought insertion
  4. Pressure of speech

Explanation

Thought blocking is an abrupt interruption in the flow of thought, often experienced as the mind going blank, after which speech resumes on an unrelated theme. It is classically associated with schizophrenia.

Question 29Psychopathology and psychiatric interviewing/mental state examination

Which mood description is most consistent with a manic episode?

  1. Perplexity with fearful apprehension
  2. Elevated, expansive mood with irritability and increased energy Correct answer.
  3. Blunted affect with emotional flatness
  4. Persistently low mood with diurnal variation

Explanation

Mania is characterised by an elevated, expansive, or irritable mood accompanied by increased energy and activity, often with grandiosity and reduced need for sleep. Elevated mood with irritability and heightened drive is the classic picture.

Question 30Psychopathology and psychiatric interviewing/mental state examination

A patient repeatedly uses the same phrase and returns to the same answer regardless of the question asked, continuing long after the topic has changed. This abnormality of speech is called:

  1. Neologism
  2. Palilalia
  3. Verbigeration
  4. Perseveration Correct answer.

Explanation

Perseveration is the inappropriate repetition of a previous response or theme despite a change in stimulus, and it usually signals an organic brain disorder. The repetition is of the prior answer rather than of a meaningless stereotyped phrase.

Question 31Psychopathology and psychiatric interviewing/mental state examination

A 28-year-old woman reports that her thoughts are being repeated aloud immediately after she thinks them, and that others can hear them. Which symptom is she describing?

  1. Gedankenlautwerden (thought echo) Correct answer.
  2. Depersonalisation
  3. Obsessional rumination
  4. Thought insertion

Explanation

Thought echo, or Gedankenlautwerden, is the experience of hearing one's own thoughts spoken aloud, often immediately after thinking them, and is a classic first-rank symptom described by Schneider. It differs from thought insertion because the thoughts are recognised as one's own.

Question 32Psychopathology and psychiatric interviewing/mental state examination

A patient claims that his thoughts leave his mind and become known to everyone around him without his speaking. This symptom is best termed:

  1. Delusion of reference
  2. Thought insertion
  3. Thought broadcasting Correct answer.
  4. Thought withdrawal

Explanation

Thought broadcasting is the belief that one's thoughts are transparent and accessible to others, often described as thoughts escaping or being read. It is a passivity-type phenomenon strongly associated with schizophrenia.

Question 33Psychopathology and psychiatric interviewing/mental state examination

On examination a patient's affect is described as inappropriate. Which observation best supports this description?

  1. The patient laughs while describing the death of his child Correct answer.
  2. The patient's mood varies with the topic being discussed
  3. The patient cries while describing the death of his child
  4. The patient shows reduced range of emotional expression throughout

Explanation

Inappropriate affect is emotional expression that is incongruous with the content of thought or speech, such as laughter while describing a bereavement. It is distinct from blunted or restricted affect, in which the range of expression is diminished.

Question 34Psychopathology and psychiatric interviewing/mental state examination

A patient insists that a stranger's casual remark on the street was a coded message intended specifically for him. This is best classified as:

  1. Delusion of control
  2. Erotomanic delusion
  3. Nihilistic delusion
  4. Delusion of reference Correct answer.

Explanation

A delusion of reference is the false belief that neutral events, remarks, or objects carry special personal significance directed at the patient. The belief that a stranger's remark is a coded personal message is the classic example.

Question 35Psychopathology and psychiatric interviewing/mental state examination

Which finding on mental state examination most strongly suggests a delirium rather than a functional psychosis?

  1. Persecutory delusions of being poisoned
  2. Third-person auditory hallucinations
  3. Fluctuating level of consciousness with impaired attention Correct answer.
  4. Grandiose beliefs about special powers

Explanation

Delirium is an acute, fluctuating disturbance of attention and awareness, often with disorientation and perceptual abnormalities. Fluctuating consciousness with impaired attention points to an organic cause, whereas hallucinations and delusions alone can occur in functional psychosis.

Question 36Psychopathology and psychiatric interviewing/mental state examination

A patient describes a sensation that his own body has changed shape and that his limbs feel unreal or detached from him. This disturbance is best described as:

  1. Autoscopy
  2. Cenesthopathy Correct answer.
  3. Depersonalisation
  4. Derealisation

Explanation

Cenesthopathy refers to abnormal, often bizarre bodily sensations in which the patient experiences his body or its parts as altered, distorted, or unreal. It is distinguished from depersonalisation, which concerns the self as a whole, and from derealisation, which concerns the external world.

Question 37Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

Under ICD-11, which category replaces the ICD-10 grouping of schizophrenia, schizotypal disorder, persistent delusional disorders, and acute and transient psychotic disorders?

  1. Schizophrenia and other primary psychotic disorders Correct answer.
  2. Organic, including symptomatic, mental disorders
  3. Disorders of adult personality and behaviour
  4. Neurotic, stress-related and somatoform disorders

Explanation

ICD-11 restructured the psychoses into a single block titled schizophrenia and other primary psychotic disorders, which gathers schizophrenia, schizoaffective disorder, schizotypal disorder, delusional disorder, and acute and transient psychotic disorder. Symptomatic psychotic states secondary to a medical condition or substance are placed in separate aetiological blocks rather than inside this grouping.

Question 38Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A 29-year-old presents with 2 weeks of elevated mood, decreased need for sleep, and grandiosity requiring hospital admission. For a DSM-5-TR diagnosis of bipolar I disorder, which additional criterion must be satisfied?

  1. A concurrent major depressive episode must be documented
  2. The episode has caused marked impairment in social or occupational functioning
  3. At least one lifetime manic episode has occurred, irrespective of depressive episodes Correct answer.
  4. Symptoms must have persisted for at least 4 weeks despite treatment

Explanation

Bipolar I disorder is defined by the occurrence of at least one manic episode; depressive episodes are common but not required, and a manic episode need not produce marked impairment because hospitalisation alone can satisfy severity. The duration criterion for mania is at least 1 week, or any duration if hospitalisation is required.

Question 39Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

Which epidemiological finding about schizophrenia is most consistently replicated across settings?

  1. Prevalence exceeds 5% in most urban populations
  2. Onset after age 60 accounts for the majority of cases
  3. Risk is unrelated to urban birth or migration status
  4. Incidence is roughly equal in men and women, but onset is earlier in men Correct answer.

Explanation

Incidence of schizophrenia is broadly similar between sexes, while men typically have an earlier onset, often in the early twenties versus the late twenties in women. Prevalence is generally estimated near 0.3–0.7%, and late-onset cases are a minority.

Question 40Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A patient describes hearing voices that comment on his actions, and his family report that he sometimes speaks to the voices. Which ICD-11 symptom domain does this best illustrate?

  1. Positive symptoms Correct answer.
  2. Negative symptoms
  3. Disorganised thinking
  4. Cognitive symptoms

Explanation

Hallucinations and commenting auditory hallucinations are positive symptoms, meaning experiences added to normal function. ICD-11 requires at least one core symptom from delusions, hallucinations, thought disorder, or experiences of influence/passivity for a schizophrenia diagnosis.

Question 41Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A 45-year-old Iraqi man attributes his palpitations and chest tightness to 'spiritual possession' and seeks help first from a traditional healer. Which principle should guide the psychiatric assessment?

  1. Defer assessment until the patient accepts a biomedical explanation
  2. Explore the explanatory model and its cultural meaning before deciding on management Correct answer.
  3. Immediately confront the belief as a delusion and start antipsychotic medication
  4. Record the belief as a fixed delusion of possession without further enquiry

Explanation

Cultural psychiatry requires eliciting the patient's explanatory model, idioms of distress, and help-seeking pathway, because these shape engagement and treatment negotiation. Such beliefs are not automatically delusional; they must be judged against the person's cultural reference group.

Question 42Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

Which statement best describes the relationship between ICD-11 and DSM-5-TR in psychiatric classification?

  1. ICD-11 is designed for global clinical and statistical use, while DSM-5-TR serves mainly North American clinical and research purposes Correct answer.
  2. Both systems are produced by the World Health Organization
  3. The two systems use identical diagnostic criteria for every disorder
  4. DSM-5-TR has replaced ICD-11 in all WHO member states

Explanation

ICD-11 is the WHO's international system used for clinical, epidemiological, and mortality reporting worldwide, whereas DSM-5-TR is published by the American Psychiatric Association and dominates North American practice and research. Their criteria overlap substantially but are not identical.

Question 43Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A 34-year-old woman reports low mood for 3 weeks with insomnia, poor concentration, and guilt, and also has a 6-month history of intermittent elevated mood lasting 2–3 days. Which diagnosis should be considered?

  1. Major depressive disorder, single episode
  2. Bipolar II disorder Correct answer.
  3. Cyclothymic disorder
  4. Persistent depressive disorder

Explanation

Bipolar II disorder requires at least one hypomanic episode of at least 4 days plus at least one major depressive episode. The 2–3 day elevations described fall short of the hypomania duration threshold, so careful longitudinal history and clarification of duration are needed before concluding.

Question 44Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

In ICD-11, which feature is central to the diagnosis of a personality disorder?

  1. A single episode of self-harm in the absence of personality disturbance
  2. A stable pattern of mood elevation lasting more than 2 years
  3. An enduring disturbance in self-functioning and interpersonal functioning with associated maladaptive traits Correct answer.
  4. Presence of at least one enduring hallucinatory experience

Explanation

ICD-11 reconceptualised personality disorders around the severity of disturbance in self and interpersonal functioning, with optional trait qualifiers such as negative affectivity or dissociality. The categorical DSM-style named disorders are not the ICD-11 organising principle.

Question 45Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

Which of the following is the best example of a culture-bound idiom of distress rather than a diagnostic category?

  1. Schizophrenia
  2. Susto, a Latin American illness attributed to fright with soul loss Correct answer.
  3. Panic disorder
  4. Generalised anxiety disorder

Explanation

Susto is a culturally patterned explanatory model and idiom of distress, not a discrete diagnostic entity in ICD or DSM. It illustrates how cultures shape the expression and interpretation of distress.

Question 46Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A researcher studies incidence of first-episode psychosis in Baghdad and notes a higher rate among migrants. Which explanation is most consistent with current epidemiological evidence?

  1. Migration itself is a direct cause of psychosis through genetic selection
  2. Migrant status is protective against psychosis
  3. Social adversity, discrimination, and minority status contribute to elevated risk in migrant groups Correct answer.
  4. The finding is entirely explained by diagnostic bias and has no social component

Explanation

Elevated psychosis risk in some migrant and minority groups is attributed to social factors such as discrimination, social defeat, and deprivation rather than to migration as a biological cause. Diagnostic bias may contribute but does not fully explain the consistent association.

Question 47Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

Which criterion distinguishes a brief psychotic disorder from schizophrenia in DSM-5-TR?

  1. Absence of any hallucination
  2. Presence of negative symptoms
  3. Presence of a major depressive episode
  4. Duration of disturbance of at least 1 day but less than 1 month with return to premorbid functioning Correct answer.

Explanation

Brief psychotic disorder lasts at least 1 day and less than 1 month, with eventual full return to premorbid functioning. Schizophrenia requires continuous signs persisting for at least 6 months.

Question 48Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A 60-year-old man develops a fixed belief that his neighbour is poisoning him, with no hallucinations, no mood disturbance, and preserved functioning apart from the belief. Which diagnosis fits best?

  1. Schizoaffective disorder
  2. Obsessive-compulsive disorder
  3. Schizophrenia
  4. Delusional disorder Correct answer.

Explanation

Delusional disorder is characterised by one or more delusions persisting for at least 1 month without prominent hallucinations, with functioning otherwise relatively preserved and mood episodes absent or brief. The content is often non-bizarre, such as persecution or poisoning.

Question 49Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

Which statement about the epidemiology of major depressive disorder is most accurate?

  1. Onset is most common after age 65
  2. Prevalence is higher in low-income than high-income countries for all age groups
  3. Women have roughly twice the prevalence of men in most community surveys Correct answer.
  4. Lifetime prevalence is approximately 1% worldwide

Explanation

Community surveys consistently show a female-to-male ratio of about 2:1 for major depression. Lifetime prevalence varies but is commonly estimated around 10–17% in many high-income settings, and onset peaks in young to middle adulthood.

Question 50Classification and diagnosis (ICD/DSM), epidemiology and cultural psychiatry

A clinician must decide whether a patient's distress reflects a normal grief reaction or a depressive episode. Which approach reflects current classification principles?

  1. Assess duration, severity, and functional impairment, recognising that grief may resemble depression without automatically being one Correct answer.
  2. Exclude any diagnosis for 12 months after every bereavement
  3. Rely solely on the presence of tearfulness to distinguish the two
  4. Diagnose major depression whenever sadness follows bereavement

Explanation

Both ICD-11 and DSM-5-TR require attention to duration, severity, and impairment rather than assuming that bereavement protects against or automatically produces depression. DSM-5-TR removed the bereavement exclusion but retained clinical judgement about whether symptoms exceed expected grief.