1. A 23-year-old woman complains that her mother is selfish, stupid and cunning. At the same time, she praises another relative whom she describes as kind, wise and helpful. Which defence mechanism is suggested by this behaviour?
A. Conversion
B. Idealisation
C. Symbolisation
D. Splitting
E.Projection
2. A 9-year-old boy constantly disobeys his parents and teachers. He gets along well with his peers and completes projects that he likes. His developmental milestones are normal and he has no history of fighting, theft or destruction of property. Mental status examination reveals an assertive child who tells the examiner that he does not wish to discuss his problems. What is the most likely diagnosis?
A. Oppositional defiant disorder
B. Mental retardation
C. Conduct disorder
D. Childhood disintegrative disorder
E. Attention-deficit hyperactivity disorder
3. A teenage girl complains that her mother interferes in every aspect of her life and tries to control her. The girl no longer speaks to her parents or eats meals with them. The mother has increased her efforts to maintain control. What condition could arise from this situation?
A. Anorexia nervosa
B. Dissociative identity disorder
C. Narcissistic personality disorder
D. Schizophrenia
E. Separation anxiety disorder
4. after an automobile accident that kills her child but leaves her with only minor injuries, a mother appears very calm and says that she has no emotion. What mechanism is she using?
A. Derealisation
B. Isolation
C. Depersonalisation
D. Disorientation
E. Intellectualisation
5. CT scan image that shows enlargement of the ventricles due to atrophy of the head of the Caudate Nucleus is usually found in:
A. Lewy body dementia.
B. Alzheimer’s disease.
C. Pick’s disease.
D. Huntington’s disease.
E. Parkinson’s disease.
6. Which of the following is not one of the basic elements of the Insanity Defence?
A. Finding of incompetence to stand trial.
B. Presence of a defect of reason.
C. Presence of a mental disorder.
D. Incapacity to refrain from the act.
E. Lack of knowledge of the nature of the act.
1 comment:
1.D
Splitting is described as the psychological separation of all good qualities into one individual and all bad qualities into another. Children and persons with borderline personality disorder often manifest evidence of splitting. Conversion refers to the transformation of psychological stressors into physical complaints. Idealisation refers to the exaggeration of an individual's qualities by an admirer. Projection refers to the attribution of one's feelings or beliefs to another. Symbolisation refers to the selection of a particular object or event to represent other meanings.
2.A
Oppositional defiant disorder involves problems in relating to authority figures. Such children get along well with their peers and have no other problems of conduct or development. Mental retardation is associated with delayed developmental milestones and other evidence of impaired intellectual abilities. Conduct disorder is characterised by violation of age-appropriate social norms, fighting, runaway behaviour, theft and destruction of property. Childhood disintegrative disorder involves the development of severe disturbances in social, communicative and cognitive functions followed by a period of normal development. Attention-deficit hyperactivity disorder is characterised by inattention, impulsivity and hyperactivity. Individuals with this disorder would be unlikely to complete projects even if they were interested. Conduct disorder is a sequel to oppositional defiant disorder.
3.A
Family dynamics are strongly implicated in the development of anorexia nervosa. Food restriction and weight loss are postulated as attempts to regain some control and avoid sexual issues. Dissociative identity disorder is associated with childhood sexual abuse. Narcissistic personality and schizophrenia are not associated with family dynamics. There is no situation here that could cause separation anxiety disorder.
4.B
Isolation describes the separation of a thought from its attached emotional tone, thereby making it tolerable. This defence mechanism is often used during highly stressful events. Depersonalisation and Derealisation are other defences that involve dissociation of mental functions, but both are more often accompanied by anxiety. Disorientation and intellectualisation are not accompanied by unnatural calmness.
5.D
Huntington’s disease is an autosomal dominant neurodegenerative disorder characterised by midlife onset, a relentlessly progressive course and a combination of motor, psychiatrics and cognitive symptoms. The disease is caused by a CAG repeat expansion mutation in the Huntington gene on chromosome 4. Gross pathology of Huntington’s disease often shows enlarged lateral ventricles, atrophy of the caudate and putamen, and atrophy of the cerebral cortex due to neuronal loss in these areas. Huntington’s disease remains an important example of subcortical dementia and the prominence of the psychiatric consequences of neurodegenerative disorders. In Alzheimer’s disease, there is cerebral atrophy mainly in the frontal, temporal and parietal regions. As a consequence there is ex vacuo ventricular dilatation. The cerebral atrophy of Pick’s disease is lobar and typically involves the frontal and temporal lobes. The atrophy is so striking that it is “knife-like” in appearance. This atrophy may be asymmetrical. Microscopically, there is marked loss of cortical neurons with gliosis. Pick’s bodies, cytoplasmic inclusions that are highlighted by silver stain, are seen in the cortex. In Parkinson’s disease, Lewy bodies are found in the substantia nigra of the midbrain, coupled with the loss of pigmented neurons. In persons with the dementia of Diffuse Lewy Body disease there are Lewy bodies in the neocortex. Some persons have the Lewy bodies in both locations. The basal ganglia and diencephalons may also be involved in some cases.
6.A
No precise generally accepted definition of legal insanity exists. Tests of insanity have always been controversial and have undergone much modification and refinement over the years. The insanity defence standard has four basic elements:
1.Presence of a mental disorder.
2.Presence of a defect of reason.
3.A lack of knowledge of the nature or wrongfulness of the act.
4.Incapacity to refrain from the act.
The insanity defence is one of the most controversial issues in American jurisprudence. The presence of a mental disorder has remained the consistent core of the insanity defence. The other elements have varied in importance over time. The finding of incompetence to stand trial is unrelated to this defence. Defendants with mental impairments ho are found competent to stand trial may still seek acquittal on the claim of insanity, alleging that they were not criminally responsible for their actions at the time the offence was committed. The term insanity is a legal construct, not a psychiatric diagnosis.
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