1. MRCPsych Exam Practice: Classification (all are past MCQs used in the exams) Dr Gareth Thomas (Consultant Psychiatrist for Older People) September 2014

2. 1.Which of the following can be a discriminating symptom when making a clinical diagnosis? A.Poor concentration B.Psychomotor retardation C.Thought withdrawal D.Anhedonia E.Panic attacks

3. 1.Which of the following can be a discriminating symptom when making a clinical diagnosis? A.Poor concentration B.Psychomotor retardation C.Thought withdrawal D.Anhedonia E.Panic attacks

4. Explanation Thought withdrawal is the delusion that thoughts have been taken out of the patient's mind Other symptoms may be associated with other conditions, but thought withdrawal is associated with schizophrenia only This is one of Schneider's first rank symptoms for schizophrenia (read) These form the basis for the ICD10 criteria for Schizophrenia (read) This is also a ‘positive symptom’ (read)

5. 2A 35 year old man has low mood, poor energy levels, anhedonia with associated loss of appetite, poor sleep and reduced libido. What is the severity of his depression? A.Mild B.Moderate C.Severe D.Dysthymia E.No depression

6. 2A 35 year old man has low mood, poor energy levels, anhedonia with associated loss of appetite, poor sleep and reduced libido. What is the severity of his depression? A.Mild B.Moderate C.Severe D.Dysthymia E.No depression

7. Explanation Duration of at least 2 weeks Depressed mood, loss of interest and enjoyment and reduced energy are the core symptoms Other symptoms – Reduced concentration and attention – Reduced self-esteem and self-confidence – Ideas of guilt and unworthiness – Bleak and pessimistic views of the future – Ideas or acts of self-harm or suicide – Disturbed sleep – Diminished appetite Severity – Mild 2-3 symptoms – Moderate > 4 – Severe > 6

8. 3.Which of the following subtypes of schizophrenia is classified in DSM, not ICD? A.Hebephrenic schizophrenia B.Paranoid schizophrenia C.Undifferentiated schizophrenia D.Disorganised schizophrenia E.Catatonic schizophrenia

9. 3.Which of the following subtypes of schizophrenia is classified in DSM, not ICD? A.Hebephrenic schizophrenia B.Paranoid schizophrenia C.Undifferentiated schizophrenia D.Disorganised schizophrenia E.Catatonic schizophrenia

10. Explanation

11. 4.The following is true regarding persistent delusional disorder according to ICD-10? A.Delusions of more than 3 months duration B.Delusions incongruent to mood C.No hallucinations D.Single theme of delusions only E.Identifiable preceding stressor

12. 4.The following is true regarding persistent delusional disorder according to ICD-10? A.Delusions of more than 3 months duration B.Delusions incongruent to mood C.No hallucinations D.Single theme of delusions only E.Identifiable preceding stressor

13. Explanation Persistent delusional disorder is characterised by a persistent delusion(s) Transient auditory and visual hallucinations may occur but not as clear as in Schizophrenia No blunting of affect There is no necessity to have an identifiable stressor DSM-IV specifies that symptoms should have been present for at least 1 month ICD-10 specifies at least 3 months

14. 5.A 40 year old woman had an episode of depression four years ago. For the last four weeks, she is low in mood, socially isolative and fears leaving the house in case she has a panic attack. She is tearful and not sleeping well. The most likely diagnosis is: A.Panic disorder B.Agoraphobia C.Depression D.Anxiety E.Dysthymia

15. 5.A 40 year old woman had an episode of depression four years ago. For the last four weeks, she is low in mood, socially isolative and fears leaving the house in case she has a panic attack. She is tearful and not sleeping well. The most likely diagnosis is: A.Panic disorder B.Agoraphobia C.Depression D.Anxiety E.Dysthymia

16. Explanation In the exams, Depression almost always the answer if given the choice between Depression and Anxiety

17. Any questions? Thanks.