Sample Exam Questions

What are the main clinical uses of atypical antipsychotics and provide some examples?

Primarily used to treat psychotic disorders (e.g., schizophrenia) and target positive symptoms (hallucinations and delusions) e.g., risperidone, Clozapine, Olanzapine

Name two key differences between typical antipsychotics and atypical antipsychotics?

1. Typical antipsychotics are associated with side effects such as tremors whereas atypical antipsychotics are associated with metabolic side effects such as weight gain.

2. Atypical antipsychotics are primarily dopamine antagonists whereas typical antipsychotics are both dopamine and serotoning antagonists.

Describe the similarities and differences between a manic and a hypomanic episode, including differences in symptom severity, duration, and functional impact.

Similarities:
- Both involve elevated/expansive or irritable mood and increased energy/activity
- Both include symptoms such as reduced need for sleep, increased confidence, sociability

Differences:

Differences in Duration:
- Mania must last for at least 1 week (or any duration if hospitalisation required)
- Hypomania only requires four or more 4 consecutive days

Differences in psychotic features:

• Mania may include psychotic symptoms

• Hypomania does not include psychosis

Differences in Functional impact:

• Mania results in significant impairment in functioning (work, relationships), may
  require hospitalisation

• Hypomania does not need to result in marked impairment, may even show increased productivity

Discuss the main clinical uses of mood stabilisers and provide
an example

Mood stabilisers are used to

• stabilise mood fluctuations in bipolar disorder

• to reduce frequency and severity of manic/hypomanic episodes

• for relapse prevention and long-term mood regulation
  Example: Lithium (or valproate)

Discuss the pharmacology and the main clinical uses of the atypical antipsychotics. (5 marks)

• Used as first line of treatment of psychotic disorders like schizophrenia

• Act as dopamine and serotonin antagonist

• Lower risk for EPS side effects when compared to typical psychotics

• Can also be used for bipolar disorder to treat acute mania

• They are also used for acute agitation, behavioural disturbance, and irritability in conditions such as autism spectrum disorder.

• Example includes risperidone and olanzapine

Discuss the pharmacology and the main clinical uses of the antidepressant medications (5 marks)

• SSRIs (e.g., fluoxetine, sertraline) selectively inhibit the serotonin transporter (SERT), increasing serotonin availability in the synapse.

• SNRIs (e.g., venlafaxine, duloxetine) inhibit both serotonin and noradrenaline reuptake transporters, increasing levels of both neurotransmitters.

• Antidepressants are mainly used for major depressive disorder (MDD) as first-line pharmacological treatment (especially SSRIs).

• They are used for anxiety disorders, including generalised anxiety disorder, panic disorder, and social anxiety disorder.

• They are used in obsessive-compulsive disorder (OCD) (particularly SSRIs at higher doses).

Outline the role of hypervigilance and avoidance in maintaining anxiety. (5 marks)

• Hypervigilance involves heightened and sustained attention to potential threat cues, where the individual constantly scans their environment and bodily sensations for signs of danger. This increases the detection of ambiguous stimuli as threatening, which biases information processing toward threat interpretation.

• This continual threat monitoring amplifies anxiety symptoms, as normal bodily sensations (e.g., increased heart rate) are misinterpreted as evidence of danger, reinforcing fear.

• Avoidance refers to behavioural or cognitive efforts to escape or prevent exposure to feared situations, thoughts, or sensations. While avoidance reduces anxiety in the short term, it prevents the person from learning that the feared outcome is unlikely.

• Because the individual does not remain in the situation long enough for habituation or extinction learning to occur, the fear response is not disconfirmed.

• Together, hypervigilance and avoidance create a self-perpetuating cycle, where threat perception is strengthened and anxiety is maintained over time.

Briefly discuss the function of the autonomic nervous system, noting the different functions of the sympathetic versus parasympathetic nervous system. (5 marks)

• The autonomic nervous system regulates involuntary physiological processes, including heart rate, digestion, respiration, and glandular activity, helping maintain homeostasis.

• Divided into the sympathetic and parasympathetic nervous systems, which typically have opposing effects.

• The sympathetic nervous system (SNS) is responsible for the “fight or flight” response, preparing the body for action by increasing heart rate, blood pressure, and respiration, and redirecting blood flow to skeletal muscles. It also inhibits non-essential functions during threat, such as digestion and salivation, and promotes energy mobilisation (e.g., glucose release).

• The parasympathetic nervous system (PNS) is responsible for “rest and digest” functions, promoting recovery by decreasing heart rate and blood pressure and stimulating digestion and energy conservation.

Similarities between anorexia nervousa and bulimia nervousa

• Both involve a disturbance in body image

• Both include an intense fear of gaining weight

• Both are associated with maladaptive eating-related behaviours and psychopathology

• Both commonly onset in adolescence or young adulthood

• Both often co-occur with anxiety and depressive disorders

Differences between anorexia nervosa and bulimia nervosa

Anorexia Nervosa:

• Significantly low body weight (below expected for age/height/development)

• Restriction of energy intake leading to weight loss is central

• May include binge–purge subtype, but restriction is core feature

• Disturbance in body perception or denial of seriousness of low weight is required

• Medical consequences often involve malnutrition and endocrine dysfunction

Bulimia Nervosa:

• Typically normal or above-normal body weight

• Recurrent binge eating episodes with loss of control

• Followed by compensatory behaviours (vomiting, laxatives, fasting, excessive exercise)

• Binge–purge cycle occurs at least once per week for 3 months

• Body image disturbance is present but no requirement for low weight or weight denial

Outline a CBT model of the development of Anorexia Nervosa or Bulimia Nervosa (5 marks)

• Step 1: Core belief develops

  • Individual develops an overvaluation of weight, shape, and control over eating as central to self-worth.

• Step 2: Dysfunctional assumptions form

  • Rigid beliefs emerge (e.g., “If I am not thin, I am worthless” or “If I eat normally, I will lose control/gain weight”).

• Step 3: Triggering thoughts and anxiety

  • Body-related or food-related cues activate anxiety and negative automatic thoughts about weight gain or body image.

• Step 4: Maladaptive behaviours occur

  • In anorexia: dietary restriction, excessive exercise

  • In bulimia: binge eating followed by compensatory behaviours (vomiting, laxatives, fasting)

• Step 5: Maintenance via negative reinforcement

  • Behaviours temporarily reduce anxiety about weight/shape, reinforcing them and preventing corrective learning, which maintains the disorder cycle.

Theoretical models of eating disorders

• The cognitive–behavioural model (CBT) proposes that eating disorders develop due to an overvaluation of weight, shape, and control, leading to dysfunctional beliefs and maladaptive behaviours such as restriction, bingeing, and purging, which are maintained through negative reinforcement.

• The biopsychosocial model suggests eating disorders arise from an interaction of biological factors (e.g., genetics, neurotransmitters), psychological factors (e.g., perfectionism, low self-esteem), and social factors (e.g., cultural pressure for thinness, media influence).

• The psychodynamic model proposes eating disorders reflect unconscious conflicts, often related to control, autonomy, or family dynamics, where disordered eating becomes a way of expressing or managing emotional distress.

• The sociocultural model emphasises the role of societal and cultural ideals of thinness, where internalisation of media-driven body ideals leads to body dissatisfaction and dieting behaviours that can develop into disordered eating.

Describe the main clinical features you would use to identify Alcohol Use Disorder. (5 marks)

• A strong craving or compulsion to drink alcohol, often experienced as difficulty controlling urges to drink.

• Loss of control over drinking, such as difficulty limiting the amount consumed or unsuccessful efforts to cut down.

• Tolerance, meaning increased amounts of alcohol are needed to achieve the same effect.

• Withdrawal symptoms when alcohol use is reduced or stopped (e.g., tremor, sweating, anxiety), or drinking to relieve withdrawal.

• Continued alcohol use despite harmful consequences, such as physical health problems, psychological distress, or social/occupational impairment.

Describe the key features and potential problems associated with alcohol withdrawal. (5 marks)

• Autonomic hyperactivity, such as sweating, rapid heart rate (tachycardia), raised blood pressure, and tremors (“shakes”).

• Psychological symptoms, including anxiety, irritability, restlessness, and insomnia.

• Gastrointestinal symptoms, such as nausea, vomiting, and loss of appetite.

• Perceptual disturbances, including hallucinations (visual, tactile, or auditory) in more severe withdrawal.

• Severe complications, including seizures and delirium tremens (DTs), which can involve confusion, agitation, fever, and can be life-threatening if untreated.

Similarities and differences between schizophrenia and schizoaffective disorder?

Similarities

• Both have psycotic symptoms e.g., hallucinations, delusions and disorganised thinking

Differences

• Mood symptoms required for schizoaffective disorder (mania, depression or both) but not for schizophrenia

• Schizophrenia duration must be at least 6 months whereas psychotic symptoms only need to be present for at least 2 weeks for schizoaffective disorder

Describe the similarities and differences between PTSD and Acute Stress Disorder, including how duration of symptoms is used to differentiate them. (3 marks)

• Similarities: Both PTSD and Acute Stress Disorder involve exposure to a traumatic event and share core symptom clusters, including intrusion (flashbacks/nightmares), avoidance, negative mood/cognition changes, and arousal symptoms.

• Differences in duration: The key distinction is time since trauma and symptom duration. Acute Stress Disorder occurs from 3 days to 1 month after the trauma, whereas PTSD is diagnosed when symptoms persist for more than 1 month following the traumatic event.

• Course and persistence: ASD is often considered an early, short-term stress response, while PTSD reflects a more persistent and enduring disorder, with symptoms continuing long-term and associated with greater functional impairment.