True: Klein’s (1993) suffocation false alarm theory hypothesizes that panic attacks represent a false triggering of a suffocation alarm. Many spontaneous panic attacks are due to a ‘suffocation monitor’ in the brain erroneously signalling a lack of useful air, and triggering an evolved ‘suffocation alarm system’. He proposed that carbon dioxide acts as a panic stimulus because rising arterial carbon dioxide suggests that suffocation may be imminent (Klein 1993; Sadock & Sadock 2005, p. 1732).

True: The prevalence of mitral valve prolapse is 5% in the general population and as high as 37% in anxiety disorder (Gelder et al 2000, p. 59).

True: In DSM-IV, ‘Impulse control disorders not elsewhere classified’ includes intermittent explosive disorder, kleptomania, pathological gambling, pyromania, trichotillomania and impulse control disorders not otherwise specified. The latter includes compulsive buying or oniomania, delicate self-cutting, compulsive skin picking, severe nail biting, internet compulsion, mobile phone compulsion and compulsive sexual behavior (Sadock & Sadock 2002, p. 792).

False: There are two broad groups of patients with factitious disorders: the less common group present repeatedly to hospital emergency departments with symptoms suggesting medical or surgical emergencies. In the more common group, signs of disease are fabricated in a subtle and deceitful manner. They may produce superficial ulcerating wounds or they may repeatedly bleed themselves to induce the clinical and laboratory picture of iron-deficiency anaemia (Murray et al 1997, p. 549).

False: Mechanic (1962) defined ‘illness behaviour’ as the ways in which given symptoms may be differentially perceived, evaluated and acted (or not acted) upon by different kinds of persons. This may include consulting doctors, taking medicines, seeking help from relatives and friends and giving up inappropriate activities.

Abnormal illness behaviour (Pilowsky 1969) or dysnosognosia is persistently pathological modes of experiencing, evaluating and responding to one’s own health status despite lucid and accurate appraisal and management options provided by health professionals (Gelder et al 2006, p. 165; Johnstone et al 2004, p. 687; Murray et al 1997, pp. 51, 483; Stein & Wilkinson 1998, p. 719).

False: Health professionals can detect subjects simulating illness effectively if they are forewarned that simulation is a possibility. If not forewarned, they wrongly accept symptoms at face value. David Rosenhan’s study of malingerers faking psychosis on an inpatient psychiatric ward confirms the inability of psychiatrists to differentiate real from feigned mental illness, at least in certain contexts (Gelder et al 2000, p. 1130; Sadock & Sadock 2005, p. 2252).

False: PET studies in OCD show abnormally increased resting blood flow and glucose metabolism in the orbital cortex and caudate nucleus. On symptom provocation with exposure to relevant stimuli, the flow increases further in the prefrontal cortex and basal ganglia: prefrontal, orbital, anterior cingulate, lateral frontal, anterior temporal, parietal and insular cortices, caudate, putamen and thalamus (Gelder et al 2000, p. 825; Gelder et al 2006, p. 198; Sadock & Sadock 2005, p. 1755).

False: In general, the type of symptoms or pre-treatment severity has no prognostic value in OCD.

However, poor prognosis has been associated with early onset and associated personality disorders, especially schizotypal personality disorder. Overvalued or fixed obsessive ideation, hoarding behaviour and avoidance behaviour have been associated with poor response to behavioural treatments. Somatic obsessions and poor insight are also associated with poor prognosis.

Indicators of better prognosis include a precipitating factor, good social and occupational adjustment, episodic course and a positive family history (Gelder et al 2000, p. 825; Gelder et al 2006, p. 199).

True: Cognitive restructuring and reconceptualization of the individual’s experience of pain are used in pain management. They may increase self-efficacy as well as alter the patient’s appraisal of their ability to manage pain (Sadock & Sadock 2005, p. 2192).

False: In panic disorder the optimum duration of treatment with SSRIs is unknown but at least 8–18 months is recommended. The recurrence rate on stopping SSRIs is 30–90% (Sadock & Sadock 2002, p. 608; Taylor et al 2005, p. 186).

True: In a randomized controlled trial, compared to treatment as usual, psychoanalytically informed day hospital significantly reduced self-harm behaviour, hospitalization and psychiatric symptoms and improved self-reported mood (Gelder et al 2006, p. 149).

False: There have been reports of improvement in dissocial personality disorder with supportive psychotherapy, problem-solving counselling, Beckian cognitive therapy adapted for personality disorders, individual dynamic psychotherapy in which individuals are confronted repeatedly and directly with evidence of their abnormal behaviour and small-group therapy with groups comprising entirely of patients with dissocial personality disorders. The Henderson Hospital runs a therapeutic community for patients with antisocial and other personality disorders. Follow-up studies have shown improvement in general social functioning, employment and reconviction rates (Bateman & Tyrer 2004; Gelder et al 2006, p. 145; Johnstone et al 2004, p. 517; Sadock & Sadock 2005, p. 2493).

False: REBT was developed by Albert Ellis in 1955 in the USA. He emphasized the importance of thoughts and philosophies in creating and maintaining psychological disturbance. REBT emphasizes the importance of the interaction between cognitive, emotive and behavioural factors in human functioning as well as in dysfunction. There is no evidence for REBT in the treatment of emotionally unstable personality disorder (Bateman & Tyrer 2004).

True: There are two theories that explain this phenomenon. Lykken’s punishment/low-fear theory focuses on sensation-seeking and insensitivity to punishment. Blair’s violence inhibition mechanism deficit hypothesis focuses on the specific failure of basic emotions. These include failure of fear to cause autonomic arousal and the inhibition of ongoing behaviour in individuals with psychopathic personality (Dolan 2004).

False: Habituation is a form of counter-conditioning whereby the successive presentation of a stimulus leads to a decrease in the intensity of the response which it elicits. Instinctive and acquired fear responses can be extinguished by habituation in animals and in humans. Systematic desensitization is an example of habituation. The converse of habituation is sensitization where responses are increased. Once sensitized with an electric shock, the previously sub-threshold stimulus causes the animal to withdraw. It is sensitization which may increase phobic avoidance (Munafo 2002, p. 10; Sadock & Sadock 2002, p. 147).

True: The famous ‘cliff experiment’ by Gibson & Walk in 1960 demonstrated that babies can perceive depth and the danger associated with heights within the first year of life (Gross 2001, p. 237).

True: Derealization and depersonalization are features of panic attacks (in panic disorder with agoraphobia) and ‘panic-like symptoms’ (in agoraphobia without history of panic disorder) (DSM-IV 1994, pp. 395, 403; Sims 2004, p. 237).

False: Animal phobias in children occur equally in both sexes. Boys lose their animal phobias around puberty. A few girls maintain theirs. Women comprise 95% of the adult sufferers of animal phobia.

True: DSM-IV criterion C (3) is ‘inability to recall an important aspect of the trauma’.

True: Yohimbine is an α₂-adrenergic receptor blocker. It provokes panic attacks in patients with a history of panic attacks. It can worsen the core symptoms including startle responses, intrusive thoughts and emotional numbing in PTSD patients. It can provoke flashbacks and panic attacks in a subgroup of PTSD patients (Gelder et al 2000, p. 764; Sadock & Sadock 2005, p. 2999).

True: Sense of ‘numbness’ and emotional blunting, detachment from others, unresponsiveness to surroundings and anhedonia are typical symptoms of PTSD (Gelder et al 2000, p. 760).

False: Dramatic acute bursts of fear, panic or aggression triggered by reminders are rare symptoms of PTSD. They are neither necessary for a diagnosis, or typical nor common (Gelder et al 2000, p. 759).

True: Aphthous ulcers or canker sores are ulcers on the mucous membranes of the mouth or genitals. The commonest form is recurrent aphthous stomatitis. Aphthous ulcers may be precipitated by emotional stress, lack of sleep or deficiency of vitamins.

False: Low control in the work environment is associated with an increased risk of coronary heart disease. This association could not be explained by employment grade, negative affectivity, or classic coronary risk factors. Job demands and social support at work were not related to the risk of coronary heart disease. Giving employees more variety in tasks and a stronger say in decisions about work may decrease the risk of coronary heart disease (Bosma et al 1997).

True: Kivimaki et al (2003) found that male and female employees taking a medically certified sick leave (>7 days) on average more than once in 2 years had mortality rates 2 to 5 times greater than their colleagues with no such absence. However, compared with no absence, taking a few brief absences decreases rather than increases the risk of mortality. This U-shaped association was statistically significant in men. Short-term absences may represent healthy coping behaviours or may be otherwise affected by factors causing variation in the threshold of taking sick leave.