False: Cardiac neurosis, Da Costa’s syndrome or neurocirculatory asthenia is a ‘somatoform autonomic dysfunction’ (F45.3) involving the heart and cardiovascular system. The diagnostic features of F45.3 include symptoms of autonomic arousal, subjective symptoms referred to a specific organ or system, preoccupation with and distress about the possibility of a serious disorder and no evidence of a significant disturbance of structure or function of the stated system or organ.

Orthopnoea is discomfort in breathing that is relieved by sitting up or standing. It is not a feature of cardiac neurosis but a sign of cardiac failure (ICD-10 1992).

True: Panic disorder patients are less sensitive than controls to the effects of diazepam. This may suggest a decreased functional sensitivity of the GABA–benzodiazepine supramolecular complex (Sadock & Sadock 2005, p. 1744).

True: The symptoms of normal bereavement may meet the criteria for major depression, including weight loss. However, normal grief is not associated with morbid feelings of guilt and worthlessness, suicidal thoughts, psychomotor retardation or severe functional impairment (DSM-IV 1994).

True: CBT, interpersonal therapy and imipramine have been found to be equally effective and superior to placebo in moderate depression. Moreover, 1 year after treatment discontinuation, the relapse rate in CBT patients was one-half that of the antidepressant drug group, who were not on maintenance treatment (Sadock & Sadock 2005, p. 2609).

False: Sick role (Parsons 1951) involves:

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 (Gelder et al 2006, p. 165; Murray et al 1997, p. 51; Stein & Wilkinson 1998, p. 719).

False: Compared to the general population, independent life events are more likely to occur prior to episodes of both schizophrenia and depression. In schizophrenia, independent life events are more likely to occur prior to relapse rather than prior to first onset. Life events are more likely prior to both the first episode and relapses of depression than those of schizophrenia.

Adverse life events, particularly loss events, increase the risk of an episode of major depression. The increased vulnerability to an episode appears to last for 2 to 3 months following such an event. Some studies show that in the 6–12 months prior to the onset of depression, compared with normal controls, patients have a 3 to 5-fold greater chance of having suffered at least one life event with major negative long-term implications (Puri & Hall 2004, p. 141; Gelder et al 2000, pp. 603, 699).

False: OCD spectrum disorders have been described on a dimension of compulsivity and impulsivity. Compulsivity reflects harm-avoidance while impulsivity reflects risk-seeking. Thus OCD falls at the compulsive end. Tourette syndrome, trichotillomania and anankastic personality disorder have both compulsive and impulsive features. Kleptomania, pathological gambling, pyromania and uncontrolled buying fall at the impulsive end. Rarely, there are some patients with kleptomania who show compulsive features, e.g. they have to steal exactly three items on each occasion, while others hoard stolen items. Shoplifters, however, do not have true compulsive rituals. They have an impulse to steal as opposed to a compulsion (Bluglass & Bowden 1990, p. 793).

False: About two-thirds of patients with moderately severe obsessional rituals improve substantially with exposure and response prevention. When rituals improve with CBT, the accompanying ruminations usually improve as well. CBT is much less effective for obsessional ruminations without rituals (Gelder et al 2006, p. 200).

False: There is no evidence of a specific effect (Gelder et al 2006, p. 200).

False: There are three types of panic attacks with respect to the presence or absence of triggers: unexpected, situationally bound and situationally triggered. Unexpected or uncued panic attacks occur out of the blue. Recurrent unexpected panic attacks are essential for a diagnosis of panic disorder (DSM-IV 1994, p. 395).

True: About a third of people with persistent antisocial behaviour in early adult life improve later, as indicated by the number of arrests and contacts with social agencies. However, they still have problems in relationships, as indicated by hostility to partners and neighbours. They also have an increased suicide rate (Gelder et al 2006, p. 144).

False: Sublimation is a mature defence mechanism. It involves satisfying an unacceptable desire indirectly in a socially acceptable manner. Patients with personality disorders use immature and primitive defence mechanisms. Patients with borderline personality disorder often use defence mechanisms such as splitting and projective identification (Gelder et al 2000, p. 341; Johnstone et al 2004, p. 313; Sadock & Sadock 2005, p. 723).

True: Psychoanalytically oriented therapies, especially mentalization-based treatment, have been shown to be efficacious and cost effective in borderline personality disorder (Bateman & Tyrer 2004).

True: DBT was initially devised for the treatment of patients who repeatedly harm themselves. Later it was developed as a treatment for borderline personality disorder. DBT is based on CBT, dialectical influences and Zen principles. Clinical trials have shown DBT to be of some benefit in treating borderline personality disorder (Bateman & Tyrer 2004; Gelder et al 2006, p. 149).

True: The most common anxiety disorder is specific phobia, followed by social phobia, generalized anxiety disorder and other anxiety disorder subtypes. An early indicator of the vulnerability to develop anxiety disorders is behavioural inhibition, i.e. increased physiological reactivity or behavioural withdrawal in the face of novel or challenging situations. Another indicator is anxiety sensitivity, i.e. the belief that anxiety sensations are indicative of harmful physiological, psychological or social consequence (Gelder et al 2000, p. 811; Sadock & Sadock 2005, p. 1726).

True: In negative reinforcement, a response that leads to the removal of an aversive event is increased. Any behaviour that enables a person or animal to avoid or escape a punishing consequence is strengthened. In phobia the subject tries to avoid the feared object or situation and this is rewarded by a reduction in anxiety. This becomes a learned behaviour and negatively reinforces the avoidant behaviour (Sadock & Sadock 2002, p. 146).

False: Anxiety about being in places or situations from which escape may be difficult or help may not be available in case of having a panic attack is the central feature of agoraphobia. These circumstances may include being outside home alone, being in crowds or public places or travelling alone (DSM-IV 1994; ICD-10 1992).

True: Aaron Beck suggested that in anxiety states individuals systematically overestimate the danger inherent in a given situation. David Clark elaborated this cognitive concept. He proposed that the external and internal stimuli are perceived as threats and result in a state of apprehension. The wide range of bodily sensation that normally accompanies apprehension is interpreted in a catastrophic fashion and a further increase in apprehension occurs. Further apprehension produces further increase in bodily sensation, resulting in a vicious circle which culminates in a panic attack.

False: Exposure in vivo with anxiety management produces better long-term results than exposure in imagination or exposure alone. Partner-assisted and therapist-assisted exposure improves the outcome (Gelder et al 2000, p. 818).

False: The hypothalamic-pituitary-adrenal axis is dysregulated in PTSD. Even though stress usually causes an increase in cortisol levels, patients with PTSD have low circulating cortisol levels. Moreover, they show enhanced response to the dexamethasone suppression test, in contrast to depression. One hypothesis is that an increase in glucocorticoid receptors in the hypothalamus results in supersuppression to cortisol feedback and hence decreased peripheral cortisol. Low cortisol levels immediately after trauma are associated with the development of PTSD, while high levels are associated with depression (Gelder et al 2000, p. 764; Gelder et al 2006, p. 160; Sadock & Sadock 2005, p. 1741).

False: The Impact of Event Scale (IES) was developed to assess current subjective distress to any specific event. IES used to be the most widely used self-report measure of PTSD. It contained an intrusion scale and an avoidance scale. The revised version (IES-R) included an additional hyperarousal scale. The Post-traumatic Stress Diagnostic Scale (PSDS) is modelled on DSM-IV and is now commonly used in research.

True: Rape is associated with the highest rates of PTSD. Two-thirds of male and one-half of female victims of rape develop trauma. Other traumatic events associated with high rates of PTSD include combat exposure, childhood neglect and physical abuse, and sexual molestation (Gelder et al 2000, p. 762).

True: Adult survivors of childhood sexual abuse have high rates of depression, guilt, low self-esteem, alcoholism, sexual problems, eating disorders, agoraphobia, panic disorder, self-harm and further victimization. However, most of them have no significant abuse-related symptoms (Gelder et al 2000, p. 1827; Johnstone et al 2004, p. 716; Sadock & Sadock 2005, p. 3416).

True: Habit reversal training (HRT) was developed by Azrin and Nunn for the treatment of tics and other habits. HRT includes behaviour monitoring, relaxation and competing-response training. A competing response is a response incompatible with the tic. The patient performs this competing response, e.g. clenching a fist for 3 minutes, when faced with the urge to perform the tic or when catching themselves performing the tic. HRT has been found to be useful in Tourette syndrome. HRT has been shown to be superior to negative practice in trichotillomania. Relaxation and massed practice can also be helpful (Gelder et al 2000, p. 989; Johnstone et al 2004, p. 597; Sadock & Sadock 2005, p. 3234).

True: After adjustment for differences in age and grade, women have a 1.5-fold higher risk of medically certified sickness absence and a 1.2-fold higher risk of self-certified sickness absence compared with men (Kivimaki et al 2003).