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  • Question 1 - What percentage of individuals with Munchausen's syndrome by proxy are younger than 6...

    Correct

    • What percentage of individuals with Munchausen's syndrome by proxy are younger than 6 years old?

      Your Answer: 75%

      Explanation:

      Munchausen’s syndrome by proxy, also known as fabricated or induced illness, is a rare form of child abuse where a caregiver, usually the mother, falsifies illness in a child by fabricating of producing symptoms and presenting the child for medical care while denying knowledge of the cause. It is most commonly seen in children under the age of 4, with symptoms including apnoea, anorexia, feeding problems, and seizures. The disorder is now recognized as ‘Factitious Disorder Imposed on Another’ in the DSM-5, with criteria including falsification of physical of psychological signs of symptoms, presentation of the victim as ill, and evident deceptive behavior. The perpetrator, not the victim, receives this diagnosis. Presenting signs of symptoms can take the form of covert injury, fabrication of symptoms, of exaggeration of existing symptoms. Symptoms are often subjective and easy to fake.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      4.6
      Seconds
  • Question 2 - Which of the following is not a known adverse effect of bulimia nervosa?...

    Correct

    • Which of the following is not a known adverse effect of bulimia nervosa?

      Your Answer: Peptic ulcer disease

      Explanation:

      Eating Disorders: Lab Findings and Medical Complications

      Eating disorders can lead to a range of medical complications, including renal failure, peripheral edema, sinus bradycardia, QT-prolongation, pericardial effusion, and slowed GI motility. Other complications include constipation, cathartic colon, esophageal esophagitis, hair loss, and dental erosion. Blood abnormalities are also common in patients with eating disorders, including hyponatremia, hypokalemia, hypophosphatemia, and hypoglycemia. Additionally, patients may experience leucopenia, anemia, low albumin, elevated liver enzymes, and vitamin deficiencies. These complications can cause significant morbidity and mortality in patients with eating disorders. It is important for healthcare providers to monitor patients for these complications and provide appropriate treatment.

    • This question is part of the following fields:

      • General Adult Psychiatry
      20.2
      Seconds
  • Question 3 - An 87-year-old male is admitted with increasing confusion and lethargy, and his family...

    Correct

    • An 87-year-old male is admitted with increasing confusion and lethargy, and his family have been particularly concerned that he has been unable to look after himself.
      He has a recent history of hypertension and diabetes for which he takes lisinopril, metformin and amlodipine. On examination, he has a temperature of 36.2°C, and is confused in time and place.
      His blood pressure is 140/80 mmHg and his pulse 60 bpm regular. Abdominal examination reveals little but PR examination reveals that the rectum is loaded with faeces. Examination of the CNS reveals blunted tendon reflexes but no focal neurology. Initial investigations reveal:
      Haemoglobin 130 g/L (120-160)
      MCV 98 fL (80-100)
      Platelets 200 ×109/L (150-400)
      White cell count 7.2 ×109/L (4-11)
      Sodium 135 mmol/L (135-145)
      Potassium 4.0 mmol/L (3.5-5.0)
      Urea 7.5 mmol/L (2.5-7.5)
      Creatinine 120 mmol/L (60-110)
      Glucose 10.5 mmol/L (4-7)
      Which one of the following is the most appropriate investigation for this patient?

      Your Answer: Thyroid function tests

      Explanation:

      The patient has a brief history of growing confusion and struggling to cope, with primary symptoms of confusion, constipation, hypothermia, and reduced tendon reflexes. The tests indicate a higher than normal mean corpuscular volume (MCV) and mild hyponatremia. These symptoms are consistent with hypothyroidism, and the most suitable test would be thyroid function tests, which should show a decrease in free thyroxine (T4) and an increase in thyroid-stimulating hormone (TSH).

    • This question is part of the following fields:

      • Old Age Psychiatry
      77.8
      Seconds
  • Question 4 - Which statement accurately reflects the relationship between migration and the risk of developing...

    Incorrect

    • Which statement accurately reflects the relationship between migration and the risk of developing schizophrenia?

      Your Answer: First generation migrants are at a higher risk of developing schizophrenia than second generation migrants

      Correct Answer: The relative risk for developing schizophrenia among second-generation migrants is 4.5

      Explanation:

      The risk of obstetric complications is about twice as high in individuals with schizophrenia compared to those without the condition.

      Schizophrenia and Migration: A Meta-Analysis and Review

      Migration is a significant risk factor for the development of schizophrenia, according to a comprehensive review of the topic. The study found that the mean weighted relative risk for first-generation migrants was 2.7, while the relative risk for second-generation migrants was 4.5. When analyzing both first- and second-generation migrants, the relative risk was 2.9. The study also found that migrants from developing countries and areas with a majority black population had significantly greater effect sizes. These findings highlight the importance of considering migration status when assessing risk for schizophrenia.

    • This question is part of the following fields:

      • General Adult Psychiatry
      66.5
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  • Question 5 - A male patient in his mid-20s is referred for treatment due to a...

    Incorrect

    • A male patient in his mid-20s is referred for treatment due to a depressive illness. On first meeting him, the female doctor is uncomfortable with his clear attempts to be seductive. He explains that he has been rejected by his male friends as they have told him that he is overly sexual with their girlfriends and he demands too much attention from them.

      He reports getting easily bored and quickly losing interest in jobs causing him issues with his career. There is no evidence of identity disturbance. He explains that his last relationship ended due to him repeatedly sending messages to his girlfriend saying he would hurt himself if she didn't stop seeing her friends and spend more time with him. He denied any actual acts of self-harm and insisted that he never had intent to hurt himself and only sent the messages to get more of his girlfriend's time.

      Which of the following is most likely to be present?

      Your Answer: Personality disorder with negative affectivity

      Correct Answer: Histrionic personality disorder

      Explanation:

      This scenario strongly indicates the presence of histrionic personality disorder, which often involves individuals displaying sexualized behaviors towards their partners and a constant desire for attention, leading to social alienation. While individuals with borderline personality disorder may also exhibit attention-seeking behaviors, their condition is typically characterized by self-destructive tendencies, tumultuous relationships, and persistent feelings of emptiness and identity disturbance, setting it apart from histrionic personality disorder.

      Personality Disorder: Histrionic

      A histrionic personality disorder, also known as a dramatic personality disorder, is a psychiatric condition characterized by a consistent pattern of attention-seeking behaviors and exaggerated emotional responses. To diagnose this disorder, the DSM-5 requires the presence of at least five of the following symptoms: discomfort when not the center of attention, seductive of provocative behavior, shallow and shifting emotions, using appearance to draw attention, vague and impressionistic speech, dramatic of exaggerated emotions, suggestibility, and considering relationships to be more intimate than they actually are. However, the ICD-11 has removed the diagnosis of histrionic personality disorder from its list of recognized disorders.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 6 - How can the ICD-11 diagnosis of personality disorder with borderline pattern be identified?...

    Correct

    • How can the ICD-11 diagnosis of personality disorder with borderline pattern be identified?

      Your Answer: Transient, psychotic-like features

      Explanation:

      It is important to note that the question is asking for the option that is the most suggestive of a diagnosis of personality disorder with borderline pattern in the ICD-11. The correct answer is ‘transient, psychotic-like features’ as this is a qualifying element of the diagnosis. While the other options may also be present in individuals with this condition, they are not defining features.

      Personality Disorder (Borderline)

      History and Terminology

      The term borderline personality disorder originated from early 20th-century theories that the disorder was on the border between neurosis and psychosis. The term borderline was coined by Adolph Stern in 1938. Subsequent attempts to define the condition include Otto Kernberg’s borderline personality organization, which identified key elements such as ego weakness, primitive defense mechanisms, identity diffusion, and unstable reality testing.

      Features

      The DSM-5 and ICD-11 both define borderline personality disorder as a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Symptoms include efforts to avoid abandonment, unstable relationships, impulsivity, suicidal behavior, affective instability, chronic feelings of emptiness, difficulty controlling temper, and transient dissociative symptoms.

      Abuse

      Childhood abuse and neglect are extremely common among borderline patients, with up to 87% having suffered some form of trauma. The effect of abuse seems to depend on the stage of psychological development at which it takes place.

      comorbidity

      Borderline PD patients are more likely to receive a diagnosis of major depressive disorder, bipolar disorder, panic disorder, PTSD, OCD, eating disorders, and somatoform disorders.

      Psychological Therapy

      Dialectical Behavioral Therapy (DBT), Mentalization-Based Treatment (MBT), Schema-Focused Therapy (SFT), and Transference-Focused Psychotherapy (TFP) are the main psychological treatments for BPD. DBT is the most well-known and widely available, while MBT focuses on improving mentalization, SFT generates structural changes to a patient’s personality, and TFP examines dysfunctional interpersonal dynamics that emerge in interactions with the therapist in the transference.

      NICE Guidelines

      The NICE guidelines on BPD offer very little recommendations. They do not recommend medication for treatment of the core symptoms. Regarding psychological therapies, they make reference to DBT and MBT being effective but add that the evidence base is too small to draw firm conclusions. They do specifically say Do not use brief psychotherapeutic interventions (of less than 3 months’ duration) specifically for borderline personality disorder of for the individual symptoms of the disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
      164.8
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  • Question 7 - According to Klerman's bipolar subtypes, which of the following refers to hypomania of...

    Correct

    • According to Klerman's bipolar subtypes, which of the following refers to hypomania of mania precipitated by antidepressant drugs?

      Your Answer: Bipolar IV

      Explanation:

      Bipolar Disorder: Historical Subtypes

      Bipolar disorder is a complex mental illness that has been classified into several subtypes over the years. The most widely recognized subtypes are Bipolar I, Bipolar II, and Cyclothymia. However, there have been other classification systems proposed by experts in the field.

      In 1981, Gerald Klerman proposed a classification system that included Bipolar I, Bipolar II, Bipolar III, Bipolar IV, Bipolar V, and Bipolar VI. This system was later expanded by Akiskal in 1999, who added more subtypes such as Bipolar I 1/2, Bipolar II 1/2, and Bipolar III 1/2.

      Bipolar I is characterized by full-blown mania, while Bipolar II is characterized by hypomania with depression. Cyclothymia is a milder form of bipolar disorder that involves cycling between hypomania and mild depression.

      Other subtypes include Bipolar III, which is associated with hypomania of mania precipitated by antidepressant drugs, and Bipolar IV, which is characterized by hyperthymic depression. Bipolar V is associated with depressed patients who have a family history of bipolar illness, while Bipolar VI is characterized by mania without depression (unipolar mania).

      Overall, the classification of bipolar disorder subtypes has evolved over time, and different experts have proposed different systems. However, the most widely recognized subtypes are still Bipolar I, Bipolar II, and Cyclothymia.

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.4
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  • Question 8 - What is a known contributing factor to the development of ADHD? ...

    Correct

    • What is a known contributing factor to the development of ADHD?

      Your Answer: Low birth weight

      Explanation:

      Risk Factors for ADHD

      There are several risk factors associated with the development of ADHD. According to the NICE guidelines, these include maternal smoking, alcohol consumption, and heroin use during pregnancy, as well as low birth weight and fetal hypoxia. Additionally, severe early psychosocial adversity has also been identified as a potential risk factor for ADHD. This refers to experiences of significant stress of trauma during early childhood, such as abuse, neglect, of exposure to violence. These factors can have a lasting impact on a child’s development and may contribute to the development of ADHD symptoms. It is important for healthcare professionals to be aware of these risk factors and to provide appropriate support and interventions to children and families who may be affected.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      45.6
      Seconds
  • Question 9 - What is the recommended initial medication for treating panic disorder, as per the...

    Correct

    • What is the recommended initial medication for treating panic disorder, as per the NICE guidelines?

      Your Answer: SSRI

      Explanation:

      Understanding Panic Disorder: Key Facts, Diagnosis, and Treatment Recommendations

      Panic disorder is a mental health condition characterized by recurrent unexpected panic attacks, which are sudden surges of intense fear of discomfort that reach a peak within minutes. Females are more commonly affected than males, and the disorder typically onsets during the early 20s. Panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      To diagnose panic disorder, the individual must experience recurrent panic attacks that are not restricted to particular stimuli of situations and are unexpected. The panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms are not a manifestation of another medical condition of substance use, and they result in significant impairment in functioning.

      Panic disorder is differentiated from normal fear reactions by the frequent recurrence of panic attacks, persistent worry of concern about the panic attacks of their meaning, and associated significant impairment in functioning. Treatment recommendations vary based on the severity of the disorder, with mild to moderate cases recommended for individual self-help and moderate to severe cases recommended for cognitive-behavioral therapy of antidepressant medication. The classes of antidepressants that have an evidence base for effectiveness are SSRIs, SNRIs, and TCAs. Benzodiazepines are not recommended for the treatment of panic disorder due to their association with a less favorable long-term outcome. Sedating antihistamines of antipsychotics should also not be prescribed for the treatment of panic disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
      40.7
      Seconds
  • Question 10 - What is a true statement about searching in PubMed? ...

    Correct

    • What is a true statement about searching in PubMed?

      Your Answer: Truncation is generally not a recommended search technique for PubMed

      Explanation:

      Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.

      When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.

      There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      482.3
      Seconds
  • Question 11 - A 14 year old boy has been experiencing symptoms of schizophrenia for the...

    Correct

    • A 14 year old boy has been experiencing symptoms of schizophrenia for the past year. What course of action would you suggest?

      Your Answer: Risperidone with family intervention with individual CBT

      Explanation:

      NICE recommends a combination of oral antipsychotic medication and psychological interventions, specifically family intervention with individual cognitive-behavioral therapy, for children and young people experiencing their first episode of psychosis.

      Schizophrenia in children and young people is treated similarly to adults, according to the NICE Guidelines. The Maudsley Guidelines suggest avoiding first generation antipsychotics and using olanzapine, aripiprazole, and risperidone, which have been proven effective in randomized controlled trials. In cases where treatment resistance is present, clozapine should be considered.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      44.2
      Seconds
  • Question 12 - What is the recommendation of NICE guidelines regarding the use of a certain...

    Incorrect

    • What is the recommendation of NICE guidelines regarding the use of a certain treatment for depression?

      Your Answer: Paroxetine

      Correct Answer: Dosulepin

      Explanation:

      NICE recommends against the use of dosulepin due to the higher risk of cardiac complications and overdose toxicity, which outweigh any potential benefits in terms of tolerability compared to other antidepressants.

      Depression Treatment Guidelines by NICE

      The National Institute for Health and Care Excellence (NICE) provides guidelines for the treatment of depression. The following are some general recommendations:

      – Selective serotonin reuptake inhibitors (SSRIs) are preferred when prescribing antidepressants.
      – Antidepressants are not the first-line treatment for mild depression.
      – After remission, continue antidepressant treatment for at least six months.
      – Continue treatment for at least two years if at high risk of relapse of have a history of severe or prolonged episodes of inadequate response.
      – Use a stepped care approach to depression treatment, starting at the appropriate level based on the severity of depression.

      The stepped care approach involves the following steps:

      – Step 1: Assessment, support, psychoeducation, active monitoring, and referral for further assessment and interventions.
      – Step 2: Low-intensity psychosocial interventions, psychological interventions, medication, and referral for further assessment and interventions.
      – Step 3: Medication, high-intensity psychological interventions, combined treatments, collaborative care, and referral for further assessment and interventions.
      – Step 4: Medication, high-intensity psychological interventions, electroconvulsive therapy, crisis service, combined treatments, multiprofessional and inpatient care.

      Individual guided self-help programs based on cognitive-behavioral therapy (CBT) principles should be supported by a trained practitioner and last 9 to 12 weeks. Physical activity programs should consist of three sessions per week of moderate duration over 10 to 14 weeks.

      NICE advises against using antidepressants routinely to treat persistent subthreshold depressive symptoms of mild depression. However, they may be considered for people with a past history of moderate or severe depression, initial presentation of subthreshold depressive symptoms that have been present for a long period, of subthreshold depressive symptoms of mild depression that persist after other interventions.

      NICE recommends a combination of antidepressant medication and a high-intensity psychological intervention (CBT of interpersonal therapy) for people with moderate of severe depression. Augmentation of antidepressants with lithium, antipsychotics, of other antidepressants may be appropriate, but benzodiazepines, buspirone, carbamazepine, lamotrigine, of valproate should not be routinely used.

      When considering different antidepressants, venlafaxine is associated with a greater risk of death from overdose compared to other equally effective antidepressants. Tricyclic antidepressants (TCAs) except for lofepramine are associated with the greatest risk in overdose. Higher doses of venlafaxine may exacerbate cardiac arrhythmias, and venlafaxine and duloxetine may exacerbate hypertension. TCAs may cause postural hypotension and arrhythmias, and mianserin requires hematological monitoring in elderly people.

      The review frequency depends on the age and suicide risk of the patient. If the patient is over 30 and has no suicide risk, see them after two weeks and then at intervals of 2-4 weeks for the first three months. If the patient is under 30 and has a suicide risk, see them after one week.

    • This question is part of the following fields:

      • General Adult Psychiatry
      91.8
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  • Question 13 - What is the ratio of suicide rates between individuals with Huntington's disease and...

    Correct

    • What is the ratio of suicide rates between individuals with Huntington's disease and the general population?

      Your Answer: 6

      Explanation:

      Patients with Huntington’s disease have a suicide rate that is four to six times higher than the general population.

      Psychiatric and Behavioural Symptoms of Huntington’s Disease

      Huntington’s disease is a condition that affects individuals with a triad of symptoms, including motor, cognitive, and psychiatric symptoms. While the symptoms typically begin in the third and fourth decades of life, individuals with a high number of CAG repeats may experience symptoms before the age of 20, known as juvenile Huntington’s disease.

      The psychiatric symptoms of Huntington’s disease can include depression, apathy, dementia, psychosis, anxiety, mania, sexual dysfunction, and even suicide. These symptoms can significantly impact an individual’s quality of life and require appropriate treatment. Advances in psychiatric treatment have been made to address these symptoms and improve the overall well-being of individuals with Huntington’s disease.

    • This question is part of the following fields:

      • Old Age Psychiatry
      4.5
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  • Question 14 - What is the appropriate course of action for an adult with ADHD who...

    Correct

    • What is the appropriate course of action for an adult with ADHD who experiences tics as a side effect of taking methylphenidate?

      Your Answer: Atomoxetine

      Explanation:

      According to NICE guidelines (ng87 1.8.14), atomoxetine is the recommended medication in this situation, rather than clonidine or guanfacine.

      ADHD Diagnosis and Management in Adults

      ADHD is a behavioural syndrome characterised by symptoms of inattention, hyperactivity, and impulsivity. The DSM-5 and ICD-11 provide diagnostic criteria for ADHD, with the DSM-5 recognising three subtypes of the condition: predominantly inattentive, predominantly hyperactive-impulsive, and combined.

      Treatment for ADHD in adults includes medication and non-pharmacological interventions. NICE recommends offering medication to adults with ADHD if their symptoms are still causing significant impairment after environmental modifications have been implemented and reviewed. Methylphenidate of lisdexamfetamine are first-line medications, with atomoxetine offered for those who cannot tolerate the former two. Additional medication options may be considered with advice from a tertiary ADHD service.

      NICE advises against elimination diets, dietary fatty acid supplementation, and the use of the ‘few foods diet’ for ADHD. Prior to initiating medication, referral to cardiology is recommended if there is a suggestion of cardiac pathology. If a person with ADHD develops mania of psychosis, ADHD treatment should be stopped until the episode has resolved. If a person taking stimulants develops tics, medication options may be adjusted.

    • This question is part of the following fields:

      • General Adult Psychiatry
      14.8
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  • Question 15 - What is the most precise approximation of the percentage of individuals over the...

    Incorrect

    • What is the most precise approximation of the percentage of individuals over the age of 60 who engage in suicide within 12 months after experiencing self-harm?

      Your Answer: 10%

      Correct Answer: 1.50%

      Explanation:

      The rate is considerably greater than that of adults who are of working age.

      Suicide Rates Following Self-Harm

      Most individuals who engage in self-harm do not go on to commit suicide, which makes risk assessment challenging. A study conducted in the UK in 2015 by Hawton found that 0.5% of individuals died by suicide in the first year following self-harm, with a higher rate among males (0.82%) than females (0.27%). Over the two-year period following self-harm, 1.6% died by suicide, with more occurrences in the second year. Interestingly, a study by Murphy in 2012 found that the rate of suicide following self-harm was higher in the elderly (those over 60), with a rate of 1.5 suicides in the first 12 months. The only significant risk factor for suicide following self-harm in this study was the use of a violent method in the initial episode.

    • This question is part of the following fields:

      • General Adult Psychiatry
      41.2
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  • Question 16 - What is a known factor that can lead to inaccurate positive results for...

    Correct

    • What is a known factor that can lead to inaccurate positive results for amphetamine on drug screening tests?

      Your Answer: Atomoxetine

      Explanation:

      Drug Screening

      Drug testing can be conducted through various methods, but urinalysis is the most common. Urine drug tests can be either screening of confirmatory. Screening tests use enzymatic immunoassays to detect drug metabolites of classes of drug metabolites in the urine. However, these tests have limitations, such as false positives due to cross-reactivity. Therefore, any positive test should be confirmed through gas chromatography of mass spectrometry.

      People may try to manipulate drug testing procedures by adulterating the sample. Normal urine parameters, such as temperature, specific gravity, and pH, can assist in detecting adulterated samples. Adulterants include household items like vinegar, detergent, and ammonia, as well as commercially available products. Diluted urine may also yield false negatives.

      Detection times vary from person to person, and the approximate drug detection time in urine can be found in a table provided by Nelson (2016). False positives can occur due to cross-reactivity, as illustrated by Moeller (2017). Clinicians should be aware of the limitations of urine drug tests and the potential for manipulation.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 17 - What is the most frequently reported side-effect of methylphenidate? ...

    Correct

    • What is the most frequently reported side-effect of methylphenidate?

      Your Answer: Insomnia

      Explanation:

      It is important to note that while these side-effects are listed as very common, not everyone will experience them. It is also important to discuss any concerns of side-effects with a healthcare professional before making any changes to medication. Additionally, it is important to weigh the potential benefits of medication in treating ADHD symptoms against the potential side-effects.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      23.1
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  • Question 18 - What is the most significant risk factor for developing schizophrenia? ...

    Correct

    • What is the most significant risk factor for developing schizophrenia?

      Your Answer: Being a migrant

      Explanation:

      The AESOP study provides current evidence that being a migrant is a significant risk factor for the onset of schizophrenia.

      Schizophrenia: Understanding the Risk Factors

      Social class is a significant risk factor for schizophrenia, with people of lower socioeconomic status being more likely to develop the condition. Two hypotheses attempt to explain this relationship, one suggesting that environmental exposures common in lower social class conditions are responsible, while the other suggests that people with schizophrenia tend to drift towards the lower class due to their inability to compete for good jobs.

      While early studies suggested that schizophrenia was more common in black populations than in white, the current consensus is that there are no differences in rates of schizophrenia by race. However, there is evidence that rates are higher in migrant populations and ethnic minorities.

      Gender and age do not appear to be consistent risk factors for schizophrenia, with conflicting evidence on whether males of females are more likely to develop the condition. Marital status may also play a role, with females with schizophrenia being more likely to marry than males.

      Family history is a strong risk factor for schizophrenia, with the risk increasing significantly for close relatives of people with the condition. Season of birth and urban versus rural place of birth have also been shown to impact the risk of developing schizophrenia.

      Obstetric complications, particularly prenatal nutritional deprivation, brain injury, and influenza, have been identified as significant risk factors for schizophrenia. Understanding these risk factors can help identify individuals who may be at higher risk for developing the condition and inform preventative measures.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 19 - Which of the following is most commonly associated with pica? ...

    Correct

    • Which of the following is most commonly associated with pica?

      Your Answer: Autism

      Explanation:

      Pica: Eating Non-Nutritive Substances

      Pica is a condition where a person persistently eats non-nutritive substances for at least a month. The name pica comes from the Latin word for magpie, a bird known for its large and random appetite. To be diagnosed with pica, the behavior must be developmentally inappropriate, not culturally sanctioned, and severe enough to require clinical attention. It is more common in young people than adults and is often associated with mental retardation.

      There are various causes of pica, including mental disorders such as autism and schizophrenia, iron and zinc deficiency (although this is rare and not clear if it is a cause of effect), and pregnancy. The DSM-5 requires a minimum age of 2 before a diagnosis can be made. Pregnant women have been reported to experience certain forms of pica, such as geophagia (clay eating) and amylophagia (starch eating).

      Pica affects both sexes equally and is estimated to occur in up to 15% of those with severe intellectual disability. However, aside from cases of autistic spectrum disorder of intellectual disability, pica usually remits by adolescence.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      2.6
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  • Question 20 - With which condition are raised liver function tests most commonly associated? ...

    Incorrect

    • With which condition are raised liver function tests most commonly associated?

      Your Answer: Vigabatrin

      Correct Answer: Valproate

      Explanation:

      Biochemical Changes Associated with Psychotropic Drugs

      Psychotropic drugs can have incidental biochemical of haematological effects that need to be identified and monitored. The evidence for many of these changes is limited to case reports of information supplied by manufacturers. The Maudsley Guidelines 14th Edition summarises the important changes to be aware of.

      One important parameter to monitor is ALT, a liver enzyme. Agents that can raise ALT levels include clozapine, haloperidol, olanzapine, quetiapine, chlorpromazine, mirtazapine, moclobemide, SSRIs, carbamazepine, lamotrigine, and valproate. On the other hand, vigabatrin can lower ALT levels.

      Another liver enzyme to monitor is ALP. Haloperidol, clozapine, olanzapine, duloxetine, sertraline, and carbamazepine can raise ALP levels, while buprenorphine and zolpidem (rarely) can lower them.

      AST levels are often associated with ALT levels. Trifluoperazine and vigabatrin can raise AST levels, while agents that raise ALT levels can also raise AST levels.

      TSH levels, which are associated with thyroid function, can be affected by aripiprazole, carbamazepine, lithium, quetiapine, rivastigmine, sertraline, and valproate (slightly). Moclobemide can lower TSH levels.

      Thyroxine levels can be affected by dexamphetamine, moclobemide, lithium (which can raise of lower levels), aripiprazole (rarely), and quetiapine (rarely).

      Overall, it is important to monitor these biochemical changes when prescribing psychotropic drugs to ensure the safety and well-being of patients.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 21 - Which of the following symptoms is most indicative of anxiety? ...

    Correct

    • Which of the following symptoms is most indicative of anxiety?

      Your Answer: Tightness in the throat

      Explanation:

      Globus, a sensation of tightness of feeling of something stuck in the throat, can be caused by stress of anxiety. It is a common symptom that often improves after eating and is not considered a serious condition. Despite being bothersome, globus is generally harmless.

      Generalised Anxiety Disorder: Symptoms and Diagnosis

      Generalised anxiety disorder is a condition characterized by persistent symptoms of anxiety that last for several months and occur on most days. The symptoms can be either general apprehension of excessive worry about multiple everyday events, such as family, health, finances, and work of school. In addition to these symptoms, individuals with generalised anxiety disorder may experience muscular tension, motor restlessness, sympathetic autonomic overactivity, nervousness, difficulty concentrating, irritability, of sleep disturbance.

      To diagnose generalised anxiety disorder, healthcare professionals look for specific essential features. These include marked symptoms of anxiety that are not restricted to any particular environmental circumstance, and are accompanied by additional characteristic symptoms such as muscle tension, autonomic overactivity, nervousness, difficulty concentrating, irritability, and sleep disturbances. The symptoms must persist for at least several months, for more days than not, and cannot be better accounted for by another mental disorder of medical condition. The symptoms must also result in significant distress of impairment in personal, family, social, educational, occupational, of other important areas of functioning.

    • This question is part of the following fields:

      • General Adult Psychiatry
      31.5
      Seconds
  • Question 22 - Which age group in the UK has the highest incidence of suicide? ...

    Correct

    • Which age group in the UK has the highest incidence of suicide?

      Your Answer: 45-49

      Explanation:

      2021 National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) report reveals key findings on suicide rates in the UK from 2008-2018. The rates have remained stable over the years, with a slight increase following the 2008 recession and another rise since 2015/2016. Approximately 27% of all general population suicides were patients who had contact with mental health services within 12 months of suicide. The most common methods of suicide were hanging/strangulation (52%) and self-poisoning (22%), mainly through prescription opioids. In-patient suicides have continued to decrease, with most of them occurring on the ward itself from low lying ligature points. The first three months after discharge remain a high-risk period, with 13% of all patient suicides occurring within this time frame. Nearly half (48%) of patient suicides were from patients who lived alone. In England, suicide rates are higher in males (17.2 per 100,000) than females (5.4 per 100,000), with the highest age-specific suicide rate for males in the 45-49 years age group (27.1 deaths per 100,000 males) and for females in the same age group (9.2 deaths per 100,000). Hanging remains the most common method of suicide in the UK, accounting for 59.4% of all suicides among males and 45.0% of all suicides among females.

    • This question is part of the following fields:

      • General Adult Psychiatry
      1.9
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  • Question 23 - What diagnostic indicator would be the most beneficial in identifying depression in a...

    Incorrect

    • What diagnostic indicator would be the most beneficial in identifying depression in a patient who has multiple sclerosis?

      Your Answer: Anhedonia

      Correct Answer: Suicidal ideation

      Explanation:

      Psychiatric Consequences of Multiple Sclerosis

      Multiple sclerosis (MS) is a neurological disorder that affects individuals between the ages of 20 and 40. It is characterized by multiple demyelinating lesions in the optic nerves, cerebellum, brainstem, and spinal cord. MS presents with diverse neurological signs, including optic neuritis, internuclear ophthalmoplegia, and ocular motor cranial neuropathy.

      Depression is the most common psychiatric condition seen in MS, with a lifetime prevalence of 25-50%. The symptoms of depression in people with MS tend to be different from those without MS. The preferred diagnostic indicators for depression in MS include pervasive mood change, diurnal mood variation, suicidal ideation, functional change not related to physical disability, and pessimistic of negative patterns of thinking. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for depression in patients with MS.

      Suicide is common in MS, with recognized risk factors including male gender, young age at onset of illness, current of previous history of depression, social isolation, and substance misuse. Mania is more common in people with MS, and mood stabilizers are recommended for treatment. Pathological laughing and crying, defined as uncontrollable laughing and/of crying without the associated affect, occurs in approximately 10% of cases of MS. Emotional lability, defined as an excessive emotional response to a minor stimulus, is also common in MS and can be treated with amitriptyline and SSRIs.

      The majority of cases of neuropsychiatric side effects from corticosteroids fit an affective profile of mania and/of depression. Psychotic symptoms, particularly hallucinations, are present in up to half of these cases. Glatiramer acetate has not been associated with neuropsychiatric side-effects. The data regarding the risk of mood symptoms related to interferon use is conflicting.

      In conclusion, MS has significant psychiatric consequences, including depression, suicide, mania, pathological laughing and crying, emotional lability, and neuropsychiatric side effects from treatment. Early recognition and treatment of these psychiatric symptoms are essential for improving the quality of life of individuals with MS.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 24 - For what purpose is the SCOFF questionnaire used as a screening tool? ...

    Correct

    • For what purpose is the SCOFF questionnaire used as a screening tool?

      Your Answer: Eating disorders

      Explanation:

      The SCOFF Questionnaire for Screening Eating Disorders

      The SCOFF questionnaire is a tool used to screen for eating disorders. It consists of five questions that aim to identify symptoms of anorexia nervosa or bulimia. The questions include whether the individual makes themselves sick because they feel uncomfortably full, worries about losing control over how much they eat, has recently lost more than one stone in a three-month period, believes themselves to be fat when others say they are too thin, and whether food dominates their life.

      A score of two or more positive responses indicates a likely case of anorexia nervosa or bulimia. The questionnaire has a sensitivity of 84.6% and specificity of 98.6% when two or more questions are answered positively. This means that if a patient responds positively to two of more questions, there is a high likelihood that they have an eating disorder. The negative predictive value of the questionnaire is 99.3%, which means that if a patient responds negatively to the questions, there is a high probability that they do not have an eating disorder.

      Overall, the SCOFF questionnaire is a useful tool for healthcare professionals to quickly screen for eating disorders and identify individuals who may require further assessment and treatment.

    • This question is part of the following fields:

      • General Adult Psychiatry
      2.3
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  • Question 25 - Which of the following is not a valid type of validity? ...

    Correct

    • Which of the following is not a valid type of validity?

      Your Answer: Inter-rater

      Explanation:

      Validity in statistics refers to how accurately something measures what it claims to measure. There are two main types of validity: internal and external. Internal validity refers to the confidence we have in the cause and effect relationship in a study, while external validity refers to the degree to which the conclusions of a study can be applied to other people, places, and times. There are various threats to both internal and external validity, such as sampling, measurement instrument obtrusiveness, and reactive effects of setting. Additionally, there are several subtypes of validity, including face validity, content validity, criterion validity, and construct validity. Each subtype has its own specific focus and methods for testing validity.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      3.2
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  • Question 26 - What resource is committed to offering complete articles of systematic reviews on the...

    Incorrect

    • What resource is committed to offering complete articles of systematic reviews on the impacts of healthcare interventions?

      Your Answer: DARE

      Correct Answer: CDSR

      Explanation:

      When faced with a question, it’s helpful to consider what the letters in the question might represent, even if you don’t know the answer right away. Don’t become overwhelmed and keep this strategy in mind.

      Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.

      When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.

      There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      10.8
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  • Question 27 - What is the truth about controlled drugs in the UK? ...

    Correct

    • What is the truth about controlled drugs in the UK?

      Your Answer: A single drug can have more than one scheduling status

      Explanation:

      Drug Misuse (Law and Scheduling)

      The Misuse of Drugs Act (1971) regulates the possession and supply of drugs, classifying them into three categories: A, B, and C. The maximum penalty for possession varies depending on the class of drug, with Class A drugs carrying a maximum sentence of 7 years.

      The Misuse of Drugs Regulations 2001 further categorizes controlled drugs into five schedules. Schedule 1 drugs are considered to have no therapeutic value and cannot be lawfully possessed of prescribed, while Schedule 2 drugs are available for medical use but require a controlled drug prescription. Schedule 3, 4, and 5 drugs have varying levels of restrictions and requirements.

      It is important to note that a single drug can have multiple scheduling statuses, depending on factors such as strength and route of administration. For example, morphine and codeine can be either Schedule 2 of Schedule 5.

      Overall, the Misuse of Drugs Act and Regulations aim to regulate and control the use of drugs in the UK, with the goal of reducing drug misuse and related harm.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      27.1
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  • Question 28 - What is the highest approved dosage of risperidone that can be administered for...

    Correct

    • What is the highest approved dosage of risperidone that can be administered for treating aggression and agitation related to Alzheimer's disease?

      Your Answer: 1 mg BD

      Explanation:

      According to the Maudsley 14th, Risperidone is approved for a maximum dosage of 1 mg twice daily, but the recommended of optimal dose is 500 µg.

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 29 - What is the main cannabinoid responsible for the psychoactive effects of cannabis? ...

    Correct

    • What is the main cannabinoid responsible for the psychoactive effects of cannabis?

      Your Answer: Tetrahydrocannabinol

      Explanation:

      Cannabis, also known as marijuana, grass, pot, weed, tea, of Mary Jane, is a plant that contains over 60 unique cannabinoids. The primary psychoactive component of cannabis is delta-9-tetrahydrocannabinol (Delta 9-THC), which is rapidly converted into 11-hydroxy-delta 9-THC, the active metabolite in the central nervous system. Specific cannabinoid receptors, including CB1 and CB2 receptors, have been identified in the body. CB1 receptors are found mainly at nerve terminals, where they inhibit transmitter release, while CB2 receptors occur mainly on immune cells and modulate cytokine release. The cannabinoid receptor is found in highest concentrations in the basal ganglia, hippocampus, and cerebellum, with lower concentrations in the cerebral cortex. Cannabis use has been associated with the amotivational syndrome, characterized by apathy, anergy, weight gain, and a lack of persistence in tasks requiring prolonged attention of tenacity.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 30 - What is an example of a neurovegetative symptom? ...

    Incorrect

    • What is an example of a neurovegetative symptom?

      Your Answer: Impaired concentration

      Correct Answer: Insomnia

      Explanation:

      Symptoms related to inadequate performance of the autonomic nervous system, such as difficulties with sleep, exhaustion, and reduced energy levels, are referred to as neurovegetative symptoms.

      Bipolar Disorder Diagnosis

      Bipolar and related disorders are mood disorders characterized by manic, mixed, of hypomanic episodes alternating with depressive episodes. The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. Under the ICD-11, there are three subtypes of bipolar disorder: Bipolar I, Bipolar II, and Cyclothymic disorder.

      Bipolar I disorder is diagnosed when an individual has a history of at least one manic of mixed episode. The typical course of the disorder is characterized by recurrent depressive and manic of mixed episodes. Onset of the first mood episode most often occurs during the late teen years, but onset of bipolar type I can occur at any time through the life cycle. The lifetime prevalence of bipolar I disorder is estimated to be around 2.1%.

      Bipolar II disorder is diagnosed when an individual has a history of at least one hypomanic episode and at least one depressive episode. The typical course of the disorder is characterized by recurrent depressive and hypomanic episodes. Onset of bipolar type II most often occurs during the mid-twenties. The number of lifetime episodes tends to be higher for bipolar II disorder than for major depressive disorder of bipolar I disorder.

      Cyclothymic disorder is diagnosed when an individual experiences mood instability over an extended period of time characterized by numerous hypomanic and depressive periods. The symptoms are present for more days than not, and there is no history of manic or mixed episodes. The course of cyclothymic disorder is often gradual and persistent, and onset commonly occurs during adolescence of early adulthood.

      Rapid cycling is not a subtype of bipolar disorder but instead is a qualifier. It is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode. Rapid cycling is associated with an increased risk of suicide and tends to be precipitated by stressors such as life events, alcohol abuse, use of antidepressants, and medical disorders.

      Overall, the diagnosis of bipolar disorder requires careful evaluation of an individual’s symptoms and history. Treatment typically involves a combination of medication and psychotherapy.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 31 - What are the defining characteristics of borderline personality disorder? ...

    Incorrect

    • What are the defining characteristics of borderline personality disorder?

      Your Answer: Affective instability

      Correct Answer: Dissociative symptoms

      Explanation:

      Borderline personality disorder often presents with stress-related dissociation as a prominent symptom. Dissociation refers to a disturbance of interruption in the typical functioning of various cognitive processes, including consciousness, perception, attention, memory, and identity. This can manifest as feelings of detachment from oneself (depersonalization) of the surroundings (derealization), which may seem surreal, hazy, of insignificant. Memory disturbances can range from difficulty recalling information to complete dissociative amnesia.

      Personality Disorder (Borderline)

      History and Terminology

      The term borderline personality disorder originated from early 20th-century theories that the disorder was on the border between neurosis and psychosis. The term borderline was coined by Adolph Stern in 1938. Subsequent attempts to define the condition include Otto Kernberg’s borderline personality organization, which identified key elements such as ego weakness, primitive defense mechanisms, identity diffusion, and unstable reality testing.

      Features

      The DSM-5 and ICD-11 both define borderline personality disorder as a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Symptoms include efforts to avoid abandonment, unstable relationships, impulsivity, suicidal behavior, affective instability, chronic feelings of emptiness, difficulty controlling temper, and transient dissociative symptoms.

      Abuse

      Childhood abuse and neglect are extremely common among borderline patients, with up to 87% having suffered some form of trauma. The effect of abuse seems to depend on the stage of psychological development at which it takes place.

      comorbidity

      Borderline PD patients are more likely to receive a diagnosis of major depressive disorder, bipolar disorder, panic disorder, PTSD, OCD, eating disorders, and somatoform disorders.

      Psychological Therapy

      Dialectical Behavioral Therapy (DBT), Mentalization-Based Treatment (MBT), Schema-Focused Therapy (SFT), and Transference-Focused Psychotherapy (TFP) are the main psychological treatments for BPD. DBT is the most well-known and widely available, while MBT focuses on improving mentalization, SFT generates structural changes to a patient’s personality, and TFP examines dysfunctional interpersonal dynamics that emerge in interactions with the therapist in the transference.

      NICE Guidelines

      The NICE guidelines on BPD offer very little recommendations. They do not recommend medication for treatment of the core symptoms. Regarding psychological therapies, they make reference to DBT and MBT being effective but add that the evidence base is too small to draw firm conclusions. They do specifically say Do not use brief psychotherapeutic interventions (of less than 3 months’ duration) specifically for borderline personality disorder of for the individual symptoms of the disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 32 - What is the primary benefit of conducting non-inferiority trials in the evaluation of...

    Incorrect

    • What is the primary benefit of conducting non-inferiority trials in the evaluation of a new medication?

      Your Answer: Prevents ethical dilemmas

      Correct Answer: Small sample size is required

      Explanation:

      Study Designs for New Drugs: Options and Considerations

      When launching a new drug, there are various study design options available. One common approach is a placebo-controlled trial, which can provide strong evidence but may be deemed unethical if established treatments are available. Additionally, it does not allow for a comparison with standard treatments. Therefore, statisticians must decide whether the trial aims to demonstrate superiority, equivalence, of non-inferiority to an existing treatment.

      Superiority trials may seem like the obvious choice, but they require a large sample size to show a significant benefit over an existing treatment. Equivalence trials define an equivalence margin on a specified outcome, and if the confidence interval of the difference between the two drugs falls within this margin, the drugs are assumed to have a similar effect. Non-inferiority trials are similar to equivalence trials, but only the lower confidence interval needs to fall within the equivalence margin. These trials require smaller sample sizes, and once a drug has been shown to be non-inferior, larger studies may be conducted to demonstrate superiority.

      It is important to note that drug companies may not necessarily aim to show superiority over an existing product. If they can demonstrate that their product is equivalent of even non-inferior, they may compete on price of convenience. Overall, the choice of study design depends on various factors, including ethical considerations, sample size, and the desired outcome.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 33 - Which substance withdrawal is linked to symptoms of hypersomnia, hyperphagia, and irritability? ...

    Correct

    • Which substance withdrawal is linked to symptoms of hypersomnia, hyperphagia, and irritability?

      Your Answer: Amphetamine

      Explanation:

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 34 - What is a true statement about antisocial personality disorder? ...

    Incorrect

    • What is a true statement about antisocial personality disorder?

      Your Answer: It is synonymous with the term psychopathy

      Correct Answer: In the ICD-11 it is referred to as personality disorder with dissociation

      Explanation:

      Individuals with antisocial personality disorder were more likely to have a history of aggression, unemployment, and promiscuity than to have committed serious crimes.

      Personality Disorder (Antisocial / Dissocial)

      Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.

      The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.

      Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.

      The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.

      The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 35 - What is a true statement about dissociative disorders? ...

    Incorrect

    • What is a true statement about dissociative disorders?

      Your Answer: The disruption to the normal integration is considered voluntary

      Correct Answer: The onset is usually acute

      Explanation:

      Dissociative disorders involve an involuntary disturbance of interruption in the usual integration of various aspects such as identity, sensations, perceptions, emotions, thoughts, memories, bodily movements, of behavior. This disruption can be complete of partial and may vary in intensity over time. The condition usually develops suddenly.

      Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 36 - Who is responsible for outlining the pathways to care? ...

    Correct

    • Who is responsible for outlining the pathways to care?

      Your Answer: Goldberg and Huxley

      Explanation:

      The study by Brown and Harris explores the societal factors that contribute to the development of depression.

      Model for Identifying Pathways to Psychiatric Care

      Goldberg and Huxley (1992) proposed a model that can be used to examine the identification, assessment, and pathway to psychiatric care for individuals with common mental health disorders. The model consists of five levels of care, with filters between them that are influenced by the behavior of those with the disorders and the healthcare practitioners they encounter. The authors highlight that only a small percentage of individuals with mental disorders receive specialized psychiatric care.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 37 - Which statement accurately describes infanticide? ...

    Correct

    • Which statement accurately describes infanticide?

      Your Answer: Infanticide can only be committed by biological mothers under English law

      Explanation:

      Infanticide is considered both a criminal offence and a partial defence to murder in the legal system of England and Wales. This defence can only be used by a mother who has killed her own child within a year of its birth, and the cause of death can be either an action of a failure to act.

      Infant Homicide

      Homicide is a significant contributor to infant mortality, with infants under 1 year of age being more likely to be victims of homicide than older children of the general population. Neonaticide, the killing of a baby within 24 hours of delivery, is different from the homicide of infants older than a day. Neonaticide is usually committed by the mother, who is often young, single, and living with her parents. The pregnancy is often unintentional and concealed, and the motivation to kill is usually because the child was unwanted. In contrast, the homicide of infants older than a day is more likely to be committed by a parent, with boys at greater risk than girls. Risk factors for the homicide of infants older than a day include younger age, family history of violence, violence in current relationships of the perpetrator, evidence of past abuse of neglect of children, and personality disorder and/of depression.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 38 - A 14 year old boy is brought to clinic by his father. He...

    Incorrect

    • A 14 year old boy is brought to clinic by his father. He is struggling with both obsessive compulsive disorder and depression. Despite trying psychological approaches, he has not found relief and is interested in trying medication. What is the most suitable medication to consider?

      Your Answer: Clomipramine

      Correct Answer: Fluoxetine

      Explanation:

      According to NICE, when a patient has both depression and OCD, the preferred treatment is fluoxetine.

      OCD and BDD are two mental health disorders that can affect children. OCD is characterized by obsessions and compulsions, while BDD is characterized by a preoccupation with an imagined defect in one’s appearance. Both disorders can cause significant distress and impairment in daily functioning.

      For mild cases of OCD, guided self-help may be considered along with support and information for the family of caregivers. For moderate to severe cases of OCD, cognitive-behavioral therapy (CBT) that involves the family of caregivers and is adapted to suit the child’s developmental age is recommended. For all children and young people with BDD, CBT (including exposure and response prevention) is recommended.

      If a child declines psychological treatment, a selective serotonin reuptake inhibitor (SSRI) may be prescribed. However, a licensed medication (sertraline of fluvoxamine) should be used for children and young people with OCD, while fluoxetine should be used for those with BDD. If an SSRI is ineffective of not tolerated, another SSRI of clomipramine may be tried. Tricyclic antidepressants other than clomipramine should not be used to treat OCD of BDD in children and young people. Other antidepressants (MAOIs, SNRIs) and antipsychotics should not be used alone in the routine treatment of OCD of BDD in children of young people, but may be considered as an augmentation strategy.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 39 - A researcher wants to compare the mean age of two groups of participants...

    Incorrect

    • A researcher wants to compare the mean age of two groups of participants who were randomly assigned to either a standard exercise program of a standard exercise program + new supplement. The data collected is parametric and continuous. What is the most appropriate statistical test to use?

      Your Answer: Pearson correlation

      Correct Answer: Unpaired t test

      Explanation:

      The two sample unpaired t test is utilized to examine whether the null hypothesis that the two populations related to the two random samples are equivalent is true of not. When dealing with continuous data that is believed to conform to the normal distribution, a t test is suitable, making it appropriate for comparing weight loss between two groups. In contrast, a paired t test is used when the data is dependent, meaning there is a direct correlation between the values in the two samples. This could include the same subject being measured before and after a process change of at different times.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      535
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  • Question 40 - Which country's data is excluded from the World Mental Health Survey Initiative? ...

    Correct

    • Which country's data is excluded from the World Mental Health Survey Initiative?

      Your Answer: England

      Explanation:

      World Mental Health Survey Initiative: Variations in Prevalence of Mental Disorders Across Countries

      The World Mental Health Survey Initiative aims to gather accurate cross-national information on the prevalence and correlates of mental, substance, and behavioural disorders. The initiative includes nationally of regionally representative surveys in 28 countries, with a total sample size of over 154,000. All interviews are conducted face-to-face by trained lay interviewers using the WMH-CIDI, a fully structured diagnostic interview.

      As of 2009, data from 17 countries and 70,000 respondents have been returned. The main findings show that the US has the highest prevalence of any disorder, with anxiety disorder being the most common condition, followed by mood disorder. However, there is significant variation in prevalence between countries. These findings highlight the importance of understanding the cultural and societal factors that contribute to the prevalence of mental disorders in different regions.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 41 - What is a distinguishing trait of being intoxicated with phencyclidine? ...

    Incorrect

    • What is a distinguishing trait of being intoxicated with phencyclidine?

      Your Answer: Pupillary dilatation

      Correct Answer: Analgesia

      Explanation:

      PCP Intoxication: A Dangerous Hallucinogenic

      Phencyclidine (PCP), also known as angel dust, is a hallucinogenic drug that is popular for inducing feelings of euphoria, superhuman strength, and social and sexual prowess. It is a NMDA receptor antagonist that has dissociative properties, similar to ketamine. PCP was previously used as an anesthetic and animal tranquilizer, but was soon recalled due to its adverse effects, including psychosis, agitation, and dysphoria post-operatively.

      PCP is available in various forms, including white crystalline powder, tablets, crystals, and liquid. It can be snorted, smoked, ingested, of injected intravenously or subcutaneously. People who have taken PCP often present with violent behavior, nystagmus, tachycardia, hypertension, anesthesia, and analgesia. Other symptoms include impaired motor function, hallucinations, delusions, and paranoia.

      PCP intoxication is best managed with benzodiazepines along with supportive measures for breathing and circulation. Antipsychotics are not recommended as they can amplify PCP-induced hyperthermia, dystonic reactions, and lower the seizure threshold. However, haloperidol may be useful for treating PCP-induced psychosis in patients who are not hyperthermic. Most deaths in PCP-intoxicated patients result from violent behavior rather than direct effects of the drug.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 42 - What is a significant obstacle for individuals to participate in mental health services?...

    Correct

    • What is a significant obstacle for individuals to participate in mental health services?

      Your Answer: Significant financial and time costs that are associated with this involvement

      Explanation:

      Challenges and Benefits of Service User Involvement

      Paragraph 1: Implementing service user involvement can be costly and time-consuming for both organisations and service users. However, if done properly, it can bring significant benefits.

      Paragraph 2: In the past, there has been resistance to the idea of using service users as experts. However, involving service users in decision-making processes can lead to more effective and relevant services.

      Paragraph 3: Contrary to popular belief, service user involvement can actually help overcome social isolation and improve mental health outcomes.

      Paragraph 4: Despite the benefits, there has historically been a lack of resources for service users and carers on how to get involved in their local services. This needs to be addressed to ensure that service user involvement is accessible and inclusive.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      275.5
      Seconds
  • Question 43 - A client who has recently been diagnosed with schizophrenia asks for information regarding...

    Correct

    • A client who has recently been diagnosed with schizophrenia asks for information regarding their prognosis. What factor has been consistently linked to a poor prognosis in schizophrenia?

      Your Answer: Younger age of onset

      Explanation:

      Schizophrenia Epidemiology

      Prevalence:
      – In England, the estimated annual prevalence for psychotic disorders (mostly schizophrenia) is around 0.4%.
      – Internationally, the estimated annual prevalence for psychotic disorders is around 0.33%.
      – The estimated lifetime prevalence for psychotic disorders in England is approximately 0.63% at age 43, consistent with the typically reported 1% prevalence over the life course.
      – Internationally, the estimated lifetime prevalence for psychotic disorders is around 0.48%.

      Incidence:
      – In England, the pooled incidence rate for non-affective psychosis (mostly schizophrenia) is estimated to be 15.2 per 100,000 years.
      – Internationally, the incidence of schizophrenia is about 0.20/1000/year.

      Gender:
      – The male to female ratio is 1:1.

      Course and Prognosis:
      – Long-term follow-up studies suggest that after 5 years of illness, one quarter of people with schizophrenia recover completely, and for most people, the condition gradually improves over their lifetime.
      – Schizophrenia has a worse prognosis with onset in childhood of adolescence than with onset in adult life.
      – Younger age of onset predicts a worse outcome.
      – Failure to comply with treatment is a strong predictor of relapse.
      – Over a 2-year period, one-third of patients with schizophrenia showed a benign course, and two-thirds either relapsed of failed to recover.
      – People with schizophrenia have a 2-3 fold increased risk of premature death.

      Winter Births:
      – Winter births are associated with an increased risk of schizophrenia.

      Urbanicity:
      – There is a higher incidence of schizophrenia associated with urbanicity.

      Migration:
      – There is a higher incidence of schizophrenia associated with migration.

      Class:
      – There is a higher prevalence of schizophrenia among lower socioeconomic classes.

      Learning Disability:
      – Prevalence rates for schizophrenia in people with learning disabilities are approximately three times greater than for the general population.

    • This question is part of the following fields:

      • General Adult Psychiatry
      61
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  • Question 44 - Which syndrome is typically not classified as a Parkinson's plus syndrome? ...

    Incorrect

    • Which syndrome is typically not classified as a Parkinson's plus syndrome?

      Your Answer: Lewy body dementia

      Correct Answer: Alzheimer's disease

      Explanation:

      While some believe that Alzheimer’s disease falls under the category of Parkinson’s plus syndrome, this viewpoint is not widely accepted.

      Parkinsonian Plus Syndromes: Additional Features to Parkinsonism

      The Parkinsonian plus syndromes are a group of neurological disorders that share the core features of Parkinsonism, such as tremors, rigidity, and bradykinesia. However, they also have additional features that distinguish them from Parkinson’s disease. These syndromes include multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, Pick’s disease, and Parkinson’s disease with amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).

      Multiple system atrophy is a rare disorder that affects the autonomic nervous system, causing symptoms such as orthostatic hypotension, urinary incontinence, and constipation. Progressive supranuclear palsy is characterized by the inability to move the eyes vertically, leading to difficulty with balance and coordination. Corticobasal degeneration affects both the motor and cognitive functions, causing symptoms such as apraxia, dystonia, and aphasia. Lewy body dementia is a type of dementia that shares symptoms with both Parkinson’s disease and Alzheimer’s disease. Pick’s disease is a rare form of dementia that affects the frontal and temporal lobes of the brain, leading to personality changes and language difficulties. Finally, Parkinson’s disease with amyotrophic lateral sclerosis is a rare combination of Parkinson’s disease and Lou Gehrig’s disease, which affects both the motor neurons and the muscles.

      In summary, the Parkinsonian plus syndromes are a group of disorders that share the core features of Parkinsonism but also have additional features that distinguish them from Parkinson’s disease. These syndromes can be challenging to diagnose and manage, and early recognition is crucial for appropriate treatment and care.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 45 - Out of the options provided, which one is the least probable cause of...

    Incorrect

    • Out of the options provided, which one is the least probable cause of postural hypotension?

      Your Answer: Quetiapine

      Correct Answer: Aripiprazole

      Explanation:

      Antipsychotics: Common Side Effects and Relative Adverse Effects

      Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.

      Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.

      Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.

      Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.

      Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.

      The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.

      Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
      Amisulpride – + + + – – +++
      Aripiprazole – +/- – +/- – – –
      Asenapine + + +/- +/- – – +/-
      Clozapine +++ +++ +++ – +++ +++ –
      Flupentixol + ++ + ++ ++ + +++
      Fluphenazine + + + +++ ++ + +++
      Haloperidol + + +/- +++ + + +++
      Olanzapine ++ +++ +++ +/- + + +
      Paliperidone + ++ + + + ++ +++
      Pimozide + + – + + + +++
      Quetiapine ++ ++ ++ – + ++ –
      Risperidone + ++ + + + ++ +++
      Zuclopenthixol ++ ++ + ++ ++ + +++

      Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 46 - What category does country of origin fall under in terms of data classification?...

    Correct

    • What category does country of origin fall under in terms of data classification?

      Your Answer: Nominal

      Explanation:

      Scales of Measurement in Statistics

      In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.

      Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.

      Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.

      Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 47 - Which option is not advised by NICE for the treatment of delirium? ...

    Correct

    • Which option is not advised by NICE for the treatment of delirium?

      Your Answer: Avoid regular visits from family

      Explanation:

      Delirium Management

      Pharmacological management of delirium includes the use of haloperidol as a prophylactic measure. NICE guidelines recommend short-term use of haloperidol in cases where delirium is associated with distress of risk to self/others. Quetiapine is also considered a first-choice option in many units. Lorazepam can be used as an alternative if haloperidol is contraindicated, but it is more likely to cause respiratory depression, over-sedation, and paradoxical excitement.

      Non-pharmacological management of delirium includes appropriate lighting and clear signage, talking to the person to reorient them, cognitively stimulating activities, regular visits from family and friends, and promoting good sleep patterns. Additional options such as donepezil, rivastigmine, melatonin, trazodone, and sodium valproate are not recommended. It is important to carefully consider the individual’s needs and medical history when choosing a management plan for delirium.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 48 - What is the term used to describe the inclination to attribute a shift...

    Correct

    • What is the term used to describe the inclination to attribute a shift in conduct of mood to a learning disability rather than the manifestation of a coexisting mental illness?

      Your Answer: Diagnostic overshadowing

      Explanation:

      Diagnostic Overshadowing in Learning Disability

      Diagnostic overshadowing is a common phenomenon where a change in behavior of emotion is attributed to learning disability rather than a coexisting mental disorder. This tendency can lead to misdiagnosis and inappropriate treatment, particularly in adults with learning disability admitted to psychiatric wards. It is important for healthcare professionals to consider the possibility of comorbid mental disorders and conduct a thorough assessment to ensure accurate diagnosis and appropriate treatment. By avoiding diagnostic overshadowing, individuals with learning disability can receive the necessary support and care for their mental health needs.

    • This question is part of the following fields:

      • Learning Disability
      26.8
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  • Question 49 - Which of the following statements accurately describes the relationship between odds and odds...

    Incorrect

    • Which of the following statements accurately describes the relationship between odds and odds ratio?

      Your Answer: When applied to survival analysis is termed the hazard ratio

      Correct Answer: The odds ratio approximates to relative risk if the outcome of interest is rare

      Explanation:

      Measures of Effect in Clinical Studies

      When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.

      To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.

      The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 50 - A patient in their late 50s with a history of schizophrenia attends the...

    Correct

    • A patient in their late 50s with a history of schizophrenia attends the out-patient clinic. They were discharged from hospital 9 months ago following a relapse of their psychotic illness. They report sustained improvement in their psychotic symptoms. During the clinic they complain that they are feeling very low, and lacking energy and they have felt this way for the past month. Their carer also comments that they are not attending to their self care as they usually do. What is the most probable diagnosis?

      Your Answer: Post-schizophrenic depression

      Explanation:

      If an individual experiences depression within a year of a relapse of schizophrenia, it should be classified as post-schizophrenic depression.

      Understanding Post-Psychotic Depression

      The term post-psychotic depression refers to three distinct groups of patients who experience depressive symptoms after an acute psychotic episode. The first group experiences depressive symptoms during the acute episode, which only become apparent as the positive psychotic symptoms resolve. The second group develops depressive symptoms as their positive psychotic symptoms resolve, while the third group experiences significant depressive symptoms after the acute episode has resolved.

      The timing of the onset of depressive symptoms is not important for diagnostic purposes. The ICD 10 diagnostic guidelines for post-schizophrenic depression require that the patient has met general criteria for schizophrenia within the past 12 months, with some schizophrenic symptoms still present but no longer dominating the clinical picture. The depressive symptoms must be prominent and distressing, fulfilling at least the criteria for a depressive episode, and have been present for at least two weeks. While they are rarely severe enough to meet the criteria for a severe depressive episode, they can still be debilitating for the patient.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 51 - A woman with an IQ of 28 has which of the following? ...

    Correct

    • A woman with an IQ of 28 has which of the following?

      Your Answer: Severe intellectual disability

      Explanation:

      Classification of Intellectual Disability

      Intellectual disability affects approximately 2% of the general population, with an estimated 828,000 adults aged 18 of older affected in England alone. Those with an IQ below 70 are considered to have an intellectual disability, with the average IQ being 100. The severity of intellectual disability is categorized based on IQ scores, with mild intellectual disability being the most common (85% of cases) and profound intellectual disability being the least common (1-2% of cases). People with intellectual disability may require varying levels of support in their daily lives, depending on their individual needs. It is important to use the preferred term ‘people with intellectual disability’ when referring to individuals with this condition.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 52 - What is a commonly known negative outcome of undergoing psychodynamic psychotherapy? ...

    Correct

    • What is a commonly known negative outcome of undergoing psychodynamic psychotherapy?

      Your Answer: Malignant regression and suicide

      Explanation:

      Selecting appropriate psychological interventions for individual patients can be challenging. Psychodynamic psychotherapy may not always be suitable for patients as it can potentially exacerbate their symptoms and lead to dangerous behaviors such as self-harm, suicide, violence, and stalking. However, prolonged psychosis is unlikely to occur unless the patient has a severe and enduring mental illness, which may make them unsuitable for psychodynamic psychotherapy. While the cost of attending sessions and ambivalence towards decision-making may be minor adverse effects, increased distress after sessions can occur, although it may indicate an appropriate response to the session’s content. Nonetheless, patients should not leave feeling uncontained.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 53 - As a consultant psychiatrist, you are requested by a lawyer to provide a...

    Correct

    • As a consultant psychiatrist, you are requested by a lawyer to provide a psychiatric evaluation for a 25-year-old woman who is presently on bail after being accused of murder. The lawyer asks you to assess whether the defence of 'diminished responsibility' is applicable. You inform the lawyer that this defence is only relevant to a specific offence. What is that offence?

      Your Answer: Murder

      Explanation:

      The defence of diminished responsibility is applicable only to cases of murder. If successfully argued, the accused may be convicted of manslaughter instead of murder, resulting in a less severe punishment. Two partial defences to murder are available, namely provocation and diminished responsibility. The insanity defence is a complete defence to murder, but it can be used in other criminal charges as well.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 54 - What is the term used to describe the point at which a researcher...

    Incorrect

    • What is the term used to describe the point at which a researcher chooses to reject a null hypothesis?

      Your Answer: Beta level

      Correct Answer: Alpha level

      Explanation:

      If the p-value is lower than the predetermined alpha level of 0.05, the outcome is considered significant.

      Understanding Hypothesis Testing in Statistics

      In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.

      The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.

      Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.

      P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      4.7
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  • Question 55 - Which statement accurately reflects safe alcohol consumption limits? ...

    Correct

    • Which statement accurately reflects safe alcohol consumption limits?

      Your Answer: The Department of Health currently recommends weekly safe drinking limits of 14 U for men and 14 U for women

      Explanation:

      The safe drinking limit recommended by the BMA for both men and women is 21 U per week.

      Alcohol Units and Safe Drinking Limits in the UK

      The issue of safe drinking limits is a controversial one, with different bodies having different recommendations. In the UK, recommendations are sometimes given in grams of pure alcohol, with one unit equaling 8g. The UK government first recommended in 1992 that for a single week, 21 units for men and 14 units for women was the safe drinking limit. However, in 1995 they produced a report called ‘sensible drinking’, which effectively raised the weekly limits to 28 units for men and 21 units for women. The British Medical Association (BMA) responded to this change, along with the Royal College of Psychiatrists, saying that the original limits should not be relaxed.

      In August 2016, the UK Chief Medical Officers Low Risk Drinking Guidelines revised the limits down so that the upper safe limit is now 14 units for both men and women. The Royal College of Psychiatrists welcomed this new guidance, stating that both men and women drinking less than 14 units of alcohol per week (around 7 pints of ordinary strength beer) will be at a low risk for illnesses like heart disease, liver disease, of cancer. However, for people who do drink, they should have three of more alcohol-free days to allow their bodies the opportunity to recover from the harmful effects of alcohol. The BMA also supports this new guidance.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 56 - What was the most common disorder identified in the Epidemiological Catchment Area study?...

    Incorrect

    • What was the most common disorder identified in the Epidemiological Catchment Area study?

      Your Answer: Anxiety disorders

      Correct Answer: Substance misuse disorders

      Explanation:

      The most common disorder identified in the study was substance misuse, which encompassed both alcohol and drug use. This finding differs from the National Psychiatric Morbidity Survey, which reported neurotic disorders as the most prevalent. However, this discrepancy is likely due to differences in study design rather than actual differences in prevalence. The ECA study specifically identified high rates of alcohol dependence and illicit drug use, but presented these findings as distinct categories.

      Epidemiological Catchment Area Study: A Landmark Community-Based Survey

      The Epidemiological Catchment Area Study (ECA) was a significant survey conducted in five US communities from 1980-1985. The study included 20,000 participants, with 3000 community residents and 500 residents of institutions sampled in each site. The Diagnostic Interview Schedule (DIS) was used to conduct two interviews over a year with each participant.

      However, the DIS diagnosis of schizophrenia was not consistent with psychiatrists’ classification, with only 20% of cases identified by the DIS in the Baltimore ECA site matching the psychiatrist’s diagnosis. Despite this, the ECA produced valuable findings, including a lifetime prevalence rate of 32.3% for any disorder, 16.4% for substance misuse disorder, 14.6% for anxiety disorder, 8.3% for affective disorder, 1.5% for schizophrenia and schizophreniform disorder, and 0.1% for somatization disorder.

      The ECA also found that phobia had a one-month prevalence of 12.5%, generalized anxiety and depression had a prevalence of 8.5%, obsessive-compulsive disorder had a prevalence of 2.5%, and panic had a prevalence of 1.6%. Overall, the ECA was a landmark community-based survey that provided valuable insights into the prevalence of mental disorders in the US.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 57 - Which study design involves conducting an experiment? ...

    Correct

    • Which study design involves conducting an experiment?

      Your Answer: A randomised control study

      Explanation:

      Types of Primary Research Studies and Their Advantages and Disadvantages

      Primary research studies can be categorized into six types based on the research question they aim to address. The best type of study for each question type is listed in the table below. There are two main types of study design: experimental and observational. Experimental studies involve an intervention, while observational studies do not. The advantages and disadvantages of each study type are summarized in the table below.

      Type of Question Best Type of Study

      Therapy Randomized controlled trial (RCT), cohort, case control, case series
      Diagnosis Cohort studies with comparison to gold standard test
      Prognosis Cohort studies, case control, case series
      Etiology/Harm RCT, cohort studies, case control, case series
      Prevention RCT, cohort studies, case control, case series
      Cost Economic analysis

      Study Type Advantages Disadvantages

      Randomized Controlled Trial – Unbiased distribution of confounders – Blinding more likely – Randomization facilitates statistical analysis – Expensive – Time-consuming – Volunteer bias – Ethically problematic at times
      Cohort Study – Ethically safe – Subjects can be matched – Can establish timing and directionality of events – Eligibility criteria and outcome assessments can be standardized – Administratively easier and cheaper than RCT – Controls may be difficult to identify – Exposure may be linked to a hidden confounder – Blinding is difficult – Randomization not present – For rare disease, large sample sizes of long follow-up necessary
      Case-Control Study – Quick and cheap – Only feasible method for very rare disorders of those with long lag between exposure and outcome – Fewer subjects needed than cross-sectional studies – Reliance on recall of records to determine exposure status – Confounders – Selection of control groups is difficult – Potential bias: recall, selection
      Cross-Sectional Survey – Cheap and simple – Ethically safe – Establishes association at most, not causality – Recall bias susceptibility – Confounders may be unequally distributed – Neyman bias – Group sizes may be unequal
      Ecological Study – Cheap and simple – Ethically safe – Ecological fallacy (when relationships which exist for groups are assumed to also be true for individuals)

      In conclusion, the choice of study type depends on the research question being addressed. Each study type has its own advantages and disadvantages, and researchers should carefully consider these when designing their studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 58 - You are providing oral testimony in Court in the case of a 30-year-old...

    Incorrect

    • You are providing oral testimony in Court in the case of a 30-year-old patient with a mixed personality disorder (with emotionally unstable and dissocial features) and co-occurring substance misuse (opiate dependence). The patient has been found guilty of Grievous Bodily Harm following a violent assault during a burglary, presumably to fund drug use.

      The patient is well-known to local psychiatric services and has had multiple brief admissions in the past after parasuicidal behavior. The patient has been detained in the local Medium Secure Unit for 12 months under section 38 of the Mental Health Act for assessment of his treatability in hospital. The patient has engaged with treatment, although there are concerns among the clinical team that this engagement is superficial and the patient may be using the hospital system to avoid receiving a custodial sentence.

      Based on this information, what would be the most appropriate medical recommendation for sentencing?

      Your Answer: Section 37/41 of the Mental Health Act

      Correct Answer: Section 45a of the Mental Health Act

      Explanation:

      Section 45a of the Mental Health Act allows for a Hybrid Order, which combines both a Mental Health and Criminal Justice component to a sentence. This means that the offender would receive treatment in a hospital initially, but would also be given a prison sentence. Once the treatment is complete, the offender would return to prison to serve the remaining time.

      Extending the offender’s section 38 assessment in hospital post-conviction is not possible as it can only last for a maximum of one year.

      The most appropriate sentencing option could be Section 37/41, which is a Hospital Order with Restrictions. However, it is uncertain if the offender is treatable as there seems to be little connection between his mental disorder and offending behavior.

      Section 47/49 is for the transfer of sentenced prisoners and is not applicable in this case.

      No hospital disposal is also an option, but the offender has responded well to treatment and has a mental disorder, which makes him suitable for disposal under the Mental Health Act, even if he does not have a mental illness.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 59 - What is the most effective treatment for alleviating symptoms of premenstrual syndrome? ...

    Correct

    • What is the most effective treatment for alleviating symptoms of premenstrual syndrome?

      Your Answer: SSRIs

      Explanation:

      First-line treatment for depression typically involves SSRIs, which have demonstrated consistent efficacy and can be effective even with intermittent use.

      There is currently no evidence to support the use of vitamin supplements for the treatment of premenstrual dysphoric disorder. However, lifestyle changes such as regular exercise, a healthy diet, and stress reduction techniques may be helpful in managing symptoms. It is important to consult with a healthcare provider to determine the best course of treatment for individual cases of PMDD.

    • This question is part of the following fields:

      • General Adult Psychiatry
      6.4
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  • Question 60 - What is the term used to refer to a psychotic episode that is...

    Correct

    • What is the term used to refer to a psychotic episode that is brief and lasts for less than 3 months?

      Your Answer: Bouffée délirante

      Explanation:

      The term Bouffée délirante is a distinct and historical French diagnosis used to describe a brief episode of psychosis characterized by sudden and severe psychotic symptoms that fully resolve. The oneiroid state refers to a dreamy mental state. Latent schizophrenia is an outdated term that was previously used to describe individuals with borderline, schizoid, and schizotypal personality disorders.

      – Schizophrenia and other primary psychotic disorders are characterized by impairments in reality testing and alterations in behavior.
      – Schizophrenia is a chronic mental health disorder with symptoms including delusions, hallucinations, disorganized speech of behavior, and impaired cognitive ability.
      – The essential features of schizophrenia include persistent delusions, persistent hallucinations, disorganized thinking, experiences of influence, passivity of control, negative symptoms, grossly disorganized behavior, and psychomotor disturbances.
      – Schizoaffective disorder is diagnosed when all diagnostic requirements for schizophrenia are met concurrently with mood symptoms that meet the diagnostic requirements of a moderate or severe depressive episode, a manic episode, of a mixed episode.
      – Schizotypal disorder is an enduring pattern of unusual speech, perceptions, beliefs, and behaviors that are not of sufficient intensity of duration to meet the diagnostic requirements of schizophrenia, schizoaffective disorder, of delusional disorder.
      – Acute and transient psychotic disorder is characterized by an acute onset of psychotic symptoms, which can include delusions, hallucinations, disorganized thinking, of experiences of influence, passivity of control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks.
      – Delusional disorder is diagnosed when there is a presence of a delusion of set of related delusions, typically persisting for at least 3 months and often much longer, in the absence of a depressive, manic, of mixed episode.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 61 - What substance hinders the transformation of aldehyde into acetic acid? ...

    Correct

    • What substance hinders the transformation of aldehyde into acetic acid?

      Your Answer: Disulfiram

      Explanation:

      Anticonvulsants are not recommended for relapse prevention in alcohol dependence. While some studies have shown potential benefits for certain anticonvulsants, such as carbamazepine and valproate, the evidence is not strong enough to support their routine use. Additionally, these drugs can have significant side effects, including liver toxicity and blood disorders, and require careful monitoring. Therefore, they are not recommended by NICE for this indication.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 62 - What is a true statement about Kleine-Levin syndrome? ...

    Correct

    • What is a true statement about Kleine-Levin syndrome?

      Your Answer: It is associated with hyperphagia

      Explanation:

      Kleine-Levin Syndrome: A Mysterious Condition

      Kleine-Levin syndrome is a peculiar disorder that typically affects adolescent boys. It is characterized by an excessive need for sleep and an insatiable appetite when awake. The condition is also associated with emotional and behavioral issues such as irritability and aggression.

      The onset of symptoms is sudden and can last for several days to weeks before disappearing. This is followed by a period of normalcy, only to be followed by another episode. This pattern can continue for years, but the severity of symptoms tends to decrease over time. During the periods between episodes, those affected appear to be perfectly healthy with no signs of physical of behavioral dysfunction. The media has dubbed this condition as Sleeping Beauty syndrome.

      Despite extensive research, the cause of Kleine-Levin syndrome remains unknown. However, the prognosis is generally positive, with most individuals making a full recovery.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 63 - What is the classification of reactive attachment disorder in the ICD-11? ...

    Incorrect

    • What is the classification of reactive attachment disorder in the ICD-11?

      Your Answer: Those with the condition show willingness to go off with an unfamiliar adult with minimal of no hesitation

      Correct Answer: It cannot be diagnosed before the age of 1

      Explanation:

      A diagnosis of reactive attachment disorder cannot be made until the child reaches at least one year of age.

      Disorders resulting from inadequate caregiving during childhood are recognised by both the DSM-5 and the ICD-11, with two distinct forms of disorder identified: Reactive attachment disorder and Disinhibited social engagement disorder. Reactive attachment disorder is characterised by social withdrawal and aberrant attachment behaviour, while Disinhibited social engagement disorder is characterised by socially disinhibited behaviour. Diagnosis of these disorders involves a history of grossly insufficient care, and symptoms must be evident before the age of 5. Treatment options include video feedback programs for preschool aged children and parental training with group play sessions for primary school aged children. Pharmacological interventions are not recommended in the absence of coexisting mental health problems.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      44.8
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  • Question 64 - What is the origin of the psychodynamic concept of 'containment'? ...

    Incorrect

    • What is the origin of the psychodynamic concept of 'containment'?

      Your Answer: Winnicott

      Correct Answer: Bion

      Explanation:

      The Significance of Containment in Therapeutic Relationships

      Containment is a term coined by Bion to describe the process of emotional containment, which is best exemplified by the relationship between a mother and her infant. Infants often project their unbearable feelings onto their mothers, who receive and accommodate them for a while, making them tolerable and acceptable again to the child.

      In therapeutic relationships, containment plays a crucial role. It occurs when one person receives and comprehends the emotional communication of another without being overwhelmed by it. The receiver then processes the information and communicates understanding and recognition back to the other person. This process can help restore the other person’s capacity to think.

      Overall, containment is an essential aspect of therapeutic relationships, as it allows individuals to express their emotions without fear of being judged of rejected. It creates a safe space for individuals to explore their feelings and thoughts, leading to greater self-awareness and personal growth.

    • This question is part of the following fields:

      • Psychotherapy
      4.6
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  • Question 65 - A psychologist aims to conduct a qualitative study to explore the experiences of...

    Incorrect

    • A psychologist aims to conduct a qualitative study to explore the experiences of elderly patients referred to the outpatient clinic. To obtain a sample, the psychologist asks the receptionist to hand an invitation to participate in the study to all follow-up patients who attend for an appointment. The recruitment phase continues until a total of 30 elderly individuals agree to be in the study.

      How is this sampling method best described?

      Your Answer: Snowball sampling

      Correct Answer: Opportunistic sampling

      Explanation:

      Qualitative research is a method of inquiry that seeks to understand the meaning and experience dimensions of human lives and social worlds. There are different approaches to qualitative research, such as ethnography, phenomenology, and grounded theory, each with its own purpose, role of the researcher, stages of research, and method of data analysis. The most common methods used in healthcare research are interviews and focus groups. Sampling techniques include convenience sampling, purposive sampling, quota sampling, snowball sampling, and case study sampling. Sample size can be determined by data saturation, which occurs when new categories, themes, of explanations stop emerging from the data. Validity can be assessed through triangulation, respondent validation, bracketing, and reflexivity. Analytical approaches include content analysis and constant comparison.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      84.6
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  • Question 66 - A study looks into the effects of alcohol consumption on female psychiatrists. A...

    Correct

    • A study looks into the effects of alcohol consumption on female psychiatrists. A group are selected and separated by the amount they drink into four groups. The first group drinks no alcohol, the second occasionally, the third often, and the fourth large and regular amounts. The group is followed up over the next ten years and the rates of cirrhosis are recorded.
      What is the dependent variable in the study?

      Your Answer: Rates of liver cirrhosis

      Explanation:

      Understanding Stats Variables

      Variables are characteristics, numbers, of quantities that can be measured of counted. They are also known as data items. Examples of variables include age, sex, business income and expenses, country of birth, capital expenditure, class grades, eye colour, and vehicle type. The value of a variable may vary between data units in a population. In a typical study, there are three main variables: independent, dependent, and controlled variables.

      The independent variable is something that the researcher purposely changes during the investigation. The dependent variable is the one that is observed and changes in response to the independent variable. Controlled variables are those that are not changed during the experiment. Dependent variables are affected by independent variables but not by controlled variables, as these do not vary throughout the study.

      For instance, a researcher wants to test the effectiveness of a new weight loss medication. Participants are divided into three groups, with the first group receiving a placebo (0mg dosage), the second group a 10 mg dose, and the third group a 40 mg dose. After six months, the participants’ weights are measured. In this case, the independent variable is the dosage of the medication, as that is what is being manipulated. The dependent variable is the weight, as that is what is being measured.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      52.8
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  • Question 67 - A 10 year old boy has been referred by his GP due to...

    Correct

    • A 10 year old boy has been referred by his GP due to concerns of possible ADHD. He has a history of abnormal liver function tests with an unknown cause. His mother is curious about medication options. What medication is known to be linked with severe liver damage and should be avoided in this situation?

      Your Answer: Atomoxetine

      Explanation:

      There have been rare cases of liver injury associated with the use of atomoxetine. The exact mechanism is not fully understood, but it seems to cause a type of hepatitis that can be reversed if the medication is discontinued promptly. Although atomoxetine is not prohibited for use in patients with liver insufficiency, it may be advisable to avoid it in such cases, considering the patient’s medical history.

      ADHD (Diagnosis and Management in Children)

      ADHD is a behavioural syndrome characterised by symptoms of inattention, hyperactivity, and impulsivity. The DSM-5 and ICD-11 provide diagnostic criteria for the condition, with both recognising three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined.

      Treatment for children under 5 involves offering an ADHD-focused group parent-training programme as a first-line option. Medication should only be considered after obtaining advice from a specialist ADHD service. For children and young people aged 5-18, advice and support should be given, along with an ADHD-focused group parent-training programme. Medication should only be offered if ADHD symptoms persist after environmental modifications have been implemented and reviewed. Cognitive behavioural therapy may also be considered for those who have benefited from medication but still experience significant impairment.

      NICE advises against elimination diets, dietary fatty acid supplementation, and the use of the ‘few foods diet’. Methylphenidate of lisdexamfetamine is the first-line medication option, with dexamphetamine considered for those who respond to lisdexamfetamine but cannot tolerate the longer effect profile. Atomoxetine of guanfacine may be offered for those who cannot tolerate methylphenidate of lisdexamfetamine. Clonidine and atypical antipsychotics should only be used with advice from a tertiary ADHD service.

      Drug holidays may be considered for children and young people who have not met the expected height for their age due to medication. However, NICE advises that withdrawal from treatment is associated with a risk of symptom exacerbation.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 68 - What is true about the 2014 Adult Psychiatric Morbidity Survey? ...

    Correct

    • What is true about the 2014 Adult Psychiatric Morbidity Survey?

      Your Answer: People in prisons were not included in the sample

      Explanation:

      The APMS has a significant drawback in that it solely relies on household data and does not incorporate data from institutions like prisons.

      Adult Psychiatric Morbidity Survey

      The Adult Psychiatric Morbidity Survey (APMS), also known as the National Psychiatric Morbidity Survey, is conducted every 7 years to monitor the prevalence of mental illness and access to treatment in the general population of England. The survey obtains a stratified random sample representative of the population living in private households by using postcodes. The information is gathered through questionnaires and interviews to screen for a range of mental disorders and risk factors. However, the survey does not collect data on individuals under the age of 16. The study does not include people living in institutional settings such as prisons of care homes, of those who are homeless of living in temporary housing.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 69 - A teenage male patient taking risperidone reports sexual dysfunction and is diagnosed with...

    Correct

    • A teenage male patient taking risperidone reports sexual dysfunction and is diagnosed with elevated prolactin levels. What would be the most appropriate replacement medication?

      Your Answer: Quetiapine

      Explanation:

      Management of Hyperprolactinaemia

      Hyperprolactinaemia is often associated with the use of antipsychotics and occasionally antidepressants. Dopamine inhibits prolactin, and dopamine antagonists increase prolactin levels. Almost all antipsychotics cause changes in prolactin, but some do not increase levels beyond the normal range. The degree of prolactin elevation is dose-related. Hyperprolactinaemia is often asymptomatic but can cause galactorrhoea, menstrual difficulties, gynaecomastia, hypogonadism, sexual dysfunction, and an increased risk of osteoporosis and breast cancer in psychiatric patients.

      Patients should have their prolactin measured before antipsychotic therapy and then monitored for symptoms at three months. Annual testing is recommended for asymptomatic patients. Antipsychotics that increase prolactin should be avoided in patients under 25, patients with osteoporosis, patients with a history of hormone-dependent cancer, and young women. Samples should be taken at least one hour after eating of waking, and care must be taken to avoid stress during the procedure.

      Treatment options include referral for tests to rule out prolactinoma if prolactin is very high, making a joint decision with the patient about continuing if prolactin is raised but not symptomatic, switching to an alternative antipsychotic less prone to hyperprolactinaemia if prolactin is raised and the patient is symptomatic, adding aripiprazole 5mg, of adding a dopamine agonist such as amantadine of bromocriptine. Mirtazapine is recommended for symptomatic hyperprolactinaemia associated with antidepressants as it does not raise prolactin levels.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 70 - For women who have borderline personality disorder and engage in repeated self-harm, what...

    Correct

    • For women who have borderline personality disorder and engage in repeated self-harm, what treatment is suggested?

      Your Answer: Dialectical behaviour therapy

      Explanation:

      The NICE guidelines for borderline personality disorder recommend that psychological treatment should be individualized to meet the specific needs of each patient. However, for women who experience recurrent self-harm and have BPD, dialectical behavioral therapy is recommended as a treatment option. These guidelines provide a framework for healthcare professionals to develop a personalized treatment plan for individuals with BPD.

      Personality Disorder (Borderline)

      History and Terminology

      The term borderline personality disorder originated from early 20th-century theories that the disorder was on the border between neurosis and psychosis. The term borderline was coined by Adolph Stern in 1938. Subsequent attempts to define the condition include Otto Kernberg’s borderline personality organization, which identified key elements such as ego weakness, primitive defense mechanisms, identity diffusion, and unstable reality testing.

      Features

      The DSM-5 and ICD-11 both define borderline personality disorder as a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Symptoms include efforts to avoid abandonment, unstable relationships, impulsivity, suicidal behavior, affective instability, chronic feelings of emptiness, difficulty controlling temper, and transient dissociative symptoms.

      Abuse

      Childhood abuse and neglect are extremely common among borderline patients, with up to 87% having suffered some form of trauma. The effect of abuse seems to depend on the stage of psychological development at which it takes place.

      comorbidity

      Borderline PD patients are more likely to receive a diagnosis of major depressive disorder, bipolar disorder, panic disorder, PTSD, OCD, eating disorders, and somatoform disorders.

      Psychological Therapy

      Dialectical Behavioral Therapy (DBT), Mentalization-Based Treatment (MBT), Schema-Focused Therapy (SFT), and Transference-Focused Psychotherapy (TFP) are the main psychological treatments for BPD. DBT is the most well-known and widely available, while MBT focuses on improving mentalization, SFT generates structural changes to a patient’s personality, and TFP examines dysfunctional interpersonal dynamics that emerge in interactions with the therapist in the transference.

      NICE Guidelines

      The NICE guidelines on BPD offer very little recommendations. They do not recommend medication for treatment of the core symptoms. Regarding psychological therapies, they make reference to DBT and MBT being effective but add that the evidence base is too small to draw firm conclusions. They do specifically say Do not use brief psychotherapeutic interventions (of less than 3 months’ duration) specifically for borderline personality disorder of for the individual symptoms of the disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 71 - What is the NNT for the following study data in a population of...

    Incorrect

    • What is the NNT for the following study data in a population of patients over the age of 65?
      Medication Group vs Control Group
      Events: 30 vs 80
      Non-events: 120 vs 120
      Total subjects: 150 vs 200.

      Your Answer: 3

      Correct Answer: 5

      Explanation:

      To calculate the event rates for the medication and control groups, we divide the number of events by the total number of subjects in each group. For the medication group, the event rate is 0.2 (30/150), and for the control group, it is 0.4 (80/200).

      We can also calculate the absolute risk reduction (ARR) by subtracting the event rate in the medication group from the event rate in the control group: ARR = CER – EER = 0.4 – 0.2 = 0.2.

      Finally, we can use the ARR to calculate the number needed to treat (NNT), which represents the number of patients who need to be treated with the medication to prevent one additional event compared to the control group. NNT = 1/ARR = 1/0.2 = 5.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      31.6
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  • Question 72 - What is a true statement about tardive dyskinesia that is linked to antipsychotic...

    Correct

    • What is a true statement about tardive dyskinesia that is linked to antipsychotic medication?

      Your Answer: Dose reduction may worsen tardive dyskinesia

      Explanation:

      According to a Cochrane review, while Ginkgo biloba may have the potential to decrease TD, there is insufficient evidence to support its regular use as a recommended treatment. Additionally, it should be noted that reducing medication dosage may initially exacerbate TD symptoms.

      Tardive Dyskinesia: Symptoms, Causes, Risk Factors, and Management

      Tardive dyskinesia (TD) is a condition that affects the face, limbs, and trunk of individuals who have been on neuroleptics for months to years. The movements fluctuate over time, increase with emotional arousal, decrease with relaxation, and disappear with sleep. The cause of TD remains theoretical, but the postsynaptic dopamine (D2) receptor supersensitivity hypothesis is the most persistent. Other hypotheses include the presynaptic dopaminergic/noradrenergic hyperactivity hypothesis, the cholinergic interneuron burnout hypothesis, the excitatory/oxidative stress hypothesis, and the synaptic plasticity hypothesis. Risk factors for TD include advancing age, female sex, ethnicity, longer illness duration, intellectual disability and brain damage, negative symptoms in schizophrenia, mood disorders, diabetes, smoking, alcohol and substance misuse, FGA vs SGA treatment, higher antipsychotic dose, anticholinergic co-treatment, and akathisia.

      Management options for TD include stopping any anticholinergic, reducing antipsychotic dose, changing to an antipsychotic with lower propensity for TD, and using tetrabenazine, vitamin E, of amantadine as add-on options. Clozapine is the antipsychotic most likely to be associated with resolution of symptoms. Vesicular monoamine transporter type 2 (VMAT2) inhibitors are agents that cause a depletion of neuroactive peptides such as dopamine in nerve terminals and are used to treat chorea due to neurodegenerative diseases of dyskinesias due to neuroleptic medications (tardive dyskinesia).

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 73 - In the management of acute mania in adult patients, NICE recommends which of...

    Correct

    • In the management of acute mania in adult patients, NICE recommends which of the following?

      Your Answer: Risperidone

      Explanation:

      Bipolar Disorder: Diagnosis and Management

      Bipolar disorder is a lifelong condition characterized by episodes of mania or hypomania and episodes of depressed mood. The peak age of onset is 15-19 years, and the lifetime prevalence of bipolar I disorders is estimated to be around 2.1%. The diagnosis of bipolar disorder is based on the presence of manic or hypomanic episodes, which are characterized by elevated of expansive mood, rapid speech, and increased activity of energy. Psychotic symptoms, such as delusions and hallucinations, may also be present.

      Bipolar depression differs from unipolar depression in several ways, including more rapid onset, more frequent episodes, and shorter duration. Rapid cycling is a qualifier that can be applied to bipolar I of bipolar II disorder and is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode.

      The management of bipolar disorder involves acute and long-term interventions. Acute management of mania or hypomania may involve stopping antidepressants and offering antipsychotics of mood stabilizers. Long-term management may involve psychological interventions and pharmacological treatments such as lithium, valproate, of olanzapine.

      It is important to note that valproate should not be offered to women of girls of childbearing potential for long-term bipolar disorder unless other options are ineffective of not tolerated and a pregnancy prevention program is in place. Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder.

      Overall, the diagnosis and management of bipolar disorder require a comprehensive approach that takes into account the individual’s symptoms, history, and preferences.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 74 - What is the most frequently reported symptom by caregivers in cases of Munchausen's...

    Incorrect

    • What is the most frequently reported symptom by caregivers in cases of Munchausen's syndrome by proxy?

      Your Answer: Seizures

      Correct Answer: Apnoea

      Explanation:

      Munchausen’s syndrome by proxy, also known as fabricated or induced illness, is a rare form of child abuse where a caregiver, usually the mother, falsifies illness in a child by fabricating of producing symptoms and presenting the child for medical care while denying knowledge of the cause. It is most commonly seen in children under the age of 4, with symptoms including apnoea, anorexia, feeding problems, and seizures. The disorder is now recognized as ‘Factitious Disorder Imposed on Another’ in the DSM-5, with criteria including falsification of physical of psychological signs of symptoms, presentation of the victim as ill, and evident deceptive behavior. The perpetrator, not the victim, receives this diagnosis. Presenting signs of symptoms can take the form of covert injury, fabrication of symptoms, of exaggeration of existing symptoms. Symptoms are often subjective and easy to fake.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      60.2
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  • Question 75 - An 87 year old Afro-Caribbean man who has been taking clozapine for the...

    Incorrect

    • An 87 year old Afro-Caribbean man who has been taking clozapine for the past 6 months develops agranulocytosis following an increase in the dose. He is heavy smoker and wonders if this has caused the problem. Regarding his case, which of the following is most likely to have contributed?

      Your Answer: The recent dose increase

      Correct Answer: His age

      Explanation:

      Age is the primary factor contributing to agranulocytosis, and recent dose increase and smoking status are not significant factors. The risk factors for agranulocytosis and neutropenia differ, suggesting distinct underlying mechanisms for each disorder. Agranulocytosis is more prevalent in women and Asians, with a higher incidence in older individuals. In contrast, neutropenia is more common in black individuals, but not associated with race of age.

      Clozapine is an effective antipsychotic drug used in the management of treatment-resistant schizophrenia (TRS). It was reintroduced in the 1990s with mandatory blood monitoring due to the risk of agranulocyte

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 76 - What is the relationship between depression and myocardial infarction? ...

    Correct

    • What is the relationship between depression and myocardial infarction?

      Your Answer: Sertraline has been shown to be safe for use in patients who have recently had a myocardial infarction

      Explanation:

      According to a study, the combination of clopidogrel and an SSRI was found to be more effective in reducing the risk of cardiovascular events compared to dual antiplatelet therapy alone. However, the risk of bleeding was higher among patients taking clopidogrel and an SSRI, although the sample size was not sufficient to confirm this finding. The results were consistent regardless of the affinity of the SSRI. (Labos, 2011)

      SSRI for Post-MI Depression

      Post-myocardial infarction (MI), approximately 20% of people develop depression, which can worsen prognosis if left untreated. Selective serotonin reuptake inhibitors (SSRIs) are the preferred antidepressant group for post-MI depression. However, they can increase the risk of bleeding, especially in those using anticoagulation. Mirtazapine is an alternative option, but it is also associated with bleeding. The SADHART study found sertraline to be a safe treatment for depression post-MI. It is important to consider the bleeding risk when choosing an antidepressant for post-MI depression.

      References:
      – Davies, P. (2004). Treatment of anxiety and depressive disorders in patients with cardiovascular disease. BMJ, 328, 939-943.
      – Glassman, A. H. (2002). Sertraline treatment of major depression in patients with acute MI of unstable angina. JAMA, 288, 701-709.
      – Goodman, M. (2008). Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients. Journal of Psychiatric Research, 42, 670-675.
      – Na, K. S. (2018). Can we recommend mirtazapine and bupropion for patients at risk for bleeding? A systematic review and meta-analysis. Journal of Affective Disorders, 225, 221-226.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 77 - What is the most accurate definition of 'opportunity cost'? ...

    Correct

    • What is the most accurate definition of 'opportunity cost'?

      Your Answer: The forgone benefit that would have been derived by an option not chosen

      Explanation:

      Opportunity Cost in Economics: Understanding the Value of Choices

      Opportunity cost is a crucial concept in economics that helps us make informed decisions. It refers to the value of the next-best alternative that we give up when we choose one option over another. This concept is particularly relevant when we have limited resources, such as a fixed budget, and need to make choices about how to allocate them.

      For instance, if we decide to spend our money on antidepressants, we cannot use that same money to pay for cognitive-behavioral therapy (CBT). Both options have a value, but we have to choose one over the other. The opportunity cost of choosing antidepressants over CBT is the value of the benefits we would have received from CBT but did not because we chose antidepressants instead.

      To compare the opportunity cost of different choices, economists often use quality-adjusted life years (QALYs). QALYs measure the value of health outcomes in terms of both quantity (life years gained) and quality (health-related quality of life). By using QALYs, we can compare the opportunity cost of different healthcare interventions and choose the one that provides the best value for our resources.

      In summary, understanding opportunity cost is essential for making informed decisions in economics and healthcare. By recognizing the value of the alternatives we give up, we can make better choices and maximize the benefits we receive from our limited resources.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      13.5
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  • Question 78 - What is the purpose of using the DAI and MARS scales for assessment?...

    Correct

    • What is the purpose of using the DAI and MARS scales for assessment?

      Your Answer: Compliance with medication

      Explanation:

      Non-Compliance

      Studies have shown that adherence rates in patients with psychosis who are treated with antipsychotics can range from 25% to 75%. Shockingly, approximately 90% of those who are non-compliant admit to doing so intentionally (Maudsley 12th edition). After being discharged from the hospital, the expected non-compliance rate in individuals with schizophrenia is as follows (Maudsley 12th Edition): 25% at ten days, 50% at one year, and 75% at two years. The Drug Attitude Inventory (DAI) is a useful tool for assessing a patient’s attitude towards medication and predicting compliance. Other scales that can be used include the Rating of Medication Influences Scale (ROMI), the Beliefs about Medication Questionnaire, and the Medication Adherence Rating Scale (MARS).

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 79 - Which term is not linked to Winnicott? ...

    Correct

    • Which term is not linked to Winnicott?

      Your Answer: Identity crisis

      Explanation:

      Erik Erikson coined the term identity crisis.

      Winnicott: An Overview

      Donald Winnicott, a British paediatrician and psychotherapist, is known for his contributions to the field of child development and psychoanalysis. He introduced several concepts that are still relevant today.

      Good Enough Mother: Winnicott emphasised the importance of being a good enough mother rather than a perfect one. He believed that children needed someone who would attend to them but not immediately so that they could learn to tolerate frustration.

      Holding Environment: This refers to the psychic and physical space between the mother and infant that ensures the mother is there for the child when needed but allows them to explore independently when ready.

      Transitional Object: Winnicott talked about the two separate realities for a child, the ‘me’ and the ‘not me’. The transitional object is one that represents another (e.g. Mother) and is regarded as the first ‘not me’ possession.

      False Self: Winnicott described the situation of ‘not good-enough mothering’ as one in which the mother (consciously of unconsciously) is unable to respond adequately to her infant’s spontaneous behaviour (true self), but tends to impose her own wishes and desires (e.g. for an ‘ideal’ child). This may lead the infant to an adaptation on the basis of ’compliance’ (false self) and later, in adulthood, to the loss of a sense of personal autonomy and integrity.

    • This question is part of the following fields:

      • Psychotherapy
      2
      Seconds
  • Question 80 - The following  drug should be avoided in people with epilepsy who develop depression?...

    Correct

    • The following  drug should be avoided in people with epilepsy who develop depression?

      Your Answer: Bupropion

      Explanation:

      Compared to the other options, bupropion is classified as high risk for individuals with epilepsy. The remaining options are considered low risk of likely low risk.

      Psychotropics and Seizure Threshold in People with Epilepsy

      People with epilepsy are at an increased risk for various mental health conditions, including depression, anxiety, psychosis, and suicide. It is important to note that the link between epilepsy and mental illness is bidirectional, as patients with mental health conditions also have an increased risk of developing new-onset epilepsy. Psychotropic drugs are often necessary for people with epilepsy, but they can reduce the seizure threshold and increase the risk of seizures. The following tables provide guidance on the seizure risk associated with different classes of antidepressants, antipsychotics, and ADHD medications. It is important to use caution and carefully consider the risks and benefits of these medications when treating people with epilepsy.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 81 - If the new antihypertensive therapy is implemented for the secondary prevention of stroke,...

    Correct

    • If the new antihypertensive therapy is implemented for the secondary prevention of stroke, it would result in an absolute annual risk reduction of 0.5% compared to conventional therapy. However, the cost of the new treatment is £100 more per patient per year. Therefore, what would the cost of implementing the new therapy for each stroke prevented?

      Your Answer: £20,000

      Explanation:

      The new drug reduces the annual incidence of stroke by 0.5% and costs £100 more than conventional therapy. This means that for every 200 patients treated, one stroke would be prevented with the new drug compared to conventional therapy. The Number Needed to Treat (NNT) is 200 per year to prevent one stroke. Therefore, the annual cost of this treatment to prevent one stroke would be £20,000, which is the cost of treating 200 patients with the new drug (£100 x 200).

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      4.7
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  • Question 82 - The level one treatment in the STAR*D study involved the use of which...

    Incorrect

    • The level one treatment in the STAR*D study involved the use of which SSRI?

      Your Answer: Paroxetine

      Correct Answer: Citalopram

      Explanation:

      STAR*D Study

      The STAR*D trial, conducted in the USA, aimed to evaluate the effectiveness of treatments for major depressive disorder in real-world patients. The study involved four levels of treatment, with patients starting at level 1 and progressing to the next level if they did not respond. The outcome measure used was remission, and the study entry criteria were broadly defined to ensure results could be generalized to a wide range of patients.

      A total of 4,041 patients were enrolled in the first level of treatment, making STAR*D the largest prospective clinical trial of depression ever conducted. In level 1, one-third of participants achieved remission, and a further 10-15% responded but not to the point of remission. If treatment with an initial SSRI fails, then one in four patients who choose to switch to another medication will enter remission, regardless of whether the second medication is an SSRI of a medication of a different class. If patients choose to add a medication instead, one in three will get better.

      Overall, the STAR*D study provides valuable insights into the effectiveness of different treatments for major depressive disorder and highlights the importance of considering alternative treatments if initial treatment fails.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 83 - What is the estimated percentage of individuals in Great Britain who have a...

    Correct

    • What is the estimated percentage of individuals in Great Britain who have a personality disorder?

      Your Answer: 4.40%

      Explanation:

      Personality Disorder: Understanding the Clinical Diagnosis

      A personality disorder is a long-standing pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, clinicians must first establish that the general diagnostic threshold is met before identifying the subtype(s) present. The course of personality disorders varies, with some becoming less evident of remitting with age, while others persist.

      DSM-5 and ICD-11 have different classification systems for personality disorders. DSM-5 divides them into three clusters (A, B, and C), while ICD-11 has a general category with six trait domains that can be added. The prevalence of personality disorders in Great Britain is 4.4%, with Cluster C being the most common. Clinicians are advised to avoid diagnosing personality disorders in children, although a diagnosis can be made in someone under 18 if the features have been present for at least a year (except for antisocial personality disorder).

      Overall, understanding the clinical diagnosis of personality disorders is important for effective treatment and management of these conditions.

    • This question is part of the following fields:

      • General Adult Psychiatry
      5.5
      Seconds
  • Question 84 - Which statement accurately reflects the NICE guidelines on self-harm? ...

    Correct

    • Which statement accurately reflects the NICE guidelines on self-harm?

      Your Answer: All children who have self-harmed should be admitted overnight to a paediatric ward and assessed the following day

      Explanation:

      The NICE Guidelines from 2004 provide several recommendations regarding self-harm. It is advised that harm minimisation strategies should not be offered for those who have self-harmed by poisoning, as there are no safe limits for this type of self-harm. Children and young people who have self-harmed should be admitted overnight to a paediatric ward and fully assessed the following day before any further treatment of care is initiated. The admitting team should also obtain parental consent for mental health assessment of the child of young person. For individuals with borderline personality disorder who self-harm, dialectical behaviour therapy may be considered. It is important to note that most individuals who seek emergency department care following self-harm will meet criteria for one of more psychiatric diagnoses at the time of assessment, with depression being the most common diagnosis. However, within 12-16 months, two-thirds of those diagnosed with depression will no longer meet diagnostic criteria.

      Self-Harm and its Management

      Self-harm refers to intentional acts of self-poisoning of self-injury. It is prevalent among younger people, with an estimated 10% of girls and 3% of boys aged 15-16 years having self-harmed in the previous year. Risk factors for non-fatal repetition of self-harm include previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, and drug abuse/dependence. Suicide following an act of self-harm is more likely in those with previous episodes of self-harm, suicidal intent, poor physical health, and male gender.

      Risk assessment tools are not recommended for predicting future suicide of repetition of self-harm. The recommended interventions for self-harm include 4-10 sessions of CBT specifically structured for people who self-harm and considering DBT for adolescents with significant emotional dysregulation. Drug treatment as a specific intervention to reduce self-harm should not be offered.

      In the management of ingestion, activated charcoal can help if used early, while emetics and cathartics should not be used. Gastric lavage should generally not be used unless recommended by TOXBASE. Paracetamol is involved in 30-40% of acute presentations with poisoning. Intravenous acetylcysteine is the treatment of choice, and pseudo-allergic reactions are relatively common. Naloxone is used as an antidote for opioid overdose, while flumazenil can help reduce the need for admission to intensive care in benzodiazepine overdose.

      For superficial uncomplicated skin lacerations of 5 cm of less in length, tissue adhesive of skin closure strips could be used as a first-line treatment option. All children who self-harm should be admitted for an overnight stay at a pediatric ward.

    • This question is part of the following fields:

      • General Adult Psychiatry
      35.7
      Seconds
  • Question 85 - What proportion of individuals with an intellectual disability are categorized as having a...

    Correct

    • What proportion of individuals with an intellectual disability are categorized as having a profound intellectual disability?

      Your Answer: 1%

      Explanation:

      Classification of Intellectual Disability

      Intellectual disability affects approximately 2% of the general population, with an estimated 828,000 adults aged 18 of older affected in England alone. Those with an IQ below 70 are considered to have an intellectual disability, with the average IQ being 100. The severity of intellectual disability is categorized based on IQ scores, with mild intellectual disability being the most common (85% of cases) and profound intellectual disability being the least common (1-2% of cases). People with intellectual disability may require varying levels of support in their daily lives, depending on their individual needs. It is important to use the preferred term ‘people with intellectual disability’ when referring to individuals with this condition.

    • This question is part of the following fields:

      • Learning Disability
      14.7
      Seconds
  • Question 86 - An older adult with Lewy body dementia who is prescribed donepezil, develops distressing...

    Incorrect

    • An older adult with Lewy body dementia who is prescribed donepezil, develops distressing visual hallucinations and delusions and has begun to attack members of his care team. Non-pharmacological attempts to manage him have been exhausted.
      What would be the most effective approach in managing this individual?

      Your Answer: Haloperidol

      Correct Answer: Clozapine

      Explanation:

      Cholinesterase Inhibitors are the preferred medication for treating visual hallucinations in LBD, but if they don’t work, antipsychotic drugs may be necessary. For Lewy Body psychosis, clozapine is the most effective option, although quetiapine is also a viable alternative. In Parkinson’s disease dementia with psychosis, a review by the Movement Disorder Society found that clozapine was effective and had an acceptable risk with proper monitoring. Quetiapine was considered investigational due to a lack of supporting evidence, while olanzapine was deemed unlikely to be effective and had an unacceptable risk due to its demonstrated worsening of motor function.

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
      11.8
      Seconds
  • Question 87 - What drug is classified as a class B substance in the UK? ...

    Incorrect

    • What drug is classified as a class B substance in the UK?

      Your Answer: Khat

      Correct Answer: Mephedrone

      Explanation:

      Drug Misuse (Law and Scheduling)

      The Misuse of Drugs Act (1971) regulates the possession and supply of drugs, classifying them into three categories: A, B, and C. The maximum penalty for possession varies depending on the class of drug, with Class A drugs carrying a maximum sentence of 7 years.

      The Misuse of Drugs Regulations 2001 further categorizes controlled drugs into five schedules. Schedule 1 drugs are considered to have no therapeutic value and cannot be lawfully possessed of prescribed, while Schedule 2 drugs are available for medical use but require a controlled drug prescription. Schedule 3, 4, and 5 drugs have varying levels of restrictions and requirements.

      It is important to note that a single drug can have multiple scheduling statuses, depending on factors such as strength and route of administration. For example, morphine and codeine can be either Schedule 2 of Schedule 5.

      Overall, the Misuse of Drugs Act and Regulations aim to regulate and control the use of drugs in the UK, with the goal of reducing drug misuse and related harm.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      7.3
      Seconds
  • Question 88 - A young woman in her twenties presents to the A&E department with complaints...

    Correct

    • A young woman in her twenties presents to the A&E department with complaints of abdominal cramps. Upon examination, you observe goose bumps all over her skin and dilated pupils. Which drug withdrawal is she most likely experiencing?

      Your Answer: Heroin

      Explanation:

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      51.3
      Seconds
  • Question 89 - What is the recommended duration of antidepressant treatment for a patient who has...

    Correct

    • What is the recommended duration of antidepressant treatment for a patient who has experienced a single episode of depression?

      Your Answer: For 6-9 months following complete remission

      Explanation:

      Depression Treatment Duration

      It is recommended to treat a single episode of depression for 6-9 months after complete remission. Abruptly stopping antidepressants after recovery can lead to a relapse in 50% of patients within 3-6 months. For patients who have experienced 2 of more depressive episodes in recent history, NICE recommends a minimum of 2 years of antidepressant treatment. These guidelines are outlined in the Maudsley Guidelines 10th Edition.

    • This question is part of the following fields:

      • General Adult Psychiatry
      15.7
      Seconds
  • Question 90 - What is a true statement about Charles Bonnet syndrome? ...

    Correct

    • What is a true statement about Charles Bonnet syndrome?

      Your Answer: Insight is typically preserved

      Explanation:

      Preservation of insight and absence of delusional beliefs are common in CBS, with the focus of initial treatment being on supporting the visual system through addressing underlying conditions like cataracts of improving lighting. Behavioral interventions, such as reducing isolation and stress management, can also be beneficial, along with reassurance. While psychoactive drugs have shown some success in individual cases, they are generally not effective. It is important to conduct field testing if ocular examination is normal, as CBS can result from any damage to the visual pathway, including cerebral infarcts.

      Charles Bonnet Syndrome: A Condition of Complex Visual Hallucinations

      Charles Bonnet Syndrome (CBS) is a condition characterized by persistent of recurrent complex visual hallucinations that occur in clear consciousness. This condition is observed in individuals who have suffered damage to the visual pathway, which can be caused by damage to any part of the pathway from the eye to the cortex. The hallucinations are thought to result from a release phenomenon secondary to the deafferentation of the cerebral cortex. CBS is equally distributed between sexes and does not show any familial predisposition. The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.

      Risk factors for CBS include advanced age, peripheral visual impairment, social isolation, sensory deprivation, and early cognitive impairment. Well-formed complex visual hallucinations are thought to occur in 10-30 percent of individuals with severe visual impairment. Only around a third of individuals find the hallucinations themselves an unpleasant or disturbing experience. The most effective treatment is reversal of the visual impairment. Antipsychotic drugs are commonly prescribed but are largely ineffective. CBS is a long-lasting condition, with 88% of individuals experiencing it for two years of more, and only 25% resolving at nine years.

    • This question is part of the following fields:

      • Old Age Psychiatry
      6.8
      Seconds
  • Question 91 - What is the maximum duration for which Risperidone can be prescribed for persistent...

    Incorrect

    • What is the maximum duration for which Risperidone can be prescribed for persistent aggression in Alzheimer's patients?

      Your Answer: 6 months

      Correct Answer: 6 weeks

      Explanation:

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
      7
      Seconds
  • Question 92 - What is the estimated minimum unit price for alcohol that could prevent 624...

    Correct

    • What is the estimated minimum unit price for alcohol that could prevent 624 deaths and 237,000 hospital admissions annually in England?

      Your Answer: 45 pence

      Explanation:

      According to a study conducted by the University of Sheffield, implementing a minimum unit price of 45 pence for alcohol could potentially save 624 lives and prevent 237,000 hospital admissions in England every year. Additionally, the research suggests that the ban on selling alcohol below cost, which was implemented in May 2014, could prevent 14 deaths and 500 hospital admissions annually.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      3.5
      Seconds
  • Question 93 - A middle-aged woman addicted to alcohol visits her GP. Her GP advises her...

    Correct

    • A middle-aged woman addicted to alcohol visits her GP. Her GP advises her to stop drinking and the woman replies that she enjoys drinking as it helps her forget about her problems. She does, however, acknowledge that her drinking has caused problems in her relationships and at work. According to the stages of change model, which stage is she currently at?

      Your Answer: Contemplation

      Explanation:

      The individual is currently in the contemplative stage, which is marked by conflicting thoughts and emotions and a sense of ambivalence towards their cannabis use. This indicates that they are experiencing a duality of perspectives. In contrast, someone in the pre-contemplative stage would not possess such a nuanced understanding of their behavior.

      Stages of Change Model

      Prochaska and DiClemente’s Stages of Change Model identifies five stages that individuals go through when making a change. The first stage is pre-contemplation, where the individual is not considering change. There are different types of precontemplators, including those who lack knowledge about the problem, those who are afraid of losing control, those who feel hopeless, and those who rationalize their behavior.

      The second stage is contemplation, where the individual is ambivalent about change and is sitting on the fence. The third stage is preparation, where the individual has some experience with change and is trying to change, testing the waters. The fourth stage is action, where the individual has started to introduce change, and the behavior is defined as action during the first six months of change.

      The final stage is maintenance, where the individual is involved in ongoing efforts to maintain change. Action becomes maintenance once six months have elapsed. Understanding these stages can help individuals and professionals in supporting behavior change.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      36.7
      Seconds
  • Question 94 - What is considered a prolonged seizure during electroconvulsive therapy (ECT)? ...

    Correct

    • What is considered a prolonged seizure during electroconvulsive therapy (ECT)?

      Your Answer: >120 seconds

      Explanation:

      In ECT, a seizure lasting more than 120 seconds is considered prolonged and can be stopped with intravenous diazepam. While there is no clear link between treatment success and seizure duration, it is advised to adjust the electricity dose to achieve a seizure lasting between 20 and 50 seconds. Short seizures may not be effective, while longer seizures may lead to cognitive issues.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      2
      Seconds
  • Question 95 - A new drug is trialled for the treatment of heart disease. Drug A...

    Correct

    • A new drug is trialled for the treatment of heart disease. Drug A is given to 500 people with early stage heart disease and a placebo is given to 450 people with the same condition. After 5 years, 300 people who received drug A had survived compared to 225 who received the placebo. What is the number needed to treat to save one life?

      Your Answer: 10

      Explanation:

      Measures of Effect in Clinical Studies

      When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.

      To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.

      The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      44.4
      Seconds
  • Question 96 - How do the odds of excessive drinking differ between patients with liver cirrhosis...

    Incorrect

    • How do the odds of excessive drinking differ between patients with liver cirrhosis and those without cirrhosis?

      Your Answer: 4

      Correct Answer: 16

      Explanation:

      Measures of Effect in Clinical Studies

      When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.

      To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.

      The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      5.7
      Seconds
  • Question 97 - What is a common symptom that may be present in a patient with...

    Correct

    • What is a common symptom that may be present in a patient with Charles Bonnet syndrome?

      Your Answer: Macular degeneration

      Explanation:

      Charles Bonnet Syndrome: A Condition of Complex Visual Hallucinations

      Charles Bonnet Syndrome (CBS) is a condition characterized by persistent of recurrent complex visual hallucinations that occur in clear consciousness. This condition is observed in individuals who have suffered damage to the visual pathway, which can be caused by damage to any part of the pathway from the eye to the cortex. The hallucinations are thought to result from a release phenomenon secondary to the deafferentation of the cerebral cortex. CBS is equally distributed between sexes and does not show any familial predisposition. The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.

      Risk factors for CBS include advanced age, peripheral visual impairment, social isolation, sensory deprivation, and early cognitive impairment. Well-formed complex visual hallucinations are thought to occur in 10-30 percent of individuals with severe visual impairment. Only around a third of individuals find the hallucinations themselves an unpleasant or disturbing experience. The most effective treatment is reversal of the visual impairment. Antipsychotic drugs are commonly prescribed but are largely ineffective. CBS is a long-lasting condition, with 88% of individuals experiencing it for two years of more, and only 25% resolving at nine years.

    • This question is part of the following fields:

      • Old Age Psychiatry
      11.2
      Seconds
  • Question 98 - A male patient in his 30s who takes sertraline for depression develops amenorrhoea....

    Correct

    • A male patient in his 30s who takes sertraline for depression develops amenorrhoea. Further testing reveals an elevated serum prolactin (64ng/ml). As he requires ongoing antidepressant treatment, which of the following is recommended?

      Your Answer: Mirtazapine

      Explanation:

      Although hyperprolactinemia is a rare side effect of antidepressant use, it typically does not cause any symptoms. However, if symptoms do occur, it is suggested that the patient be prescribed mirtazapine instead.

      Management of Hyperprolactinaemia

      Hyperprolactinaemia is often associated with the use of antipsychotics and occasionally antidepressants. Dopamine inhibits prolactin, and dopamine antagonists increase prolactin levels. Almost all antipsychotics cause changes in prolactin, but some do not increase levels beyond the normal range. The degree of prolactin elevation is dose-related. Hyperprolactinaemia is often asymptomatic but can cause galactorrhoea, menstrual difficulties, gynaecomastia, hypogonadism, sexual dysfunction, and an increased risk of osteoporosis and breast cancer in psychiatric patients.

      Patients should have their prolactin measured before antipsychotic therapy and then monitored for symptoms at three months. Annual testing is recommended for asymptomatic patients. Antipsychotics that increase prolactin should be avoided in patients under 25, patients with osteoporosis, patients with a history of hormone-dependent cancer, and young women. Samples should be taken at least one hour after eating of waking, and care must be taken to avoid stress during the procedure.

      Treatment options include referral for tests to rule out prolactinoma if prolactin is very high, making a joint decision with the patient about continuing if prolactin is raised but not symptomatic, switching to an alternative antipsychotic less prone to hyperprolactinaemia if prolactin is raised and the patient is symptomatic, adding aripiprazole 5mg, of adding a dopamine agonist such as amantadine of bromocriptine. Mirtazapine is recommended for symptomatic hyperprolactinaemia associated with antidepressants as it does not raise prolactin levels.

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.5
      Seconds
  • Question 99 - Who is credited with introducing the idea of the 'transitional object'? ...

    Correct

    • Who is credited with introducing the idea of the 'transitional object'?

      Your Answer: Winnicott

      Explanation:

      Winnicott: An Overview

      Donald Winnicott, a British paediatrician and psychotherapist, is known for his contributions to the field of child development and psychoanalysis. He introduced several concepts that are still relevant today.

      Good Enough Mother: Winnicott emphasised the importance of being a good enough mother rather than a perfect one. He believed that children needed someone who would attend to them but not immediately so that they could learn to tolerate frustration.

      Holding Environment: This refers to the psychic and physical space between the mother and infant that ensures the mother is there for the child when needed but allows them to explore independently when ready.

      Transitional Object: Winnicott talked about the two separate realities for a child, the ‘me’ and the ‘not me’. The transitional object is one that represents another (e.g. Mother) and is regarded as the first ‘not me’ possession.

      False Self: Winnicott described the situation of ‘not good-enough mothering’ as one in which the mother (consciously of unconsciously) is unable to respond adequately to her infant’s spontaneous behaviour (true self), but tends to impose her own wishes and desires (e.g. for an ‘ideal’ child). This may lead the infant to an adaptation on the basis of ’compliance’ (false self) and later, in adulthood, to the loss of a sense of personal autonomy and integrity.

    • This question is part of the following fields:

      • Psychotherapy
      5.7
      Seconds
  • Question 100 - Which condition has the most extensive evidence base for the use of phototherapy?...

    Correct

    • Which condition has the most extensive evidence base for the use of phototherapy?

      Your Answer: Depression

      Explanation:

      Phototherapy, also known as light therapy, has been extensively studied for its use in treating seasonal affective disorder (SAD) of winter depression. The treatment involves sitting next to a bright light for 1-2 hours. A 2005 meta-analysis of randomized, controlled trials found that bright light treatment is effective, with results equivalent to most antidepressant pharmacotherapy trials. However, the National Institute for Health and Care Excellence (NICE) advises that the evidence for the efficacy of light therapy is uncertain for those with winter depression. Light therapy has also been found to be effective in treating non-seasonal depression and ADHD. The type and strength of light that works best and the timing of the therapy remain unclear. It is important for the light to enter the eye, so it cannot be delivered while a person is asleep. (Golden, 2005).

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      13.9
      Seconds
  • Question 101 - Who developed the compensatory theory of dreaming? ...

    Incorrect

    • Who developed the compensatory theory of dreaming?

      Your Answer:

      Correct Answer: Jung

      Explanation:

      As an AI language model, I do not have personal opinions of beliefs. However, I can provide a summary of the information presented in the text. The text discusses different models of dream interpretation in psychodynamic therapy, including Freudian interpretation, compensatory theory, content analysis, the Five Star Method, and the cognitive-experiential model. Each model has its own approach to understanding the meaning of dreams, with some focusing on unconscious desires and motivations, while others emphasize personal experiences and attitudes. The text provides an overview of each model and their key assumptions and techniques.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 102 - In chronic opiate use, which effect is most likely to continue over time?...

    Incorrect

    • In chronic opiate use, which effect is most likely to continue over time?

      Your Answer:

      Correct Answer: Constipation

      Explanation:

      Tolerance in Opiate Abuse

      Tolerance is a common phenomenon that occurs in opiate abuse. It develops regarding the analgesic, euphoric, sedative, respiratory depressant, and nauseating effects of opioids. However, it does not develop to their effects on miosis and bowel motility, which can cause constipation. This means that individuals who abuse opioids may require higher doses to achieve the desired effects, leading to an increased risk of overdose and other adverse effects. Understanding the mechanisms involved in tolerance can help in developing effective interventions to prevent and treat opiate abuse.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 103 - What is the negative predictive value of the blood test for bowel cancer,...

    Incorrect

    • What is the negative predictive value of the blood test for bowel cancer, given a sensitivity of 60% and a specificity of 80% and a negative test result for a patient?

      Your Answer:

      Correct Answer: 0.5

      Explanation:

      Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and post-test odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating post-test probabilities.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 104 - What is accurate about how CADASIL is presented? ...

    Incorrect

    • What is accurate about how CADASIL is presented?

      Your Answer:

      Correct Answer: The most common presentation is that of stroke of migraine

      Explanation:

      CADASIL: A Guide to a Comparatively Unrecognised Condition in Psychiatry

      CADASIL, of Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, is a hereditary form of multi-infarct dementia that is progressive in nature. It has a prevalence of about 2 per 100,000 and typically presents at a young age, with onset occurring around 35-40 years old. The initial presentation of CADASIL is often neurological, with stroke of migraine being the primary symptoms in one-third of cases. Psychiatric manifestations are the initial presentation in 15% of cases, with mood disorders and subcortical dementia being the most common forms of psychiatric presentation. This condition is not widely recognized in psychiatry, making it important for healthcare professionals to be aware of its symptoms and potential psychiatric manifestations.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 105 - The most frequent type of sexual offence in England and Wales is what?...

    Incorrect

    • The most frequent type of sexual offence in England and Wales is what?

      Your Answer:

      Correct Answer: Sexual assault

      Explanation:

      Sexual Offending in England and Wales: Key Findings

      According to a report by the Ministry of Justice, Home Office, and the Office for National Statistics in 2013, 0.5% of females reported being victims of the most serious sexual offences, such as rape of sexual assault by penetration, in the previous year. Young males between the ages of 20 and 39 were found to be the most common offenders, accounting for 47% of cases. The majority of victims (56%) reported that the offender was their partner.

      In 2011/12, the police recorded 53,665 sexual offences, which made up approximately 1% of all recorded crimes. Sexual assault was the most commonly reported offence, accounting for 41% of cases, followed by rape at 30%. Other offences included exposure, voyeurism, and sexual activity with minors. In contrast, less than 0.1% of males (around 12,000) reported being victims of the same types of offences in the previous year.

      The report also found that around 90% of victims of the most serious sexual offences knew the perpetrator, compared to less than half for other sexual offences. These findings provide insight into the prevalence and characteristics of sexual offending in England and Wales.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 106 - What statement accurately describes population parameters? ...

    Incorrect

    • What statement accurately describes population parameters?

      Your Answer:

      Correct Answer: Parameters tend to have normal distributions

      Explanation:

      Parametric vs Non-Parametric Statistics

      Statistics are used to draw conclusions about a population based on a sample. A parameter is a numerical value that describes a population characteristic, but it is often impossible to know the true value of a parameter without collecting data from every individual in the population. Instead, we take a sample and use statistics to estimate the parameters.

      Parametric statistical procedures assume that the population distribution is normal and that the parameters (such as means and standard deviations) are known. Examples of parametric tests include the t-test, ANOVA, and Pearson coefficient of correlation.

      Non-parametric statistical procedures make few of no assumptions about the population distribution of parameters. Examples of non-parametric tests include the Mann-Whitney Test, Wilcoxon Signed-Rank Test, Kruskal-Wallis Test, and Fisher Exact Probability test.

      Overall, the choice between parametric and non-parametric tests depends on the nature of the data and the research question being asked.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 107 - What is a true statement about deep brain stimulation? ...

    Incorrect

    • What is a true statement about deep brain stimulation?

      Your Answer:

      Correct Answer: It is an invasive procedure

      Explanation:

      DBS, a type of neurosurgery, is typically conducted in an operating theatre and has been shown to be effective in treating OCD based on randomized controlled trial (RCT) data. However, there are currently no NICE Guidelines available for DBS.

      Neurostimulation is a treatment that uses electromagnetic energy targeted at the brain. There are several forms of neurostimulation, including TMS, deep brain stimulation, and ECT. TMS is a non-invasive, non-convulsive technique used to stimulate neural tissue. It involves the placement of an electromagnetic coil on the patient’s scalp to deliver a short, powerful magnetic field pulse through the scalp and induce electric current in the brain. TMS is used to treat depression when standard treatments have failed. Deep brain stimulation is a neurosurgical technique that involves placing an electrode within the brain to deliver a high-frequency current in a specific subcortical of deep cortical structure. It has been used to treat Parkinson’s, dysthymia, OCD, and Tourette syndrome. There is RCT evidence to demonstrate its effectiveness in OCD, but conflicting results in depression and Tourette’s. DBS is also being trailed in other conditions such as anorexia, bipolar, and additions.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 108 - Which statement accurately describes Freud's topographical model? ...

    Incorrect

    • Which statement accurately describes Freud's topographical model?

      Your Answer:

      Correct Answer: The unconscious system has no concept of time

      Explanation:

      Freud’s Topographical Model of the Mind

      Freud’s topographical model of the mind, introduced in his book The Interpretation of Dreams, divides the mind into three regions: the conscious system, the preconscious system, and the unconscious system.

      The conscious system refers to the part of the mind that is aware. The preconscious system is the information that is known and can potentially be brought into consciousness. Finally, the unconscious system is believed to be outside conscious awareness and operates on primary process thinking, which is aimed at wish fulfillment. It is governed by the pleasure principle, has no concept of time, denies the existence of negatives, and allows the existence of contradictions, making it irrational.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 109 - What is a partial defence to murder? ...

    Incorrect

    • What is a partial defence to murder?

      Your Answer:

      Correct Answer: Loss of control

      Explanation:

      Some partial defences to murder are available, such as diminished responsibility, loss of control, and killing in accordance with a suicide pact.

      Murder and Manslaughter: Understanding the Difference

      Homicide is the act of killing another person, but it’s important to distinguish between murder and manslaughter. Murder is committed when a person of sound mind and discretion unlawfully kills another human being who is born alive and breathing through their own lungs, with the intent to kill of cause grievous bodily harm. Manslaughter, on the other hand, can occur in three ways: killing with the intent for murder but where a partial defense applies, conduct that was grossly negligent given the risk of death, and conduct taking the form of an unlawful act involving a danger of some harm that resulted in death. Infanticide is a specific type of manslaughter that applies to women who cause the death of their child under 12 months old by a wilful act of omission, but at the time of the act of omission, the balance of their mind was disturbed by the effects of giving birth of lactation. It’s important to understand these distinctions to properly classify and prosecute these crimes.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 110 - A 50-year-old man, who has a past of opioid addiction, is interested in...

    Incorrect

    • A 50-year-old man, who has a past of opioid addiction, is interested in exploring pharmacological maintenance therapy in conjunction with psychosocial interventions. What would be your recommendation for the most suitable choice?

      Your Answer:

      Correct Answer: Buprenorphine

      Explanation:

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 111 - What is the condition that typically develops during childhood and is marked by...

    Incorrect

    • What is the condition that typically develops during childhood and is marked by sudden, involuntary, repetitive movements of vocalizations that have no clear purpose?

      Your Answer:

      Correct Answer: Tourette's syndrome

      Explanation:

      Ekbom syndrome refers to two distinct syndromes. The first is known as delusional parasitosis, which is characterized by the false belief that the skin is infested with parasites. The second, also known as Willis-Ekbom syndrome, is restless legs syndrome, which causes uncomfortable sensations in the limbs that disrupt sleep. While European physicians tend to use the term to refer to delusional parasitosis, Americans typically use it to describe restless legs syndrome.

      Lesch-Nyhan syndrome is a genetic disorder that results in congenital mental retardation. It is caused by mutations in the HPRT gene on the X chromosome, which leads to defective purine metabolism and severe self-injury. The HPRT gene codes for an enzyme called hypoxanthine phosphoribosyltransferase 1, which is responsible for recycling purines. When this enzyme is absent, purines are broken down but not recycled, resulting in abnormally high levels of uric acid.

      Rett syndrome is a developmental disorder that primarily affects girls and is caused by an X-linked dominant mutation. It is characterized by acquired microcephaly, a reversal of cognitive and social development, ataxia, and stereotypic hand movements and manual dyspraxia known as hand-wringing.

      Tourette’s Syndrome: Understanding the Disorder and Management Options

      Tourette’s syndrome is a type of tic disorder characterized by multiple motor tics and one of more vocal tics. Tics are sudden, involuntary movements of vocalizations that serve no apparent purpose and can be suppressed for varying periods of time. Unlike stereotyped repetitive movements seen in other disorders, tics lack rhythmicity. Manneristic motor activities tend to be more complex and variable than tics, while obsessive-compulsive acts have a defined purpose.

      Tourette’s syndrome typically manifests in childhood, with a mean age of onset of six to seven years. Tics tend to peak in severity between nine and 11 years of age and may be exacerbated by external factors such as stress, inactivity, and fatigue. The estimated prevalence of Tourette’s syndrome is 1% of children, and it is more common in boys than girls. A family history of tics is also common.

      Management of Tourette’s syndrome may involve pharmacological options of behavioral programs. Clonidine is recommended as first-line medication, with antipsychotics as a second-line option due to their side effect profile. Selective serotonin reuptake inhibitors (SSRIs) have not been found to be effective in suppressing tics. However, most people with tics never require medication, and behavioral programs appear to work equally as well.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 112 - After creating a scatter plot of the data, what would be the next...

    Incorrect

    • After creating a scatter plot of the data, what would be the next step for the researcher to determine if there is a linear relationship between a person's age and blood pressure?

      Your Answer:

      Correct Answer: Pearson's coefficient

      Explanation:

      Choosing the right statistical test can be challenging, but understanding the basic principles can help. Different tests have different assumptions, and using the wrong one can lead to inaccurate results. To identify the appropriate test, a flow chart can be used based on three main factors: the type of dependent variable, the type of data, and whether the groups/samples are independent of dependent. It is important to know which tests are parametric and non-parametric, as well as their alternatives. For example, the chi-squared test is used to assess differences in categorical variables and is non-parametric, while Pearson’s correlation coefficient measures linear correlation between two variables and is parametric. T-tests are used to compare means between two groups, and ANOVA is used to compare means between more than two groups. Non-parametric equivalents to ANOVA include the Kruskal-Wallis analysis of ranks, the Median test, Friedman’s two-way analysis of variance, and Cochran Q test. Understanding these tests and their assumptions can help researchers choose the appropriate statistical test for their data.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 113 - What is the primary treatment option for catatonia? ...

    Incorrect

    • What is the primary treatment option for catatonia?

      Your Answer:

      Correct Answer: Lorazepam

      Explanation:

      When treating catatonia, the preferred initial treatment is benzodiazepines such as lorazepam. If this approach is unsuccessful, electroconvulsive therapy (ECT) should be considered.

      Catatonia Treatment

      Catatonia can lead to complications such as dehydration, deep vein thrombosis, pulmonary embolism, and pneumonia. Therefore, prompt treatment is essential. The first-line treatment is benzodiazepines, particularly lorazepam. If this is ineffective, electroconvulsive therapy (ECT) may be considered. The use of antipsychotics is controversial and should be avoided during the acute phase of catatonia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 114 - What is the enzyme that is lacking in Niemann-Pick disease? ...

    Incorrect

    • What is the enzyme that is lacking in Niemann-Pick disease?

      Your Answer:

      Correct Answer: Sphingomyelinase

      Explanation:

      Phenylketonuria is caused by a deficiency in the enzyme phenylalanine hydroxylase.

      Niemann-Pick disease is a group of inherited diseases where lipids accumulate in the cells of the liver, spleen, and brain. Niemann-Pick Type C (NPC) is the most relevant type for psychiatric presentations, with about one-third of cases presenting in adolescence of adulthood. Symptoms include progressive ataxia/dystonia, cognitive decline, and atypical psychotic symptoms. There are four other types of Niemann-Pick disease, each with their own causes and symptoms. Type A and B have a lack of sphingomyelinase and present in early childhood of mid-childhood/adolescence, respectively. Type C has reduced sphingomyelinase activity and can present at any age, with symptoms including enlarged liver and spleen, learning difficulties, seizures, and slurred speech. Type D is a variant of Type C and has similar symptoms. Type E has reduced sphingomyelinase activity and presents in adulthood with similar symptoms to the other types.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 115 - What is recommended by NICE guidelines to be provided to children diagnosed with...

    Incorrect

    • What is recommended by NICE guidelines to be provided to children diagnosed with anorexia nervosa?

      Your Answer:

      Correct Answer: Family therapy

      Explanation:

      The National Institute for Health and Care Excellence (NICE) suggests that family therapy with a focus on anorexia nervosa is a recommended treatment for children and adolescents who have been diagnosed with anorexia nervosa.

      Eating Disorders: NICE Guidelines

      Anorexia:
      For adults with anorexia nervosa, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED), Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), of specialist supportive clinical management (SSCM). If these are not acceptable, contraindicated, of ineffective, consider eating-disorder-focused focal psychodynamic therapy (FPT). For children and young people, consider anorexia-nervosa-focused family therapy (FT-AN) of individual CBT-ED. Do not offer medication as the sole treatment.

      Bulimia:
      For adults, the first step is an evidence-based self-help programme. If this is not effective, consider individual CBT-ED. For children and young people, offer bulimia-nervosa-focused family therapy (FT-BN) of individual CBT-ED. Do not offer medication as the sole treatment.

      Binge Eating Disorder:
      The first step is a guided self-help programme. If this is not effective, offer group of individual CBT-ED. For children and young people, offer the same treatments recommended for adults. Do not offer medication as the sole treatment.

      Advice for those with eating disorders:
      Encourage people with an eating disorder who are vomiting to avoid brushing teeth immediately after vomiting, rinse with non-acid mouthwash, and avoid highly acidic foods and drinks. Advise against misusing laxatives of diuretics and excessive exercise.

      Additional points:
      Do not offer physical therapy as part of treatment. Consider bone mineral density scans after 1 year of underweight in children and young people, of 2 years in adults. Do not routinely offer oral of transdermal oestrogen therapy to treat low bone mineral density in children of young people with anorexia nervosa. Consider transdermal 17-β-estradiol of bisphosphonates for women with anorexia nervosa.

      Note: These guidelines are taken from NICE guidelines 2017.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 116 - What is the diagnosis criteria for anorexia nervosa according to the ICD-11? ...

    Incorrect

    • What is the diagnosis criteria for anorexia nervosa according to the ICD-11?

      Your Answer:

      Correct Answer: An explicitly stated fear of weight gain is not an absolute requirement for the diagnosis

      Explanation:

      To diagnose anorexia nervosa, a persistent pattern of restrictive eating of other behaviors aimed at maintaining an abnormally low body weight is required. These behaviors may include excessive exercise, purging, of the use of laxatives. In some cases, a low body weight may not be the essential feature, and significant weight loss within six months may replace this requirement if other diagnostic criteria are met. For individuals in recovery from anorexia nervosa who have achieved a healthy weight, the diagnosis should be retained until a full and lasting recovery is achieved, which includes maintaining a healthy weight and ceasing behaviors aimed at reducing body weight for at least one year following treatment. Intermittent bingeing may also be consistent with a diagnosis of anorexia nervosa, and a specifier of binge-purge pattern may be applied.

      Eating disorders are a serious mental health condition that can have severe physical and psychological consequences. The ICD-11 lists several types of eating disorders, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant-Restrictive Food Intake Disorder, Pica, and Rumination-Regurgitation Disorder.

      Anorexia Nervosa is characterized by significantly low body weight, a persistent pattern of restrictive eating of other behaviors aimed at maintaining low body weight, excessive preoccupation with body weight of shape, and marked distress of impairment in functioning. Bulimia Nervosa involves frequent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain, excessive preoccupation with body weight of shape, and marked distress of impairment in functioning. Binge Eating Disorder is characterized by frequent episodes of binge eating without compensatory behaviors, marked distress of impairment in functioning, and is more common in overweight and obese individuals. Avoidant-Restrictive Food Intake Disorder involves avoidance of restriction of food intake that results in significant weight loss of impairment in functioning, but is not motivated by preoccupation with body weight of shape. Pica involves the regular consumption of non-nutritive substances, while Rumination-Regurgitation Disorder involves intentional and repeated regurgitation of previously swallowed food.

      It is important to seek professional help if you of someone you know is struggling with an eating disorder. Treatment may involve a combination of therapy, medication, and nutritional counseling.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 117 - Which of the following is the correct description of construct validity? ...

    Incorrect

    • Which of the following is the correct description of construct validity?

      Your Answer:

      Correct Answer: A test has good construct validity if it has a high correlation with another test that measures the same construct

      Explanation:

      Validity in statistics refers to how accurately something measures what it claims to measure. There are two main types of validity: internal and external. Internal validity refers to the confidence we have in the cause and effect relationship in a study, while external validity refers to the degree to which the conclusions of a study can be applied to other people, places, and times. There are various threats to both internal and external validity, such as sampling, measurement instrument obtrusiveness, and reactive effects of setting. Additionally, there are several subtypes of validity, including face validity, content validity, criterion validity, and construct validity. Each subtype has its own specific focus and methods for testing validity.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 118 - Which of the following factors would be the least useful in determining a...

    Incorrect

    • Which of the following factors would be the least useful in determining a diagnosis of pathological intoxication?

      Your Answer:

      Correct Answer: Presence of liver cirrhosis

      Explanation:

      Pathological Intoxication: A Rare Legal Defence

      Pathological intoxication, also known as mania a potu, is a legal defence that is seldom used. It refers to a sudden onset of aggressive and violent behaviour that is not typical of the individual when sober. This behaviour occurs shortly after consuming small amounts of alcohol that would not typically cause intoxication in most people. The individual may experience complete of partial amnesia following the episode. Unlike regular alcohol intoxication, there is no motor incoordination, slurred speech, of diplopia present in pathological intoxication.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 119 - How would NICE recommend augmenting treatment for a patient with depression who is...

    Incorrect

    • How would NICE recommend augmenting treatment for a patient with depression who is already taking an SSRI?

      Your Answer:

      Correct Answer: Olanzapine

      Explanation:

      Depression Treatment Guidelines by NICE

      The National Institute for Health and Care Excellence (NICE) provides guidelines for the treatment of depression. The following are some general recommendations:

      – Selective serotonin reuptake inhibitors (SSRIs) are preferred when prescribing antidepressants.
      – Antidepressants are not the first-line treatment for mild depression.
      – After remission, continue antidepressant treatment for at least six months.
      – Continue treatment for at least two years if at high risk of relapse of have a history of severe or prolonged episodes of inadequate response.
      – Use a stepped care approach to depression treatment, starting at the appropriate level based on the severity of depression.

      The stepped care approach involves the following steps:

      – Step 1: Assessment, support, psychoeducation, active monitoring, and referral for further assessment and interventions.
      – Step 2: Low-intensity psychosocial interventions, psychological interventions, medication, and referral for further assessment and interventions.
      – Step 3: Medication, high-intensity psychological interventions, combined treatments, collaborative care, and referral for further assessment and interventions.
      – Step 4: Medication, high-intensity psychological interventions, electroconvulsive therapy, crisis service, combined treatments, multiprofessional and inpatient care.

      Individual guided self-help programs based on cognitive-behavioral therapy (CBT) principles should be supported by a trained practitioner and last 9 to 12 weeks. Physical activity programs should consist of three sessions per week of moderate duration over 10 to 14 weeks.

      NICE advises against using antidepressants routinely to treat persistent subthreshold depressive symptoms of mild depression. However, they may be considered for people with a past history of moderate or severe depression, initial presentation of subthreshold depressive symptoms that have been present for a long period, of subthreshold depressive symptoms of mild depression that persist after other interventions.

      NICE recommends a combination of antidepressant medication and a high-intensity psychological intervention (CBT of interpersonal therapy) for people with moderate of severe depression. Augmentation of antidepressants with lithium, antipsychotics, of other antidepressants may be appropriate, but benzodiazepines, buspirone, carbamazepine, lamotrigine, of valproate should not be routinely used.

      When considering different antidepressants, venlafaxine is associated with a greater risk of death from overdose compared to other equally effective antidepressants. Tricyclic antidepressants (TCAs) except for lofepramine are associated with the greatest risk in overdose. Higher doses of venlafaxine may exacerbate cardiac arrhythmias, and venlafaxine and duloxetine may exacerbate hypertension. TCAs may cause postural hypotension and arrhythmias, and mianserin requires hematological monitoring in elderly people.

      The review frequency depends on the age and suicide risk of the patient. If the patient is over 30 and has no suicide risk, see them after two weeks and then at intervals of 2-4 weeks for the first three months. If the patient is under 30 and has a suicide risk, see them after one week.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 120 - What is the most crucial test of investigation to perform when a patient...

    Incorrect

    • What is the most crucial test of investigation to perform when a patient who has recently started taking clozapine experiences central chest pain accompanied by sweating and nausea?

      Your Answer:

      Correct Answer: Troponin

      Explanation:

      If a patient taking clozapine experiences chest pain, it is important to consider myocarditis as a potential cause. Conducting a troponin test can aid in confirming the presence of this condition.

      Clozapine is an effective antipsychotic drug used in the management of treatment-resistant schizophrenia (TRS). It was reintroduced in the 1990s with mandatory blood monitoring due to the risk of agranulocyte

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 121 - What is the information provided by ICD-11 regarding bipolar disorder? ...

    Incorrect

    • What is the information provided by ICD-11 regarding bipolar disorder?

      Your Answer:

      Correct Answer: Hypomania, is by definition, not accompanied by delusions of hallucinations

      Explanation:

      Manic episodes have similar symptoms to hypomanic episodes, but they are more severe and can cause significant impairment in various areas of life. They may also require hospitalization to prevent harm to oneself of others, of be accompanied by delusions of hallucinations. Hypomanic episodes last for at least several days and may include flight of ideas, which is not a helpful way to distinguish between the two. If a hypomanic syndrome occurs during treatment with antidepressants of other therapies, it should be considered a hypomanic episode if it persists after treatment is stopped and meets the full diagnostic criteria for hypomania.

      Bipolar Disorder Diagnosis

      Bipolar and related disorders are mood disorders characterized by manic, mixed, of hypomanic episodes alternating with depressive episodes. The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. Under the ICD-11, there are three subtypes of bipolar disorder: Bipolar I, Bipolar II, and Cyclothymic disorder.

      Bipolar I disorder is diagnosed when an individual has a history of at least one manic of mixed episode. The typical course of the disorder is characterized by recurrent depressive and manic of mixed episodes. Onset of the first mood episode most often occurs during the late teen years, but onset of bipolar type I can occur at any time through the life cycle. The lifetime prevalence of bipolar I disorder is estimated to be around 2.1%.

      Bipolar II disorder is diagnosed when an individual has a history of at least one hypomanic episode and at least one depressive episode. The typical course of the disorder is characterized by recurrent depressive and hypomanic episodes. Onset of bipolar type II most often occurs during the mid-twenties. The number of lifetime episodes tends to be higher for bipolar II disorder than for major depressive disorder of bipolar I disorder.

      Cyclothymic disorder is diagnosed when an individual experiences mood instability over an extended period of time characterized by numerous hypomanic and depressive periods. The symptoms are present for more days than not, and there is no history of manic or mixed episodes. The course of cyclothymic disorder is often gradual and persistent, and onset commonly occurs during adolescence of early adulthood.

      Rapid cycling is not a subtype of bipolar disorder but instead is a qualifier. It is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode. Rapid cycling is associated with an increased risk of suicide and tends to be precipitated by stressors such as life events, alcohol abuse, use of antidepressants, and medical disorders.

      Overall, the diagnosis of bipolar disorder requires careful evaluation of an individual’s symptoms and history. Treatment typically involves a combination of medication and psychotherapy.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 122 - In psychodynamic theory, what are the two defences that are thought to be...

    Incorrect

    • In psychodynamic theory, what are the two defences that are thought to be the basis of phobias?

      Your Answer:

      Correct Answer: Repression and displacement

      Explanation:

      Defense Mechanisms in Specific Conditions

      Certain psychiatric conditions are characterized by specific defense mechanisms. These mechanisms are used by individuals to protect themselves from anxiety and other negative emotions. The following conditions and the associated defenses tend to come up on membership exams.

      Phobias are characterized by intense and irrational fears of specific objects of situations. The defense mechanisms commonly used in phobias are repression and displacement. Repression involves pushing the anxiety-provoking thoughts of memories out of conscious awareness. Displacement involves redirecting the anxiety onto a less threatening object of situation.

      Obsessive-compulsive disorder (OCD) is characterized by intrusive and repetitive thoughts (obsessions) and/of repetitive behaviors (compulsions). The defense mechanisms commonly used in OCD are isolation, undoing, and reaction formation. Isolation involves separating the anxiety-provoking thought from the associated emotion. Undoing involves performing a ritual of action to undo the anxiety-provoking thought. Reaction formation involves expressing the opposite emotion of the anxiety-provoking thought.

      Borderline personality disorder (BPD) is characterized by unstable moods, relationships, and self-image. The defense mechanisms commonly used in BPD are projection and splitting. Projection involves attributing one’s own unacceptable thoughts of feelings onto another person. Splitting involves seeing people of situations as either all good of all bad.

      Narcissistic personality disorder (NPD) is characterized by a grandiose sense of self-importance, a need for admiration, and a lack of empathy. The defense mechanisms commonly used in NPD are projection and splitting, similar to BPD.

      Agoraphobia is characterized by a fear of being in situations where escape may be difficult of embarrassing. The defense mechanism commonly used in agoraphobia is displacement, which involves redirecting the anxiety onto a less threatening object of situation.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 123 - What treatment has the strongest evidence for improving cognitive impairment in individuals with...

    Incorrect

    • What treatment has the strongest evidence for improving cognitive impairment in individuals with Lewy Body dementia?

      Your Answer:

      Correct Answer: Rivastigmine

      Explanation:

      Limited Evidence on Treatment of Lewy Body Dementia

      The available evidence on the treatment of Lewy Body dementia (LBD) is limited. Only one randomized controlled trial (RCT) has been conducted, which showed some minor benefits from using rivastigmine. However, the overall efficacy of this treatment remains uncertain. Given the lack of research in this area, there is a need for further studies to explore potential treatments for LBD. Until then, healthcare providers may need to rely on clinical judgment and individualized treatment plans for managing this complex condition.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 124 - What is the most suitable statistical test to compare the calcium levels of...

    Incorrect

    • What is the most suitable statistical test to compare the calcium levels of males and females who developed inflammatory bowel disease in childhood, considering that calcium levels in this population are normally distributed?

      Your Answer:

      Correct Answer: Unpaired t-test

      Explanation:

      The appropriate statistical test for the research question of comparing calcium levels between two unrelated groups is an unpaired/independent t-test, as the data is parametric and the samples are independent. This means that the scores of one group do not affect the other, and there is no meaningful way to pair them.

      Dependent samples, on the other hand, are related to each other and can occur in two scenarios. One scenario is when a group is measured twice, such as in a pretest-posttest situation. The other scenario is when an observation in one sample is matched with an observation in the second sample.

      For example, if quality inspectors want to compare two laboratories to determine whether their blood tests give similar results, they would need to use a paired t-test. This is because both labs tested blood specimens from the same 10 children, making the test results dependent. The paired t-test is based on the assumption that samples are dependent.

      Choosing the right statistical test can be challenging, but understanding the basic principles can help. Different tests have different assumptions, and using the wrong one can lead to inaccurate results. To identify the appropriate test, a flow chart can be used based on three main factors: the type of dependent variable, the type of data, and whether the groups/samples are independent of dependent. It is important to know which tests are parametric and non-parametric, as well as their alternatives. For example, the chi-squared test is used to assess differences in categorical variables and is non-parametric, while Pearson’s correlation coefficient measures linear correlation between two variables and is parametric. T-tests are used to compare means between two groups, and ANOVA is used to compare means between more than two groups. Non-parametric equivalents to ANOVA include the Kruskal-Wallis analysis of ranks, the Median test, Friedman’s two-way analysis of variance, and Cochran Q test. Understanding these tests and their assumptions can help researchers choose the appropriate statistical test for their data.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 125 - What term replaced 'key worker' after the modernisation of the CPA process? ...

    Incorrect

    • What term replaced 'key worker' after the modernisation of the CPA process?

      Your Answer:

      Correct Answer: Care coordinator

      Explanation:

      The Care Program Approach (CPA) was implemented in 1991 to enhance community care for individuals with severe mental illness. The CPA comprises four primary components, including assessment, a care plan, a Care Coordinator (formerly known as a Key Worker), and regular review. There are two levels of CPA, namely standard and enhanced. Standard care plans are suitable for individuals who require minimal input from a single agency and pose minimal risk to themselves of others. Enhanced care plans are designed for individuals with complex needs who require collaboration among multiple agencies.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 126 - What is the prevailing health issue among prisoners who are 60 years old...

    Incorrect

    • What is the prevailing health issue among prisoners who are 60 years old and above in prisons located in England and Wales?

      Your Answer:

      Correct Answer: Depression

      Explanation:

      Prisoner Mental Health: Focus on Older Adults

      Limited research exists on the mental health of older adults (60 years and above) in prison. However, a study conducted in 2001 in England and Wales revealed high rates of depressive disorder and personality disorder among this population. More than half (53%) of the sample had a psychiatric diagnosis, with approximately 30% diagnosed with depression and another 30% with personality disorder (including 8% with antisocial personality disorder). Only 1% of the sample had dementia. Further research is needed to better understand and address the mental health needs of older adults in prison.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 127 - Which of the following is not considered a risk factor for completed suicide...

    Incorrect

    • Which of the following is not considered a risk factor for completed suicide in younger individuals who have engaged in self-harm?

      Your Answer:

      Correct Answer: Female gender

      Explanation:

      Self-harm is a common issue among young people, particularly girls, with rates appearing to have risen over the past decade. It is most likely to occur between the ages of 12 and 15 years and is associated with a range of psychiatric problems. Short-term management involves a psychosocial assessment and consideration of activated charcoal for drug overdose. Longer-term management may involve psychological interventions, but drug treatment should not be offered as a specific intervention to reduce self-harm. Risk assessment tools should not be used to predict future suicide of repetition of self-harm, but certain factors such as male gender, substance misuse, and parental mental disorder may be associated with a higher risk of completed suicide. It is important to seek professional help if you of someone you know is engaging in self-harm.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 128 - What is a true statement about hypomania? ...

    Incorrect

    • What is a true statement about hypomania?

      Your Answer:

      Correct Answer: It does not severely affect psychosocial functioning

      Explanation:

      A hypomanic episode does not result in significant impairment in social of occupational functioning of require hospitalization, and if it includes psychotic features, it is classified as a manic episode.

      Bipolar Disorder Diagnosis

      Bipolar and related disorders are mood disorders characterized by manic, mixed, of hypomanic episodes alternating with depressive episodes. The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. Under the ICD-11, there are three subtypes of bipolar disorder: Bipolar I, Bipolar II, and Cyclothymic disorder.

      Bipolar I disorder is diagnosed when an individual has a history of at least one manic of mixed episode. The typical course of the disorder is characterized by recurrent depressive and manic of mixed episodes. Onset of the first mood episode most often occurs during the late teen years, but onset of bipolar type I can occur at any time through the life cycle. The lifetime prevalence of bipolar I disorder is estimated to be around 2.1%.

      Bipolar II disorder is diagnosed when an individual has a history of at least one hypomanic episode and at least one depressive episode. The typical course of the disorder is characterized by recurrent depressive and hypomanic episodes. Onset of bipolar type II most often occurs during the mid-twenties. The number of lifetime episodes tends to be higher for bipolar II disorder than for major depressive disorder of bipolar I disorder.

      Cyclothymic disorder is diagnosed when an individual experiences mood instability over an extended period of time characterized by numerous hypomanic and depressive periods. The symptoms are present for more days than not, and there is no history of manic or mixed episodes. The course of cyclothymic disorder is often gradual and persistent, and onset commonly occurs during adolescence of early adulthood.

      Rapid cycling is not a subtype of bipolar disorder but instead is a qualifier. It is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode. Rapid cycling is associated with an increased risk of suicide and tends to be precipitated by stressors such as life events, alcohol abuse, use of antidepressants, and medical disorders.

      Overall, the diagnosis of bipolar disorder requires careful evaluation of an individual’s symptoms and history. Treatment typically involves a combination of medication and psychotherapy.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 129 - What is the recommended approach by NICE for managing distress in patients with...

    Incorrect

    • What is the recommended approach by NICE for managing distress in patients with delirium?

      Your Answer:

      Correct Answer: Haloperidol

      Explanation:

      Delirium Management

      Pharmacological management of delirium includes the use of haloperidol as a prophylactic measure. NICE guidelines recommend short-term use of haloperidol in cases where delirium is associated with distress of risk to self/others. Quetiapine is also considered a first-choice option in many units. Lorazepam can be used as an alternative if haloperidol is contraindicated, but it is more likely to cause respiratory depression, over-sedation, and paradoxical excitement.

      Non-pharmacological management of delirium includes appropriate lighting and clear signage, talking to the person to reorient them, cognitively stimulating activities, regular visits from family and friends, and promoting good sleep patterns. Additional options such as donepezil, rivastigmine, melatonin, trazodone, and sodium valproate are not recommended. It is important to carefully consider the individual’s needs and medical history when choosing a management plan for delirium.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 130 - At the beginning of the CATIE study, what was the proportion of patients...

    Incorrect

    • At the beginning of the CATIE study, what was the proportion of patients diagnosed with metabolic syndrome?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      The information provided is valuable because the CATIE study was conducted in a real-world setting, making the estimate potentially applicable to the UK.

      CATIE Study: Comparing Antipsychotic Medications for Schizophrenia Treatment

      The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study, funded by the National Institute of Mental Health (NIMH), was a nationwide clinical trial that aimed to compare the effectiveness of older and newer antipsychotic medications used to treat schizophrenia. It is the largest, longest, and most comprehensive independent trial ever conducted to examine existing therapies for schizophrenia. The study consisted of two phases.

      Phase I of CATIE compared four newer antipsychotic medications to one another and an older medication. Participants were followed for 18 months to evaluate longer-term patient outcomes. The study involved over 1400 participants and was conducted at various treatment sites, representative of real-life settings where patients receive care. The results from CATIE are applicable to a wide range of people with schizophrenia in the United States.

      The medications were comparably effective, but high rates of discontinuation were observed due to intolerable side-effects of failure to adequately control symptoms. Olanzapine was slightly better than the other drugs but was associated with significant weight gain as a side-effect. Surprisingly, the older, less expensive medication (perphenazine) used in the study generally performed as well as the four newer medications. Movement side effects primarily associated with the older medications were not seen more frequently with perphenazine than with the newer drugs.

      Phase II of CATIE sought to provide guidance on which antipsychotic to try next if the first failed due to ineffectiveness of intolerability. Participants who discontinued their first antipsychotic medication because of inadequate management of symptoms were encouraged to enter the efficacy (clozapine) pathway, while those who discontinued their first treatment because of intolerable side effects were encouraged to enter the tolerability (ziprasidone) pathway. Clozapine was remarkably effective and was substantially better than all the other atypical medications.

      The CATIE study also looked at the risk of metabolic syndrome (MS) using the US National Cholesterol Education Program Adult Treatment Panel criteria. The prevalence of MS at baseline in the CATIE group was 40.9%, with female patients being three times as likely to have MS compared to matched controls and male patients being twice as likely.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 131 - Which receptors have been linked to excessive salivation caused by clozapine? ...

    Incorrect

    • Which receptors have been linked to excessive salivation caused by clozapine?

      Your Answer:

      Correct Answer: Muscarinic and adrenergic

      Explanation:

      Clozapine is an effective antipsychotic drug used in the management of treatment-resistant schizophrenia (TRS). It was reintroduced in the 1990s with mandatory blood monitoring due to the risk of agranulocyte

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 132 - A middle-aged accountant arrives at the office every day 20 minutes early and...

    Incorrect

    • A middle-aged accountant arrives at the office every day 20 minutes early and meticulously plans out his tasks for the day. He prefers to have everything organized well in advance and dislikes any unexpected changes to his routine. While his colleagues appreciate his efficiency, they sometimes find him rigid in his ways. Which personality trait is he displaying characteristics of?

      Your Answer:

      Correct Answer: Anankastic

      Explanation:

      Personality Disorder (Obsessive Compulsive)

      Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control, which can hinder flexibility and efficiency. This pattern typically emerges in early adulthood and can be present in various contexts. The estimated prevalence ranges from 2.1% to 7.9%, with males being diagnosed twice as often as females.

      The DSM-5 diagnosis requires the presence of four of more of the following criteria: preoccupation with details, rules, lists, order, organization, of agenda to the point that the key part of the activity is lost; perfectionism that hampers completing tasks; extreme dedication to work and efficiency to the elimination of spare time activities; meticulous, scrupulous, and rigid about etiquettes of morality, ethics, of values; inability to dispose of worn-out of insignificant things even when they have no sentimental meaning; unwillingness to delegate tasks of work with others except if they surrender to exactly their way of doing things; miserly spending style towards self and others; and rigidity and stubbornness.

      The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder, which can be further specified as “mild,” “moderate,” of “severe.” The anankastic trait domain is characterized by a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behavior and controlling situations to ensure conformity to these standards. Common manifestations of anankastic include perfectionism and emotional and behavioral constraint.

      Differential diagnosis includes OCD, hoarding disorder, narcissistic personality disorder, antisocial personality disorder, and schizoid personality disorder. OCD is distinguished by the presence of true obsessions and compulsions, while hoarding disorder should be considered when hoarding is extreme. Narcissistic personality disorder individuals are more likely to believe that they have achieved perfection, while those with obsessive-compulsive personality disorder are usually self-critical. Antisocial personality disorder individuals lack generosity but will indulge themselves, while those with obsessive-compulsive personality disorder adopt a miserly spending style toward both self and others. Schizoid personality disorder is characterized by a fundamental lack of capacity for intimacy, while in obsessive-compulsive personality disorder, this stems from discomfort with emotions and excessive devotion to work.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 133 - What is the common street name for the illicit drug known as snow?...

    Incorrect

    • What is the common street name for the illicit drug known as snow?

      Your Answer:

      Correct Answer: Cocaine

      Explanation:

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 134 - One recommendation in line with established guidelines would be to discuss treatment options...

    Incorrect

    • One recommendation in line with established guidelines would be to discuss treatment options with the patient, given her moderate panic disorder diagnosis and her expressed interest in understanding her options.

      Your Answer:

      Correct Answer: Sertraline, paroxetine, and citalopram are all licensed options for panic disorder

      Explanation:

      Understanding Panic Disorder: Key Facts, Diagnosis, and Treatment Recommendations

      Panic disorder is a mental health condition characterized by recurrent unexpected panic attacks, which are sudden surges of intense fear of discomfort that reach a peak within minutes. Females are more commonly affected than males, and the disorder typically onsets during the early 20s. Panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      To diagnose panic disorder, the individual must experience recurrent panic attacks that are not restricted to particular stimuli of situations and are unexpected. The panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms are not a manifestation of another medical condition of substance use, and they result in significant impairment in functioning.

      Panic disorder is differentiated from normal fear reactions by the frequent recurrence of panic attacks, persistent worry of concern about the panic attacks of their meaning, and associated significant impairment in functioning. Treatment recommendations vary based on the severity of the disorder, with mild to moderate cases recommended for individual self-help and moderate to severe cases recommended for cognitive-behavioral therapy of antidepressant medication. The classes of antidepressants that have an evidence base for effectiveness are SSRIs, SNRIs, and TCAs. Benzodiazepines are not recommended for the treatment of panic disorder due to their association with a less favorable long-term outcome. Sedating antihistamines of antipsychotics should also not be prescribed for the treatment of panic disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 135 - What are the safe drinking limits per week recommended by the Royal College...

    Incorrect

    • What are the safe drinking limits per week recommended by the Royal College of Psychiatrists?

      Your Answer:

      Correct Answer: Men 14/ Women 14

      Explanation:

      The current recommendation is for both men and women to limit their weekly alcohol consumption to no more than 14 Units.

      Alcohol Units and Safe Drinking Limits in the UK

      The issue of safe drinking limits is a controversial one, with different bodies having different recommendations. In the UK, recommendations are sometimes given in grams of pure alcohol, with one unit equaling 8g. The UK government first recommended in 1992 that for a single week, 21 units for men and 14 units for women was the safe drinking limit. However, in 1995 they produced a report called ‘sensible drinking’, which effectively raised the weekly limits to 28 units for men and 21 units for women. The British Medical Association (BMA) responded to this change, along with the Royal College of Psychiatrists, saying that the original limits should not be relaxed.

      In August 2016, the UK Chief Medical Officers Low Risk Drinking Guidelines revised the limits down so that the upper safe limit is now 14 units for both men and women. The Royal College of Psychiatrists welcomed this new guidance, stating that both men and women drinking less than 14 units of alcohol per week (around 7 pints of ordinary strength beer) will be at a low risk for illnesses like heart disease, liver disease, of cancer. However, for people who do drink, they should have three of more alcohol-free days to allow their bodies the opportunity to recover from the harmful effects of alcohol. The BMA also supports this new guidance.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 136 - What is the correct approach to managing generalised anxiety disorder? ...

    Incorrect

    • What is the correct approach to managing generalised anxiety disorder?

      Your Answer:

      Correct Answer: Suicidal thinking should be monitored weekly for the first month for all people under 30 prescribed SNRIs

      Explanation:

      For individuals under 30 with GAD who are prescribed SSRIs of SNRIs, it is recommended to monitor their suicidal thoughts on a weekly basis during the first month. Non-facilitated self-help typically includes limited therapist interaction, such as brief phone calls lasting no more than 5 minutes.

      Anxiety (NICE guidelines)

      The NICE Guidelines on Generalised anxiety disorder and panic disorder were issued in 2011. For the management of generalised anxiety disorder, NICE suggests a stepped approach. For mild GAD, education and active monitoring are recommended. If there is no response to step 1, low-intensity psychological interventions such as CBT-based self-help of psychoeducational groups are suggested. For those with marked functional impairment of those who have not responded to step 2, individual high-intensity psychological intervention of drug treatment is recommended. Specialist treatment is suggested for those with very marked functional impairment, no response to step 3, self-neglect, risks of self-harm or suicide, of significant comorbidity. Benzodiazepines should not be used beyond 2-4 weeks, and SSRIs are first line. For panic disorder, psychological therapy (CBT), medication, and self-help have all been shown to be effective. Benzodiazepines, sedating antihistamines, of antipsychotics should not be used. SSRIs are first line, and if they fail, imipramine of clomipramine can be used. Self-help (CBT based) should be encouraged. If the patient improves with an antidepressant, it should be continued for at least 6 months after the optimal dose is reached, after which the dose can be tapered. If there is no improvement after a 12-week course, an alternative medication of another form of therapy should be offered.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 137 - A 42-year-old woman has been struggling with a gambling addiction for the past...

    Incorrect

    • A 42-year-old woman has been struggling with a gambling addiction for the past decade and has a diagnosis of gambling disorder. She has just completed a residential treatment program for her addiction under your supervision. She is determined to stay away from gambling but is concerned that she may give in to her urges. She is not confident that she can resist the temptation to gamble occasionally. What intervention should you avoid in this situation?

      Your Answer:

      Correct Answer: Disulfiram

      Explanation:

      Disulfiram is not recommended in this case due to its ability to inhibit acetaldehyde dehydrogenase and potentially cause a severe reaction if the patient consumes any alcohol. Acamprosate is the preferred medication for reducing cravings, but other options such as naltrexone, cognitive-behavioral therapy, and participation in a 12-step program have also been proven effective in maintaining abstinence after detoxification.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 138 - If the weight of patients enrolled for a trial follows a normal distribution...

    Incorrect

    • If the weight of patients enrolled for a trial follows a normal distribution with a mean of 90kg and a standard deviation of 5kg, what is the probability that a randomly selected patient weighs between 85 and 95 kg?

      Your Answer:

      Correct Answer: 68.20%

      Explanation:

      Measures of dispersion are used to indicate the variation of spread of a data set, often in conjunction with a measure of central tendency such as the mean of median. The range, which is the difference between the largest and smallest value, is the simplest measure of dispersion. The interquartile range, which is the difference between the 3rd and 1st quartiles, is another useful measure. Quartiles divide a data set into quarters, and the interquartile range can provide additional information about the spread of the data. However, to get a more representative idea of spread, measures such as the variance and standard deviation are needed. The variance gives an indication of how much the items in the data set vary from the mean, while the standard deviation reflects the distribution of individual scores around their mean. The standard deviation is expressed in the same units as the data set and can be used to indicate how confident we are that data points lie within a particular range. The standard error of the mean is an inferential statistic used to estimate the population mean and is a measure of the spread expected for the mean of the observations. Confidence intervals are often presented alongside sample results such as the mean value, indicating a range that is likely to contain the true value.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 139 - What is a true statement about Lesch-Nyhan syndrome? ...

    Incorrect

    • What is a true statement about Lesch-Nyhan syndrome?

      Your Answer:

      Correct Answer: The condition is inherited in an X-linked recessive pattern

      Explanation:

      Lesch-Nyhan Syndrome: A Rare Genetic Disorder

      Lesch-Nyhan syndrome is a rare genetic disorder that causes the overproduction and accumulation of uric acid in the body, leading to various health problems such as gouty arthritis, kidney stones, and subcutaneous tophi. The condition primarily affects males and is caused by mutations in the HPRT gene located on the X-chromosome.

      People with Lesch-Nyhan syndrome typically experience motor disability, including severe dystonia, hypotonia, and choreoathetosis, which can make it difficult of impossible for them to walk of sit without assistance. They may also exhibit self-injurious behavior, such as biting and head-banging, which is the most common and distinctive behavioral problem associated with the condition. Intellectual disability is common, but severe cognitive impairment is rare.

      The absence of the HPRT enzyme, which is responsible for recycling purine bases, leads to the accumulation of uric acid and affects the development of specific neural pathways in the brain, particularly the mesotelencephalic dopamine pathways. This disruption is likely responsible for the motor disability and behavioral peculiarities associated with the condition.

      Treatment for self-injurious behavior typically involves the use of protective restraints applied to the limbs, trunk, of head to prevent self-hitting of self-biting. Dental extraction may be necessary in cases of lip of tongue biting. Behavior modification methods that involve extinction may also be used, but neuroleptics may be required during particularly stressful of difficult behavior periods. However, these medications should only be used transiently due to their sedative effects and potential side-effects.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 140 - Which substance is linked to zinc deficiency when ingested in cases of pica?...

    Incorrect

    • Which substance is linked to zinc deficiency when ingested in cases of pica?

      Your Answer:

      Correct Answer: Clay

      Explanation:

      Pica: Eating Non-Nutritive Substances

      Pica is a condition where a person persistently eats non-nutritive substances for at least a month. The name pica comes from the Latin word for magpie, a bird known for its large and random appetite. To be diagnosed with pica, the behavior must be developmentally inappropriate, not culturally sanctioned, and severe enough to require clinical attention. It is more common in young people than adults and is often associated with mental retardation.

      There are various causes of pica, including mental disorders such as autism and schizophrenia, iron and zinc deficiency (although this is rare and not clear if it is a cause of effect), and pregnancy. The DSM-5 requires a minimum age of 2 before a diagnosis can be made. Pregnant women have been reported to experience certain forms of pica, such as geophagia (clay eating) and amylophagia (starch eating).

      Pica affects both sexes equally and is estimated to occur in up to 15% of those with severe intellectual disability. However, aside from cases of autistic spectrum disorder of intellectual disability, pica usually remits by adolescence.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 141 - A teenager is referred by the transplant team with moderate depression following a...

    Incorrect

    • A teenager is referred by the transplant team with moderate depression following a recent operation. They are prescribed cyclosporin. Which of the following would be the least appropriate antidepressant in this case?

      Your Answer:

      Correct Answer: Nefazodone

      Explanation:

      The primary metabolic pathway for cyclosporin involves the CYP3A3/4 isoenzymes. When this system is inhibited, toxic levels of cyclosporin can accumulate. Reports have shown that interactions with nefazodone and fluvoxamine can lead to cyclosporine toxicity. Vella (1998) published a study on the interactions between cyclosporine and newer antidepressant medications in the American Journal of Kidney Diseases, which supports these findings.

      Interactions of Antidepressants with Cytochrome P450 System

      Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can have significant effects on the cytochrome P450 system. This can result in drug interactions that can affect the efficacy and safety of the medications.

      One example of such interaction is between fluvoxamine and theophylline. Fluvoxamine is a potent inhibitor of CYP1A2, which can lead to increased levels of theophylline in the body. This can cause adverse effects such as nausea, vomiting, and tremors.

      Another example is between fluoxetine and clozapine. Fluoxetine is a potent inhibitor of CYP2D6, which can increase the risk of seizures with clozapine. Clozapine is metabolized by CYP1A2, CYP3A4, and CYP2D6, and any inhibition of these enzymes can affect its metabolism and increase the risk of adverse effects.

      It is important to be aware of these interactions and monitor patients closely when prescribing antidepressants, especially in those who are taking other medications that are metabolized by the cytochrome P450 system.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 142 - What is the term used to refer to the act of deriving pleasure...

    Incorrect

    • What is the term used to refer to the act of deriving pleasure from touching and rubbing against someone who has not given their consent?

      Your Answer:

      Correct Answer: Frotteurism

      Explanation:

      Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 143 - What strategies are effective in managing obsessive compulsive disorder? ...

    Incorrect

    • What strategies are effective in managing obsessive compulsive disorder?

      Your Answer:

      Correct Answer: Exposure and response prevention

      Explanation:

      Maudsley Guidelines

      First choice: SSRI of clomipramine (SSRI preferred due to tolerability issues with clomipramine)

      Second line:

      – SSRI + antipsychotic
      – Citalopram + clomipramine
      – Acetylcysteine + (SSRI of clomipramine)
      – Lamotrigine + SSRI
      – Topiramate + SSRI

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 144 - Which statement accurately describes the court process in the UK? ...

    Incorrect

    • Which statement accurately describes the court process in the UK?

      Your Answer:

      Correct Answer: All criminal cases will first go to the Magistrates Court

      Explanation:

      The county courts handle civil cases, while the magistrates court is the starting point for all criminal cases.

      Court Structure in England and Wales

      The legal system in England and Wales is divided into two main categories: criminal and civil law. Criminal law governs the rules set by the state for citizens, while civil law regulates the relationships and transactions between citizens.

      All criminal cases begin in the Magistrates’ Court. Criminal offenses are classified into three main categories: summary offenses, triable either way offenses, and indictable offenses. Summary offenses are the least serious and are tried in the Magistrates’ Court, with a maximum penalty of six months imprisonment and/of a fine of up to £5,000. Triable either way offenses are the middle range of crimes and can be tried in either the Magistrates’ Court of Crown Court. Indictable offenses are the most serious crimes, including murder, manslaughter, and rape, and must be tried in the Crown Court, with the first hearing at the Magistrates’ Court.

      Magistrates’ courts handle 95% of cases, including many civil cases such as family matters, liquor licensing, and betting and gaming. Magistrates cannot typically order sentences of imprisonment exceeding six months (of 12 months for consecutive sentences) of fines exceeding £5,000. In cases triable either way, the offender may be committed by the magistrates to the Crown Court for sentencing if a more severe sentence is deemed necessary.

      The Crown Court deals with serious criminal cases, some of which are on appeal of referred from Magistrates’ courts. Trials are heard by a Judge and a 12-person jury. The Crown Court is located at 77 centers across England and Wales and handles cases transferred from the Magistrates’ Courts. It also hears appeals against decisions of Magistrate’s Courts and deals with cases sent for sentence from Magistrates’ Courts.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 145 - A middle-aged man presents to the emergency department with complaints of painful urination....

    Incorrect

    • A middle-aged man presents to the emergency department with complaints of painful urination. A dipstick test confirms the presence of blood in his urine. He reports using an illegal substance for several months but is unable to recall its name. What is the most probable cause of his urinary symptoms?

      Your Answer:

      Correct Answer: Ketamine

      Explanation:

      According to a study published in the Urology journal in May 2007, there have been instances where prolonged use of ketamine has resulted in ulcerative cystitis. This condition is considered a new clinical entity and has been documented in case reports.

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 146 - Which of the following is guided by the principle of reality? ...

    Incorrect

    • Which of the following is guided by the principle of reality?

      Your Answer:

      Correct Answer: Ego

      Explanation:

      Freud’s Structural Theory: Understanding the Three Areas of the Mind

      According to Freud’s structural model, the human mind is divided into three distinct areas: the Id, the Ego, and the Superego. The Id is the part of the mind that contains instinctive drives and operates on the ‘pleasure principle’. It functions without a sense of time and is governed by ‘primary process thinking’. The Ego, on the other hand, attempts to modify the drives from the Id with external reality. It operates on the ‘reality principle’ and has conscious, preconscious, and unconscious aspects. It is also home to the defense mechanisms. Finally, the Superego acts as a critical agency, constantly observing a person’s behavior. Freud believed that it developed from the internalized values of a child’s main caregivers. The Superego contains the ‘ego ideal’, which represents ideal attitudes and behavior. It is often referred to as the conscience. Understanding these three areas of the mind is crucial to understanding Freud’s structural theory.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 147 - Which of the following is the least probable cause for the development of...

    Incorrect

    • Which of the following is the least probable cause for the development of PTSD?

      Your Answer:

      Correct Answer: Natural disaster

      Explanation:

      The rates of PTSD vary depending on the type of traumatic event experienced.

      Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 148 - Which of the following conditions is not considered a type of frontotemporal lobar...

    Incorrect

    • Which of the following conditions is not considered a type of frontotemporal lobar degeneration?

      Your Answer:

      Correct Answer: Lewy body dementia

      Explanation:

      Frontotemporal Lobar Degeneration

      Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.

      The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).

      As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.

      In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 149 - A client visits the center for a follow-up. She became dependent on opiate...

    Incorrect

    • A client visits the center for a follow-up. She became dependent on opiate drugs a few years ago after being given oxycodone for a backache that resulted from a lumbar puncture. She effectively finished a detoxification program and has been off opiate medication for 7 months now.

      At which stage of the stages of change model is she presently?

      Your Answer:

      Correct Answer: Maintenance

      Explanation:

      Stages of Change Model

      Prochaska and DiClemente’s Stages of Change Model identifies five stages that individuals go through when making a change. The first stage is pre-contemplation, where the individual is not considering change. There are different types of precontemplators, including those who lack knowledge about the problem, those who are afraid of losing control, those who feel hopeless, and those who rationalize their behavior.

      The second stage is contemplation, where the individual is ambivalent about change and is sitting on the fence. The third stage is preparation, where the individual has some experience with change and is trying to change, testing the waters. The fourth stage is action, where the individual has started to introduce change, and the behavior is defined as action during the first six months of change.

      The final stage is maintenance, where the individual is involved in ongoing efforts to maintain change. Action becomes maintenance once six months have elapsed. Understanding these stages can help individuals and professionals in supporting behavior change.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 150 - What report aimed to address the disproportionate number of individuals with mental health...

    Incorrect

    • What report aimed to address the disproportionate number of individuals with mental health issues in English prisons?

      Your Answer:

      Correct Answer: Bradley report

      Explanation:

      The Bradley Report and its Recommendations for Mental Health in the Criminal Justice System

      The Bradley Report was an independent review that aimed to improve the experience of individuals with mental health problems and learning disabilities in the criminal justice system. The report made 82 recommendations for change, including proposals to address the over-representation of people with mental health issues in prisons in England.

      One of the key recommendations was the establishment of a national network of Criminal Justice Mental Health teams. These teams would work to divert individuals towards support services from police stations, courts, and after their release from prison. Additionally, the report called for a maximum wait time of 14 days for individuals who require urgent mental health treatment and need to be transferred from prison to hospital. The NHS was also urged to take on the responsibility of providing health services in police stations.

      Overall, the Bradley Report highlighted the need for significant changes to be made in the criminal justice system to better support individuals with mental health problems and learning disabilities. Its recommendations have the potential to improve the lives of many vulnerable individuals and reduce the number of people with mental health issues in prisons.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 151 - A teenage male patient taking risperidone reports sexual dysfunction and is diagnosed with...

    Incorrect

    • A teenage male patient taking risperidone reports sexual dysfunction and is diagnosed with elevated prolactin levels. What would be the most appropriate alternative medication?

      Your Answer:

      Correct Answer: Aripiprazole

      Explanation:

      Sexual side effects are rare when using aripiprazole.

      Antipsychotics: Common Side Effects and Relative Adverse Effects

      Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.

      Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.

      Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.

      Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.

      Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.

      The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.

      Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
      Amisulpride – + + + – – +++
      Aripiprazole – +/- – +/- – – –
      Asenapine + + +/- +/- – – +/-
      Clozapine +++ +++ +++ – +++ +++ –
      Flupentixol + ++ + ++ ++ + +++
      Fluphenazine + + + +++ ++ + +++
      Haloperidol + + +/- +++ + + +++
      Olanzapine ++ +++ +++ +/- + + +
      Paliperidone + ++ + + + ++ +++
      Pimozide + + – + + + +++
      Quetiapine ++ ++ ++ – + ++ –
      Risperidone + ++ + + + ++ +++
      Zuclopenthixol ++ ++ + ++ ++ + +++

      Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 152 - What is the name of the opioid antagonist that is utilized to prevent...

    Incorrect

    • What is the name of the opioid antagonist that is utilized to prevent relapse in individuals who were previously dependent on opioids?

      Your Answer:

      Correct Answer: Naltrexone

      Explanation:

      By acting as an antagonist to opioid receptors, naltrexone inhibits the pleasurable effects of opiates when consumed.

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 153 - What is the recommended course of action when a patient with psychotic depression...

    Incorrect

    • What is the recommended course of action when a patient with psychotic depression cannot tolerate a tricyclic antidepressant?

      Your Answer:

      Correct Answer: SSRI with antipsychotic augmentation

      Explanation:

      Psychotic Depression

      Psychotic depression is a type of depression that is characterized by the presence of delusions and/of hallucinations in addition to depressive symptoms. This condition is often accompanied by severe anhedonia, loss of interest, and psychomotor retardation. People with psychotic depression are tormented by hallucinations and delusions with typical themes of worthlessness, guilt, disease, of impending disaster. This condition affects approximately 14.7-18.5% of depressed patients and is estimated to affect around 0.4% of community adult samples, with a higher prevalence in the elderly community at around 1.4-3.0%. People with psychotic depression are at a higher risk of attempting and completing suicide than those with non-psychotic depression.

      Diagnosis

      Psychotic depression is currently classified as a subtype of depression in both the ICD-11 and the DSM-5. The main difference between the two is that in the ICD-11, the depressive episode must be moderate of severe to qualify for a diagnosis of depressive episode with psychotic symptoms, whereas in the DSM-5, the diagnosis can be applied to any severity of depressive illness.

      Treatment

      The recommended treatment for psychotic depression is tricyclics as first-line treatment, with antipsychotic augmentation. Second-line treatment includes SSRI/SNRI. Augmentation of antidepressant with olanzapine or quetiapine is recommended. The optimum dose and duration of antipsychotic augmentation are unknown. If one treatment is to be stopped during the maintenance phase, then this should be the antipsychotic. ECT should be considered where a rapid response is required of where other treatments have failed. According to NICE (ng222), combination treatment with antidepressant medication and antipsychotic medication (such as olanzapine or quetiapine) should be considered for people with depression with psychotic symptoms. If a person with depression with psychotic symptoms does not wish to take antipsychotic medication in addition to an antidepressant, then treat with an antidepressant alone.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 154 - To qualify as purposive sampling, would the researcher need to specifically target participants...

    Incorrect

    • To qualify as purposive sampling, would the researcher need to specifically target participants based on certain characteristics, such as those who had received a delayed diagnosis?

      Your Answer:

      Correct Answer: Convenience sampling

      Explanation:

      The sampling method employed was convenience sampling, which involved recruiting participants through flyers posted in clinics. However, this approach may lead to an imbalanced sample. To be considered purposive sampling, the researcher would need to demonstrate a deliberate effort to recruit participants based on specific characteristics, such as targeting individuals who had experienced a delayed diagnosis.

      Qualitative research is a method of inquiry that seeks to understand the meaning and experience dimensions of human lives and social worlds. There are different approaches to qualitative research, such as ethnography, phenomenology, and grounded theory, each with its own purpose, role of the researcher, stages of research, and method of data analysis. The most common methods used in healthcare research are interviews and focus groups. Sampling techniques include convenience sampling, purposive sampling, quota sampling, snowball sampling, and case study sampling. Sample size can be determined by data saturation, which occurs when new categories, themes, of explanations stop emerging from the data. Validity can be assessed through triangulation, respondent validation, bracketing, and reflexivity. Analytical approaches include content analysis and constant comparison.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 155 - What is the most suitable course of treatment for a preschool child diagnosed...

    Incorrect

    • What is the most suitable course of treatment for a preschool child diagnosed with reactive attachment disorder and no other accompanying mental health issues?

      Your Answer:

      Correct Answer: Video feedback sessions

      Explanation:

      NICE has recommended the use of video feedback sessions for preschool aged children with attachment disorders. These sessions are conducted in the child’s home by a trained health of social care worker who has experience working with children and young people. The programme consists of 10 sessions, each lasting at least 60 minutes, over a period of 3-4 months. During each session, the parents are filmed interacting with their child for 10-20 minutes. The health of social care worker then watches the video with the parents to highlight positive aspects of their parenting, such as sensitivity, responsiveness, and communication, as well as to acknowledge any positive changes in the behavior of both the parents and child.

      Disorders resulting from inadequate caregiving during childhood are recognised by both the DSM-5 and the ICD-11, with two distinct forms of disorder identified: Reactive attachment disorder and Disinhibited social engagement disorder. Reactive attachment disorder is characterised by social withdrawal and aberrant attachment behaviour, while Disinhibited social engagement disorder is characterised by socially disinhibited behaviour. Diagnosis of these disorders involves a history of grossly insufficient care, and symptoms must be evident before the age of 5. Treatment options include video feedback programs for preschool aged children and parental training with group play sessions for primary school aged children. Pharmacological interventions are not recommended in the absence of coexisting mental health problems.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 156 - What is true about strategies for prevention? ...

    Incorrect

    • What is true about strategies for prevention?

      Your Answer:

      Correct Answer: Indicated interventions might be reasonable even if the intervention entails some risk

      Explanation:

      Prevention measures can be classified into different levels, depending on the stage at which they are implemented. The first model, developed in the 1960s, includes primary, secondary, and tertiary prevention. Primary prevention aims to intervene before a disease of problem begins, and can be universal (targeted to the general public), selective (targeted to a high-risk population), of indicated (targeted to individuals with minimal but detectable signs of a disorder). Secondary prevention aims to detect and treat disease that has not yet become symptomatic, while tertiary prevention involves the care of established disease.

      A newer model, developed in 1992, focuses on prevention interventions used before the initial onset of a disorder. This model also includes three levels: universal prevention (targeted to the general population), selective prevention (targeted to a high-risk population), and indicated prevention (targeted to individuals with minimal but detectable signs of a disorder). Examples of prevention measures include cognitive interventions for adolescents with cognitive deficits to prevent the later phases of schizophrenia, screening procedures for early detection and treatment of disease, and the use of low-dose atypical antipsychotics and CBT for patients with prodromal symptoms of schizophrenia to delay of prevent disease onset.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 157 - What evidence would be most indicative of a diagnosis of mania? ...

    Incorrect

    • What evidence would be most indicative of a diagnosis of mania?

      Your Answer:

      Correct Answer: Mood congruent delusions

      Explanation:

      Mania: Features and Characteristics

      Mania is a mental state characterized by a range of symptoms that can significantly impact an individual’s behavior, thoughts, and emotions. Some of the key features of mania include an elated of irritable mood, restlessness, and overactivity. People experiencing mania may also exhibit disinhibited and reckless behavior, such as excessive spending of engaging in risky activities. They may have over-ambitious plans for the future and experience a flight of ideas and pressured speech. Additionally, mania can involve mood congruent delusions, increased libido, and a decreased need for sleep. Overall, mania can be a challenging and disruptive condition that requires professional treatment and support.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 158 - What is a true statement about the NICE Guidelines for rTMS? ...

    Incorrect

    • What is a true statement about the NICE Guidelines for rTMS?

      Your Answer:

      Correct Answer: rTMS shows no major safety concerns

      Explanation:

      According to NICE 2015, there are no significant safety issues associated with repetitive transcranial magnetic stimulation for depression. While the evidence for its effectiveness in the short-term is sufficient, the clinical response may vary. Therefore, it is acceptable to use this treatment with standard clinical governance and monitoring procedures.

      Neurostimulation is a treatment that uses electromagnetic energy targeted at the brain. There are several forms of neurostimulation, including TMS, deep brain stimulation, and ECT. TMS is a non-invasive, non-convulsive technique used to stimulate neural tissue. It involves the placement of an electromagnetic coil on the patient’s scalp to deliver a short, powerful magnetic field pulse through the scalp and induce electric current in the brain. TMS is used to treat depression when standard treatments have failed. Deep brain stimulation is a neurosurgical technique that involves placing an electrode within the brain to deliver a high-frequency current in a specific subcortical of deep cortical structure. It has been used to treat Parkinson’s, dysthymia, OCD, and Tourette syndrome. There is RCT evidence to demonstrate its effectiveness in OCD, but conflicting results in depression and Tourette’s. DBS is also being trailed in other conditions such as anorexia, bipolar, and additions.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 159 - You are seeing a 6-year-old child in clinic. His parents are very concerned...

    Incorrect

    • You are seeing a 6-year-old child in clinic. His parents are very concerned that over the past three months he does not seem to understand what they are saying, and has stopped talking. He has some behavioural problems, and had one seizure a few weeks prior. Previously his language skills were normal, and he has achieved his developmental milestones on time. Your neurological examination is grossly normal.
      What investigation would be the most helpful to request?

      Your Answer:

      Correct Answer: EEG

      Explanation:

      The patient’s symptoms suggest Landau-Kleffner syndrome, which requires an EEG for diagnosis. This rare disorder causes a child to lose both expressive and receptive language, despite previously developing normally. EEG abnormalities over Broca and Wernicke’s area, particularly during sleep, are common. Seizures may also occur before of after the onset of aphasia. While prognosis varies, Landau-Kleffner syndrome is typically not life-threatening. About two-thirds of children experience a receptive language deficit, while one-third recover completely. Treatment involves antiepileptic medication. CT and MRI scans, as well as CSF analysis, are typically normal. Speech and language therapy may be recommended as part of a multidisciplinary approach. However, EEG testing is essential for diagnosis.

    • This question is part of the following fields:

      • Psychiatry Of Learning Disability
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  • Question 160 - Which investigation is not typically performed as part of a dementia diagnosis? ...

    Incorrect

    • Which investigation is not typically performed as part of a dementia diagnosis?

      Your Answer:

      Correct Answer: EEG

      Explanation:

      According to NICE, the use of electroencephalography for the diagnosis of Alzheimer’s disease is not recommended.

      As an AI language model, I do not have the ability to perform investigations of provide medical advice. However, I can provide information on the NICE guidelines for investigations in people with dementia. The guidelines suggest routine blood tests to exclude reversible causes, such as full blood count, ESR, CRP, urea and electrolytes, calcium, HbA1c, liver function tests, thyroid function tests, and serum B12 and folate levels. Other investigations that may be appropriate if clinically indicated include urine microscopy and culture, chest X-ray, ECG, syphilis serology, and HIV testing. Structural imaging and CSF analysis may also be necessary to exclude other cerebral pathologies and establish the subtype diagnosis. Magnetic resonance imaging (MRI) is preferred over CT if the subtype is unclear and vascular is suspected. FDG-PET of perfusion SPECT may be considered if the diagnosis is uncertain and frontotemporal dementia of dementia with Lewy bodies is suspected. However, it is important to note that Apolipoprotein E genotyping and electroencephalography should not be used to diagnose Alzheimer’s disease. It is recommended to consult with a healthcare professional for proper evaluation and management of dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 161 - If a woman with a history of mild depression comes to the clinic...

    Incorrect

    • If a woman with a history of mild depression comes to the clinic and reports that she is pregnant, and has been in remission for 5 months after taking sertraline 50mg, what would you suggest?

      Your Answer:

      Correct Answer: Withdraw the sertraline and monitor

      Explanation:

      Although sertraline can be used to treat depression during pregnancy, it is important to note that no psychotropic medication is completely safe. Therefore, it is recommended to avoid medication if possible and carefully consider the risk versus benefit. In cases of mild depression, it may be reasonable to explore non-medication options.

      Paroxetine Use During Pregnancy: Is it Safe?

      Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 162 - Which of the following factors have not been proven to be a risk...

    Incorrect

    • Which of the following factors have not been proven to be a risk factor for postnatal depression?

      Your Answer:

      Correct Answer: Older age of the mother

      Explanation:

      Perinatal Depression, Baby Blues, and Postpartum Depression

      Perinatal depression, also known as postpartum depression, is a common mood disorder experienced by new mothers after childbirth. The term baby blues is used to describe the emotional lability that some mothers experience during the first week after childbirth, which usually resolves by day 10 without treatment. The prevalence of baby blues is around 40%. Postpartum depression, on the other hand, refers to depression that occurs after childbirth. While neither DSM-5 nor ICD-11 specifically mention postpartum depression, both diagnostic systems offer categories that encompass depression during pregnancy of in the weeks following delivery. The prevalence of postpartum depression is approximately 10-15%.

      Various factors have been shown to increase the risk of postnatal depression, including youth, marital and family conflict, lack of social support, anxiety and depression during pregnancy, substance misuse, previous pregnancy loss, ambivalence about the current pregnancy, and frequent antenatal admissions to a maternity hospital. However, obstetric factors such as length of labor, assisted delivery, of separation of the mother from the baby in the Special Care Baby Unit do not seem to influence the development of postnatal depression. Additionally, social class does not appear to be associated with postnatal depression.

      Puerperal psychosis, along with severe depression, is thought to be mainly caused by biological factors, while psychosocial factors are most important in the milder postnatal depressive illnesses.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 163 - What is the recommended course of action for a pregnant woman with a...

    Incorrect

    • What is the recommended course of action for a pregnant woman with a history of bipolar disorder who experiences mild depressive symptoms and is not currently taking any medication?

      Your Answer:

      Correct Answer: Guided self help

      Explanation:

      Bipolar Disorder in Women of Childbearing Potential

      Prophylaxis is recommended for women with bipolar disorder, as postpartum relapse rates are high. Women without prophylactic pharmacotherapy during pregnancy have a postpartum relapse rate of 66%, compared to 23% for women with prophylaxis. Antipsychotics are recommended for pregnant women with bipolar disorder, according to NICE Guidelines (CG192) and the Maudsley. Women taking valproate, lithium, carbamazepine, of lamotrigine should discontinue treatment and start an antipsychotic, especially if taking valproate. If a woman with bipolar disorder is taking lithium and becomes pregnant, she should gradually stop lithium over a 4 week period and start an antipsychotic. If this is not possible, lithium levels must be taken regularly, and the dose adjusted accordingly. For acute mania, an antipsychotic should be considered. For mild depressive symptoms, self-help approaches, brief psychological interventions, and antidepressant medication can be considered. For moderate to severe depressive symptoms, psychological treatment (CBT) for moderate depression and combined medication and structured psychological interventions for severe depression should be considered.

      Reference: Wesseloo, R., Kamperman, A. M., Munk-Olsen, T., Pop, V. J., Kushner, S. A., & Bergink, V. (2016). Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. The American Journal of Psychiatry, 173(2), 117-127.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 164 - A 56-year-old female is currently receiving care in a nursing home due to...

    Incorrect

    • A 56-year-old female is currently receiving care in a nursing home due to a diagnosis of Wernicke's encephalopathy. She has a lengthy history of alcohol addiction.
      What vitamin deficiency is the cause of Wernicke's encephalopathy?

      Your Answer:

      Correct Answer: Thiamine

      Explanation:

      Wernicke’s encephalopathy is linked to bleeding in the Mammillary bodies of the brain and is commonly seen in individuals with insufficient thiamine levels. The condition is characterized by a combination of symptoms including changes in mental state, unsteady walking, and difficulty moving the eyes. It is especially prevalent in individuals who abuse alcohol over extended periods as they rely heavily on alcohol for their energy needs.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 165 - Which of the following is not a recommended intervention for panic disorder according...

    Incorrect

    • Which of the following is not a recommended intervention for panic disorder according to NICE?

      Your Answer:

      Correct Answer: Benzodiazepines

      Explanation:

      Anxiety (NICE guidelines)

      The NICE Guidelines on Generalised anxiety disorder and panic disorder were issued in 2011. For the management of generalised anxiety disorder, NICE suggests a stepped approach. For mild GAD, education and active monitoring are recommended. If there is no response to step 1, low-intensity psychological interventions such as CBT-based self-help of psychoeducational groups are suggested. For those with marked functional impairment of those who have not responded to step 2, individual high-intensity psychological intervention of drug treatment is recommended. Specialist treatment is suggested for those with very marked functional impairment, no response to step 3, self-neglect, risks of self-harm or suicide, of significant comorbidity. Benzodiazepines should not be used beyond 2-4 weeks, and SSRIs are first line. For panic disorder, psychological therapy (CBT), medication, and self-help have all been shown to be effective. Benzodiazepines, sedating antihistamines, of antipsychotics should not be used. SSRIs are first line, and if they fail, imipramine of clomipramine can be used. Self-help (CBT based) should be encouraged. If the patient improves with an antidepressant, it should be continued for at least 6 months after the optimal dose is reached, after which the dose can be tapered. If there is no improvement after a 12-week course, an alternative medication of another form of therapy should be offered.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 166 - Which of the following is not a valid type of validity? ...

    Incorrect

    • Which of the following is not a valid type of validity?

      Your Answer:

      Correct Answer: Internal consistency

      Explanation:

      Validity in statistics refers to how accurately something measures what it claims to measure. There are two main types of validity: internal and external. Internal validity refers to the confidence we have in the cause and effect relationship in a study, while external validity refers to the degree to which the conclusions of a study can be applied to other people, places, and times. There are various threats to both internal and external validity, such as sampling, measurement instrument obtrusiveness, and reactive effects of setting. Additionally, there are several subtypes of validity, including face validity, content validity, criterion validity, and construct validity. Each subtype has its own specific focus and methods for testing validity.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 167 - A 55 year old man with multiple sclerosis is referred to you for...

    Incorrect

    • A 55 year old man with multiple sclerosis is referred to you for an opinion. His wife reports that he has been laughing inappropriately especially when sad news is delivered. The man reports being unable to control this and that whilst he laughs he does not feel happy. The man and his wife are finding this very embarrassing. Which of the following would you most suspect?:

      Your Answer:

      Correct Answer: Pseudobulbar affect

      Explanation:

      Pathological Crying

      Pathological crying, also known as pseudobulbar affect, is a condition characterized by sudden outbursts of crying of laughing in response to minor stimuli without any changes in mood. This condition can occur in response to nonspecific and inconsequential stimuli, and lacks a clear association with the prevailing mood state. Pathological crying can result from various neurological conditions, including strokes and multiple sclerosis.

      When it comes to treating pathological crying post-stroke, citalopram is often the recommended treatment due to its efficacy in open label studies. The Maudsley Guidelines suggest that TCAs of SSRIs may be effective for MS, while valproic acid and the combination of dextromethorphan and low dose quinidine have also shown efficacy.

      Understanding the neuroanatomy of pathological laughing and crying is important for diagnosing and treating this condition. Further research is needed to better understand the underlying mechanisms and develop more effective treatments.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 168 - What is the term used to describe the study design where a margin...

    Incorrect

    • What is the term used to describe the study design where a margin is set for the mean reduction of PANSS score, and if the confidence interval of the difference between the new drug and olanzapine falls within this margin, the trial is considered successful?

      Your Answer:

      Correct Answer: Equivalence trial

      Explanation:

      Study Designs for New Drugs: Options and Considerations

      When launching a new drug, there are various study design options available. One common approach is a placebo-controlled trial, which can provide strong evidence but may be deemed unethical if established treatments are available. Additionally, it does not allow for a comparison with standard treatments. Therefore, statisticians must decide whether the trial aims to demonstrate superiority, equivalence, of non-inferiority to an existing treatment.

      Superiority trials may seem like the obvious choice, but they require a large sample size to show a significant benefit over an existing treatment. Equivalence trials define an equivalence margin on a specified outcome, and if the confidence interval of the difference between the two drugs falls within this margin, the drugs are assumed to have a similar effect. Non-inferiority trials are similar to equivalence trials, but only the lower confidence interval needs to fall within the equivalence margin. These trials require smaller sample sizes, and once a drug has been shown to be non-inferior, larger studies may be conducted to demonstrate superiority.

      It is important to note that drug companies may not necessarily aim to show superiority over an existing product. If they can demonstrate that their product is equivalent of even non-inferior, they may compete on price of convenience. Overall, the choice of study design depends on various factors, including ethical considerations, sample size, and the desired outcome.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 169 - Which antipsychotic medication has the lowest likelihood of exacerbating movement difficulties in individuals...

    Incorrect

    • Which antipsychotic medication has the lowest likelihood of exacerbating movement difficulties in individuals with Parkinson's disease?

      Your Answer:

      Correct Answer: Quetiapine

      Explanation:

      In Parkinson’s disease, only clozapine and quetiapine are appropriate antipsychotic medications, and if one is not well-tolerated, the other may be considered.

      Parkinson’s Disease: Presentation, Aetiology, Medical Treatment, and Psychiatric Aspects

      Parkinson’s disease is a degenerative disease of the brain that is characterised by motor symptoms such as rigidity, bradykinesia, and tremor. It has a long prodromal phase and early symptoms generally present asymmetrically. The tremor associated with Parkinson’s disease is classically described as ‘pill rolling’. The principle abnormality is the degeneration of dopaminergic neurons in the pars compacta of the substantia nigra, which leads to an accumulation of alpha-synuclein in these abnormal dopaminergic cells. The majority of cases of Parkinson’s disease are idiopathic, but single gene mutations occur in a minority of cases. Pesticide, herbicide, and heavy metal exposures are linked to an increased risk of Parkinson’s disease in some epidemiologic studies, whereas smoking and caffeine use are associated with decreased risks.

      Treatment for Parkinson’s disease predominantly focuses on symptomatic relief with drugs aiming to either restore the level of dopamine in the striatum of to act on striatal postsynaptic dopamine receptors. However, as dopamine is not the only neurotransmitter involved in Parkinson’s disease, many other drugs are also being used to target specific symptoms, such as depression of dementia. Psychiatric symptoms are common in Parkinson’s disease and range from mild to severe. Factors associated with severe symptoms include age, sleep disturbance, dementia, and disease severity. Hallucinations are common in Parkinson’s disease and tend to be visual but can be auditory of tactile. In the majority of patients, psychotic symptoms are thought to be secondary to dopaminergic medication rather than due to the Parkinson’s disease itself. Anticholinergics and dopamine agonists seem to be associated with a higher risk of inducing psychosis than levodopa of catechol-O-methyltransferase inhibitors. Medications used for psychotic symptoms may worsen movement problems. Risperidone and the typicals should be avoided completely. Low dose quetiapine is the best tolerated. Clozapine is the most effective antipsychotic drug for treating psychosis in Parkinson’s disease but its use in clinical practice is limited by the need for monitoring and the additional physical risks.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 170 - Which symptom is not commonly linked to PTSD? ...

    Incorrect

    • Which symptom is not commonly linked to PTSD?

      Your Answer:

      Correct Answer: Hallucinations

      Explanation:

      Common signs of PTSD may include:

      Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 171 - What is a correct statement about the epidemiological catchment area study? ...

    Incorrect

    • What is a correct statement about the epidemiological catchment area study?

      Your Answer:

      Correct Answer: The survey instrument used was the Diagnostic Interview Schedule

      Explanation:

      The DIS was the survey instrument used in the Epidemiological Catchment Area Study, which was conducted in the United States.

      Epidemiological Catchment Area Study: A Landmark Community-Based Survey

      The Epidemiological Catchment Area Study (ECA) was a significant survey conducted in five US communities from 1980-1985. The study included 20,000 participants, with 3000 community residents and 500 residents of institutions sampled in each site. The Diagnostic Interview Schedule (DIS) was used to conduct two interviews over a year with each participant.

      However, the DIS diagnosis of schizophrenia was not consistent with psychiatrists’ classification, with only 20% of cases identified by the DIS in the Baltimore ECA site matching the psychiatrist’s diagnosis. Despite this, the ECA produced valuable findings, including a lifetime prevalence rate of 32.3% for any disorder, 16.4% for substance misuse disorder, 14.6% for anxiety disorder, 8.3% for affective disorder, 1.5% for schizophrenia and schizophreniform disorder, and 0.1% for somatization disorder.

      The ECA also found that phobia had a one-month prevalence of 12.5%, generalized anxiety and depression had a prevalence of 8.5%, obsessive-compulsive disorder had a prevalence of 2.5%, and panic had a prevalence of 1.6%. Overall, the ECA was a landmark community-based survey that provided valuable insights into the prevalence of mental disorders in the US.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 172 - Which of the following is the most indicative of complex visual hallucinations occurring...

    Incorrect

    • Which of the following is the most indicative of complex visual hallucinations occurring in clear consciousness and associated with visual impairment?

      Your Answer:

      Correct Answer: Charles Bonnet syndrome

      Explanation:

      Alice in Wonderland syndrome, also known as Todd syndrome, is a neurological disorder that causes distortions in a person’s perception of their body image, space, and time. This can lead to experiences such as Lilliputian hallucinations, macropsia, and altered sense of velocity. On the other hand, Diogenes syndrome is a condition commonly observed in the elderly, characterized by extreme self-neglect, social withdrawal, apathy, lack of shame, and compulsive hoarding of garbage. It is often linked to progressive dementia.

      Charles Bonnet Syndrome: A Condition of Complex Visual Hallucinations

      Charles Bonnet Syndrome (CBS) is a condition characterized by persistent of recurrent complex visual hallucinations that occur in clear consciousness. This condition is observed in individuals who have suffered damage to the visual pathway, which can be caused by damage to any part of the pathway from the eye to the cortex. The hallucinations are thought to result from a release phenomenon secondary to the deafferentation of the cerebral cortex. CBS is equally distributed between sexes and does not show any familial predisposition. The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.

      Risk factors for CBS include advanced age, peripheral visual impairment, social isolation, sensory deprivation, and early cognitive impairment. Well-formed complex visual hallucinations are thought to occur in 10-30 percent of individuals with severe visual impairment. Only around a third of individuals find the hallucinations themselves an unpleasant or disturbing experience. The most effective treatment is reversal of the visual impairment. Antipsychotic drugs are commonly prescribed but are largely ineffective. CBS is a long-lasting condition, with 88% of individuals experiencing it for two years of more, and only 25% resolving at nine years.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 173 - Which of the options below is not utilized as a means of opioid...

    Incorrect

    • Which of the options below is not utilized as a means of opioid detoxification?

      Your Answer:

      Correct Answer: Ephedrine

      Explanation:

      Medications utilized for opioid detoxification comprise of Methadone, Buprenorphine, and Lofexidine.

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 174 - Which statement accurately describes autism? ...

    Incorrect

    • Which statement accurately describes autism?

      Your Answer:

      Correct Answer: Individuals with the condition show restricted social play and reduced desire to share interests

      Explanation:

      The genetics involved in this condition are complex and do not adhere to a straightforward Mendelian pattern of inheritance. Additionally, individuals with this condition typically exhibit limited social play and experience language-related challenges.

      Autism Spectrum Disorder (ASD) is a lifelong disorder characterized by deficits in communication and social understanding, as well as restrictive and repetitive behaviors. The distinction between autism and Asperger’s has been abandoned, and they are now grouped together under the ASD category. Intellectual ability is difficult to assess in people with ASD, with an estimated 33% having an intellectual disability. ASD was first described in Europe and the United States using different terms, with Leo Kanner and Hans Asperger being the pioneers. Diagnosis is based on persistent deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior. The worldwide population prevalence is about 1%, with comorbidity being common. Heritability is estimated at around 90%, and both genetic and environmental factors seem to cause ASD. Currently, there are no validated pharmacological treatments that alleviate core ASD symptoms, but second-generation antipsychotics are the first-line pharmacological treatment for children and adolescents with ASD and associated irritability.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 175 - Which statement accurately describes the clinical symptoms of Wernicke's? ...

    Incorrect

    • Which statement accurately describes the clinical symptoms of Wernicke's?

      Your Answer:

      Correct Answer: Ophthalmoplegia is an expected feature

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 176 - A 65-year-old woman is discovered unconscious on the sidewalk. Witnesses report her holding...

    Incorrect

    • A 65-year-old woman is discovered unconscious on the sidewalk. Witnesses report her holding her stomach before collapsing. Limited information is available, but it is known that she has a history of bipolar disorder and has been taking lithium for the past year. Her electrocardiogram (ECG) appears normal. Upon reviewing the hospital's records, there is no evidence of a previous visit for a similar presentation. What is the most probable abnormality that you will detect?

      Your Answer:

      Correct Answer: Hyperglycaemia

      Explanation:

      The patient’s symptoms are consistent with diabetic ketoacidosis, which may be caused by undiagnosed and untreated hyperglycemia and diabetes resulting from clozapine-induced metabolic syndrome. This condition can lead to a medical emergency, as evidenced by a negative base excess on ABG and hyponatremia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 177 - A young adult woman is brought to the emergency department after experiencing a...

    Incorrect

    • A young adult woman is brought to the emergency department after experiencing a seizure at a nightclub. Upon your arrival, she has regained consciousness but is exhibiting signs of paranoia and teeth grinding. A nurse discovered a packet of white powder in her coat pocket, which you notice has a distinct fishy odor similar to stale urine. What substance do you suspect she may have ingested?

      Your Answer:

      Correct Answer: Mephedrone

      Explanation:

      New Psychoactive Substances, previously known as ‘legal highs’, are synthetic compounds designed to mimic the effects of traditional illicit drugs. They became popular due to their ability to avoid legislative control, but the introduction of the Psychoactive Substances Act 2016 changed this. There is no standard for clinical classification, but some common legal highs include Mephedrone, Piperazines, GBL, Synthetic cannabinoids, and Benzofuran compounds. These substances have effects similar to ecstasy, amphetamines, and cannabis, and are classified as either Class B of Class C drugs in the UK.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 178 - What methods are most effective in determining interobserver agreement? ...

    Incorrect

    • What methods are most effective in determining interobserver agreement?

      Your Answer:

      Correct Answer: Kappa

      Explanation:

      Kappa is used to assess the consistency of reliability between different raters.

      Understanding the Kappa Statistic for Measuring Interobserver Variation

      The kappa statistic, also known as Cohen’s kappa coefficient, is a useful tool for quantifying the level of agreement between independent observers. This measure can be applied in any situation where multiple observers are evaluating the same thing, such as in medical diagnoses of research studies. The kappa coefficient ranges from 0 to 1, with 0 indicating complete disagreement and 1 indicating perfect agreement. By using the kappa statistic, researchers and practitioners can gain insight into the level of interobserver variation present in their data, which can help to improve the accuracy and reliability of their findings. Overall, the kappa statistic is a valuable tool for understanding and measuring interobserver variation in a variety of contexts.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 179 - A 32-year-old male patient presents with symptoms of a depressive illness. He reports...

    Incorrect

    • A 32-year-old male patient presents with symptoms of a depressive illness. He reports experiencing episodes of binge eating where he feels out of control and consumes large amounts of food in a short period of time. He expresses self-hatred for these behaviors and compensates by engaging in excessive exercise and purging. Despite having a BMI of 18, he believes he is overweight and goes to the gym seven days a week. He frequently checks himself in the mirror and weighs himself three times a day. Based on these symptoms, what is the most likely diagnosis?

      Your Answer:

      Correct Answer: Anorexia nervosa

      Explanation:

      This vignette is most indicative of a diagnosis of anorexia nervosa, characterized by low body weight, excessive exercise, and distorted body image. Unlike in avoidant-restrictive food intake disorder, individuals with anorexia nervosa have a strong desire for thinness of fear of weight gain. This disorder can be distinguished from bulimia nervosa by the very low body weight. Binge eating disorder, on the other hand, does not typically involve compensatory behaviors to maintain weight and does not necessarily involve low body weight.

      Eating disorders are a serious mental health condition that can have severe physical and psychological consequences. The ICD-11 lists several types of eating disorders, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant-Restrictive Food Intake Disorder, Pica, and Rumination-Regurgitation Disorder.

      Anorexia Nervosa is characterized by significantly low body weight, a persistent pattern of restrictive eating of other behaviors aimed at maintaining low body weight, excessive preoccupation with body weight of shape, and marked distress of impairment in functioning. Bulimia Nervosa involves frequent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain, excessive preoccupation with body weight of shape, and marked distress of impairment in functioning. Binge Eating Disorder is characterized by frequent episodes of binge eating without compensatory behaviors, marked distress of impairment in functioning, and is more common in overweight and obese individuals. Avoidant-Restrictive Food Intake Disorder involves avoidance of restriction of food intake that results in significant weight loss of impairment in functioning, but is not motivated by preoccupation with body weight of shape. Pica involves the regular consumption of non-nutritive substances, while Rumination-Regurgitation Disorder involves intentional and repeated regurgitation of previously swallowed food.

      It is important to seek professional help if you of someone you know is struggling with an eating disorder. Treatment may involve a combination of therapy, medication, and nutritional counseling.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 180 - What was the percentage of restricted patients who were convicted again within 2...

    Incorrect

    • What was the percentage of restricted patients who were convicted again within 2 years of transitioning into the community, based on UK data from 1998 to 2006?

      Your Answer:

      Correct Answer: 7%

      Explanation:

      Recidivism Rates of Restricted Patients vs. UK Prison Population

      Restricted patients are individuals who are under the risk management of the Secretary of State for Justice and receive care in secure hospitals. From 1998 to 2006, less than 500 restricted cases per year were reintegrated into the community, and their two-year re-conviction rates were 7% for all offenses and 1% for serious offenses. In contrast, the UK prison population had a much higher recidivism rate. In the first quarter of 2004, out of 20,000 individuals released from prison, 65% were convicted again for any offense. These findings suggest that the risk management strategies for restricted patients may be more effective in reducing recidivism rates compared to the general prison population.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 181 - What is a true statement about the utilization of lithium? ...

    Incorrect

    • What is a true statement about the utilization of lithium?

      Your Answer:

      Correct Answer: People over the age of 65 should have lithium levels checked every 3 months once stabilised

      Explanation:

      It is recommended to check lithium levels every 6 months if the person has been stabilized for over a year, of every 3 months if there are additional factors such as older age, drug interactions, impaired renal of thyroid function, raised calcium levels, poor symptom control, poor adherence, of previous plasma lithium levels of 0.8 mmol per litre of higher. Thyroid function should also be checked every 6 months. Lithium is typically taken at night to allow for a blood test at least 12 hours after the last dose, and once-daily prescribing is preferred.

      Lithium – Clinical Usage

      Lithium is primarily used as a prophylactic agent for bipolar disorder, where it reduces the severity and number of relapses. It is also effective as an augmentation agent in unipolar depression and for treating aggressive and self-mutilating behavior, steroid-induced psychosis, and to raise WCC in people using clozapine.

      Before prescribing lithium, renal, cardiac, and thyroid function should be checked, along with a Full Blood Count (FBC) and BMI. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Once daily administration is preferred, and various preparations are available. Abrupt discontinuation of lithium increases the risk of relapse, and if lithium is to be discontinued, the dose should be reduced gradually over a period of at least 4 weeks.

      Inadequate monitoring of patients taking lithium is common, and it is often an exam hot topic. Lithium salts have a narrow therapeutic/toxic ratio, and samples should ideally be taken 12 hours after the dose. The target range for prophylaxis is 0.6–0.75 mmol/L.

      Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI and neuro symptoms.

      The severity of toxicity can be assessed using the AMDISEN rating scale.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 182 - A school conducts a new program in an attempt to prevent students with...

    Incorrect

    • A school conducts a new program in an attempt to prevent students with early signs of academic struggles from falling behind in their studies.

      They begin by identifying students who are showing signs of academic difficulties. Once identified, these students are offered a tutoring and mentoring intervention.

      What term best describes this intervention?

      Your Answer:

      Correct Answer: Indicated prevention

      Explanation:

      The individuals being focused on already exhibit early signs, making this a suitable approach for indicated prevention.

      Prevention measures can be classified into different levels, depending on the stage at which they are implemented. The first model, developed in the 1960s, includes primary, secondary, and tertiary prevention. Primary prevention aims to intervene before a disease of problem begins, and can be universal (targeted to the general public), selective (targeted to a high-risk population), of indicated (targeted to individuals with minimal but detectable signs of a disorder). Secondary prevention aims to detect and treat disease that has not yet become symptomatic, while tertiary prevention involves the care of established disease.

      A newer model, developed in 1992, focuses on prevention interventions used before the initial onset of a disorder. This model also includes three levels: universal prevention (targeted to the general population), selective prevention (targeted to a high-risk population), and indicated prevention (targeted to individuals with minimal but detectable signs of a disorder). Examples of prevention measures include cognitive interventions for adolescents with cognitive deficits to prevent the later phases of schizophrenia, screening procedures for early detection and treatment of disease, and the use of low-dose atypical antipsychotics and CBT for patients with prodromal symptoms of schizophrenia to delay of prevent disease onset.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 183 - What is the herbal remedy that is highly effective for anxiety but not...

    Incorrect

    • What is the herbal remedy that is highly effective for anxiety but not recommended due to its risk of hepatotoxicity?

      Your Answer:

      Correct Answer: Piper methysticum

      Explanation:

      Herbal Remedies for Depression and Anxiety

      Depression can be treated with Hypericum perforatum (St John’s Wort), which has been found to be more effective than placebo and as effective as standard antidepressants. However, its use is not advised due to uncertainty about appropriate doses, variation in preparations, and potential interactions with other drugs. St John’s Wort can cause serotonin syndrome and decrease levels of drugs such as warfarin and ciclosporin. The effectiveness of the combined oral contraceptive pill may also be reduced.

      Anxiety can be reduced with Piper methysticum (kava), but it cannot be recommended for clinical use due to its association with hepatotoxicity.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 184 - A 45-year-old woman presents to the local Emergency department with double vision.
    She has...

    Incorrect

    • A 45-year-old woman presents to the local Emergency department with double vision.
      She has been consuming more than 20 units of alcohol daily for several years. She appears unkempt, emaciated and malnourished. Her blood alcohol level is negative and she claims to have stopped drinking five days ago. She has been experiencing vomiting multiple times a day for the past three days.
      The Emergency department physician seeks your expert opinion. You observe signs of lateral rectus palsy, ataxia and nystagmus.
      What is the most probable location of the lesion in the women's nervous system?

      Your Answer:

      Correct Answer: Mammillary bodies

      Explanation:

      This case presents a man who exhibits the classic triad of symptoms associated with Wernicke’s encephalopathy, including ophthalmoplegia, ataxia, and confusion. The underlying lesion is located in the Mammillary bodies and around the third ventricle and aqueduct. This condition is typically caused by a deficiency in thiamine (vitamin B-1), which can be triggered in individuals who are malnourished and dependent on alcohol due to prolonged vomiting. Korsakoff’s amnesic syndrome is a later manifestation of this condition, characterized by memory loss and confabulation.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 185 - Which of the following factors does not increase the risk of child abuse?...

    Incorrect

    • Which of the following factors does not increase the risk of child abuse?

      Your Answer:

      Correct Answer: Old parents

      Explanation:

      Child Abuse: Risk Factors and Protective Factors

      Child abuse is a serious problem that can have long-lasting effects on a child’s physical and emotional well-being. There are several risk factors that increase the likelihood of child abuse occurring. These include a history of abuse in the caregiver, substance misuse in the caregiver, inaccurate knowledge about child development, teenage parents, children of single parents, domestic violence in the home, high levels of stress within the family, younger children, children with disabilities, poverty, social isolation, and living in a dangerous neighborhood.

      However, there are also protective factors that can help prevent child abuse from occurring. These include parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children. By promoting these protective factors, we can help reduce the risk of child abuse and create a safer and healthier environment for children to grow and thrive.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 186 - Which of the following is characterised by fluent, empty speech? ...

    Incorrect

    • Which of the following is characterised by fluent, empty speech?

      Your Answer:

      Correct Answer: Semantic dementia

      Explanation:

      Frontotemporal Lobar Degeneration

      Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.

      The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).

      As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.

      In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 187 - Which principle is not included in motivational interviewing? ...

    Incorrect

    • Which principle is not included in motivational interviewing?

      Your Answer:

      Correct Answer: Encourage confrontation

      Explanation:

      Motivational interviewing aims to prevent conflict and necessitates the therapist to maintain a neutral stance.

      Motivational Interviewing: A Model for Resolving Ambivalence and Facilitating Change

      Motivational interviewing (MI) is an evidence-based method used for people with substance misuse problems. It was introduced by William Miller in 1983, based on his experience with alcoholics. MI focuses on exploring and resolving ambivalence and centres on the motivational process that facilitates change. It is based on three key elements: collaboration, evocation, and autonomy.

      There are four principles of MI: expressing empathy, supporting self-efficacy, rolling with resistance, and developing discrepancy. MI involves the use of micro-counseling skills called OARS, which stands for open-ended questions, affirmations, reflections, and summaries.

      Change talk is defined as statements by the client that reveal consideration of, motivation for, of commitment to change. In MI, the therapist aims to guide the client to expression of change talk. Types of change talk can be remembered by the mnemonic DARN-CAT, which stands for desire, ability, reason, need, commitment, activation, and taking steps.

      Overall, MI is a model for resolving ambivalence and facilitating change that emphasizes collaboration, evocation, and autonomy. It is a useful tool for therapists working with clients with substance misuse problems.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 188 - What is the appropriate denominator for calculating the incidence rate? ...

    Incorrect

    • What is the appropriate denominator for calculating the incidence rate?

      Your Answer:

      Correct Answer: The total person time at risk during a specified time period

      Explanation:

      Measures of Disease Frequency: Incidence and Prevalence

      Incidence and prevalence are two important measures of disease frequency. Incidence measures the speed at which new cases of a disease are emerging, while prevalence measures the burden of disease within a population. Cumulative incidence and incidence rate are two types of incidence measures, while point prevalence and period prevalence are two types of prevalence measures.

      Cumulative incidence is the average risk of getting a disease over a certain period of time, while incidence rate is a measure of the speed at which new cases are emerging. Prevalence is a proportion and is a measure of the burden of disease within a population. Point prevalence measures the number of cases in a defined population at a specific point in time, while period prevalence measures the number of identified cases during a specified period of time.

      It is important to note that prevalence is equal to incidence multiplied by the duration of the condition. In chronic diseases, the prevalence is much greater than the incidence. The incidence rate is stated in units of person-time, while cumulative incidence is always a proportion. When describing cumulative incidence, it is necessary to give the follow-up period over which the risk is estimated. In acute diseases, the prevalence and incidence may be similar, while for conditions such as the common cold, the incidence may be greater than the prevalence.

      Incidence is a useful measure to study disease etiology and risk factors, while prevalence is useful for health resource planning. Understanding these measures of disease frequency is important for public health professionals and researchers in order to effectively monitor and address the burden of disease within populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 189 - A young woman with bipolar disorder who takes lithium has become pregnant. Despite...

    Incorrect

    • A young woman with bipolar disorder who takes lithium has become pregnant. Despite the potential teratogenic effects on the baby, she refuses to stop lithium as it has been the only medication that has effectively managed her symptoms in the past. What course of action would you recommend in this situation?

      Your Answer:

      Correct Answer: Continue on the current dose of lithium and monitor monthly until week 36 and then weekly thereafter

      Explanation:

      It is important to take the patient’s wishes into consideration and simply telling her to stop taking lithium is not appropriate. Providing her with all the necessary information and assisting her in making a decision is the best course of action. According to the NICE Guidelines, it is recommended to continue the current dose of lithium and monitor levels monthly until week 36, and then weekly thereafter. It is common for levels to decrease during pregnancy, so adjustments to the dose may be necessary to maintain therapeutic levels.

      Bipolar Disorder in Women of Childbearing Potential

      Prophylaxis is recommended for women with bipolar disorder, as postpartum relapse rates are high. Women without prophylactic pharmacotherapy during pregnancy have a postpartum relapse rate of 66%, compared to 23% for women with prophylaxis. Antipsychotics are recommended for pregnant women with bipolar disorder, according to NICE Guidelines (CG192) and the Maudsley. Women taking valproate, lithium, carbamazepine, of lamotrigine should discontinue treatment and start an antipsychotic, especially if taking valproate. If a woman with bipolar disorder is taking lithium and becomes pregnant, she should gradually stop lithium over a 4 week period and start an antipsychotic. If this is not possible, lithium levels must be taken regularly, and the dose adjusted accordingly. For acute mania, an antipsychotic should be considered. For mild depressive symptoms, self-help approaches, brief psychological interventions, and antidepressant medication can be considered. For moderate to severe depressive symptoms, psychological treatment (CBT) for moderate depression and combined medication and structured psychological interventions for severe depression should be considered.

      Reference: Wesseloo, R., Kamperman, A. M., Munk-Olsen, T., Pop, V. J., Kushner, S. A., & Bergink, V. (2016). Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. The American Journal of Psychiatry, 173(2), 117-127.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 190 - A 25-year-old individual has been experiencing frequent episodes of dizziness. What other symptom...

    Incorrect

    • A 25-year-old individual has been experiencing frequent episodes of dizziness. What other symptom would indicate that they may be suffering from an anxiety disorder?

      Your Answer:

      Correct Answer: Paraesthesia in the hands

      Explanation:

      Hyperventilation associated with anxiety disorders often leads to paraesthesia, which is commonly felt in the hands, feet, and perioral region. If a person experiences rotational vertigo and tinnitus, it may indicate an organic disorder. On the other hand, raised systolic blood pressure may be associated with anxiety disorder, but not diastolic.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 191 - A 67-year-old retiree presents with a four hour history of confusion and restlessness....

    Incorrect

    • A 67-year-old retiree presents with a four hour history of confusion and restlessness. He has a history of alcohol abuse but has been sober for the past week.
      During examination, he appears sweaty, agitated, and disoriented. He reports seeing hallucinations on the walls.
      His vital signs include a temperature of 37.5°C, a regular pulse of 110 bpm, and a blood pressure of 152/74 mmHg. His FBC and U&Es are both within normal limits.
      Further investigations reveal:
      Plasma glucose 4.6 mmol/L (3.6-6)
      Which of the following medications would be the most appropriate treatment for this individual?

      Your Answer:

      Correct Answer: Oral lorazepam

      Explanation:

      Delirium tremens (DTs) is a serious medical emergency that can occur in individuals who abruptly reduce their alcohol intake after prolonged excessive drinking. It is estimated that 24% of adults in the UK drink in a hazardous way, with the highest rates in the North East, North West, and Yorkshire and Humber regions. About 20% of patients admitted to hospital for non-alcohol-related illnesses are also drinking at potentially hazardous levels, highlighting the importance of screening all patients for alcohol use.

      Withdrawal symptoms typically appear about 8 hours after a significant drop in blood alcohol levels, with the peak occurring on day two and significant improvement by day five. Minor withdrawal symptoms include insomnia, fatigue, tremors, anxiety, nausea, vomiting, headache, sweating, palpitations, anorexia, depression, and craving. Alcoholic hallucinosis can occur 12-24 hours after stopping alcohol and involves visual, auditory, and tactile hallucinations. Withdrawal seizures can occur 24-48 hours after cessation and are generalized tonic-clonic seizures. DTs can occur 48-72 hours after cessation and is characterized by altered mental status, hallucinations, confusion, delusions, severe agitation, and seizures. It is a hyperadrenergic state and is often associated with tachycardia, hyperthermia, hypertension, tachypnea, tremor, and mydriasis. Patients at increased risk include those with a previous history of DTs of alcohol withdrawal seizures, co-existing infections, abnormal liver function, and older patients.

      DTs should be treated as a medical emergency with oral lorazepam as first-line treatment. If symptoms persist of medication is refused, parenteral lorazepam, haloperidol, of olanzapine should be given. Intensive care may be required. If DTs develop during treatment for acute withdrawal, the reducing regime should be reviewed. The mortality rate can be up to 35% if untreated, which reduces to 5% with early recognition and treatment.

      Patients with alcohol withdrawal seizures should be given a quick-acting benzodiazepine such as lorazepam. Phenytoin should not be given. Patients at high risk of alcohol withdrawal but with no of mild symptoms are typically given a reducing dose of chlordiazepoxide of diazepam over 5-7 days. Chlormethiazole may also be offered as an alternative, but is rarely used due to the risk of fatal respiratory depression, especially in patients with liver cirrhosis.

      It is also important to administer high-potency B vitamins, specifically thiamine (e.g. pabrinex), to all patients with a history of high alcohol intake to reduce the risk of Wernicke’s encephalopathy.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 192 - Which of the following is an example of selection bias? ...

    Incorrect

    • Which of the following is an example of selection bias?

      Your Answer:

      Correct Answer: Berkson's bias

      Explanation:

      Types of Bias in Statistics

      Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.

      There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 193 - Which statement accurately describes the epidemiology of intellectual disability? ...

    Incorrect

    • Which statement accurately describes the epidemiology of intellectual disability?

      Your Answer:

      Correct Answer: Approximately 2% of the general population is estimated to have an intellectual disability

      Explanation:

      Intellectual disability is estimated to affect around 1-3% of the overall population, with Down syndrome being the most prevalent cause. Fragile X is believed to occur in about 1 out of every 3600 males and 1 out of every 4000-6000 females.

      Classification of Intellectual Disability

      Intellectual disability affects approximately 2% of the general population, with an estimated 828,000 adults aged 18 of older affected in England alone. Those with an IQ below 70 are considered to have an intellectual disability, with the average IQ being 100. The severity of intellectual disability is categorized based on IQ scores, with mild intellectual disability being the most common (85% of cases) and profound intellectual disability being the least common (1-2% of cases). People with intellectual disability may require varying levels of support in their daily lives, depending on their individual needs. It is important to use the preferred term ‘people with intellectual disability’ when referring to individuals with this condition.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 194 - Which statement accurately describes Gilles de la Tourette's syndrome? ...

    Incorrect

    • Which statement accurately describes Gilles de la Tourette's syndrome?

      Your Answer:

      Correct Answer: Tics may be voluntarily suppressed for small periods

      Explanation:

      Tourette’s Syndrome: Understanding the Disorder and Management Options

      Tourette’s syndrome is a type of tic disorder characterized by multiple motor tics and one of more vocal tics. Tics are sudden, involuntary movements of vocalizations that serve no apparent purpose and can be suppressed for varying periods of time. Unlike stereotyped repetitive movements seen in other disorders, tics lack rhythmicity. Manneristic motor activities tend to be more complex and variable than tics, while obsessive-compulsive acts have a defined purpose.

      Tourette’s syndrome typically manifests in childhood, with a mean age of onset of six to seven years. Tics tend to peak in severity between nine and 11 years of age and may be exacerbated by external factors such as stress, inactivity, and fatigue. The estimated prevalence of Tourette’s syndrome is 1% of children, and it is more common in boys than girls. A family history of tics is also common.

      Management of Tourette’s syndrome may involve pharmacological options of behavioral programs. Clonidine is recommended as first-line medication, with antipsychotics as a second-line option due to their side effect profile. Selective serotonin reuptake inhibitors (SSRIs) have not been found to be effective in suppressing tics. However, most people with tics never require medication, and behavioral programs appear to work equally as well.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 195 - Which of the following is not considered a known factor that increases the...

    Incorrect

    • Which of the following is not considered a known factor that increases the risk of suicide in older adults?

      Your Answer:

      Correct Answer: Alzheimer's disorder

      Explanation:

      Epidemiology of Mental Disorders Among the Elderly

      Depression:
      Contrary to popular belief, studies have shown that rates of depression among the elderly in the general population are lower than in younger adults. However, elderly individuals who seek medical attention have a higher prevalence of depressive symptoms, with one study in London reporting a point prevalence of around 30%. Suicide risk factors in the elderly include a history of attempts, depressive disorder, access to lethal means, physical illness of disability, chronic pain, recent losses, and social isolation. Physician education in recognizing and treating depression and restricting access to lethal means have been found to reduce suicide rates.

      Personality Disorder:
      There is limited information on the prevalence of personality disorders in the general population, but rates tend to decrease with age.

      Psychosis:
      Very late-onset schizophrenia, with onset after the age of 60, has a 1-year prevalence of 0.1 to 0.5%. It is more common in women and has been associated with sensory impairment. Genetic factors appear to be less important than in earlier onset schizophrenia.

      Alcohol Misuse:
      Studies have shown that men have higher rates of alcohol misuse than women in the elderly population. However, precise figures and prevalence rates are unreliable, and standard assessment tools may not be valid in this group.

      Dementia:
      Dementia incidence is similar across all continents and regions of the world, with Alzheimer’s accounting for 60-70% and vascular dementia accounting for 15-20% of all dementia cases. Age is the strongest risk factor for dementia, with approximately 48% of people aged 95 and over having dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 196 - What factors have been linked to a higher seizure threshold in individuals receiving...

    Incorrect

    • What factors have been linked to a higher seizure threshold in individuals receiving right unilateral ECT treatment?

      Your Answer:

      Correct Answer: Advanced age

      Explanation:

      In patients who received right unilateral ECT, it was found through univariate analyses that a higher seizure threshold was linked to advanced age, male gender, a greater burden of medical illness, weight, longer duration of mood disorder, and a history of previous ECT. However, the average lorazepam dose taken in the 48 hours before ECT did not have a correlation with seizure threshold, but it was associated with a reduction in seizure duration.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 197 - What is the most frequently observed condition in PANDAS? ...

    Incorrect

    • What is the most frequently observed condition in PANDAS?

      Your Answer:

      Correct Answer: OCD

      Explanation:

      PANDAS: A Disorder Linked to Streptococcal Infections

      PANDAS, of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a condition that affects children who develop sudden onset of obsessive-compulsive disorder (OCD) and/of tic disorders like Tourette’s Syndrome after contracting strep infections such as Strep throat of Scarlet Fever. The National Institute of Mental Health (NIMH) has identified five criteria for diagnosing PANDAS, including the presence of OCD and/of tic disorder, pediatric onset of symptoms, episodic course of symptom severity, association with group A Beta-hemolytic streptococcal infection, and association with neurological abnormalities. The anti streptococcal DNAse B (Anti DNAse-B) titre is commonly used to determine if there is immunologic evidence of a previous strep infection. PANDAS is linked to basal ganglia dysfunction.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 198 - In which conditions has Cotard's syndrome been reported? ...

    Incorrect

    • In which conditions has Cotard's syndrome been reported?

      Your Answer:

      Correct Answer: All of the above

      Explanation:

      Cotard’s syndrome is a delusion where an individual believes they do not exist of have lost their blood, internal organs, of soul. It is commonly seen in depression, schizophrenia, and bipolar disorder, and can also occur after trauma. The condition is more prevalent in females and the elderly.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 199 - The research team is studying the effectiveness of a new treatment for a...

    Incorrect

    • The research team is studying the effectiveness of a new treatment for a certain medical condition. They have found that the brand name medication Y and its generic version Y1 have similar efficacy. They approach you for guidance on what type of analysis to conduct next. What would you suggest?

      Your Answer:

      Correct Answer: Cost minimisation analysis

      Explanation:

      Cost minimisation analysis is employed to compare net costs when the observed effects of health care interventions are similar. To conduct this analysis, it is necessary to have clinical evidence that demonstrates the differences in health effects between alternatives are negligible of insignificant. This approach is commonly used by institutions like the National Institute for Health and Care Excellence (NICE).

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 200 - What treatment option would NICE recommend for an adult patient with bipolar affective...

    Incorrect

    • What treatment option would NICE recommend for an adult patient with bipolar affective disorder and moderate depression who is currently on an effective dose of lithium?

      Your Answer:

      Correct Answer: Add fluoxetine combined with olanzapine

      Explanation:

      Bipolar Disorder: Diagnosis and Management

      Bipolar disorder is a lifelong condition characterized by episodes of mania or hypomania and episodes of depressed mood. The peak age of onset is 15-19 years, and the lifetime prevalence of bipolar I disorders is estimated to be around 2.1%. The diagnosis of bipolar disorder is based on the presence of manic or hypomanic episodes, which are characterized by elevated of expansive mood, rapid speech, and increased activity of energy. Psychotic symptoms, such as delusions and hallucinations, may also be present.

      Bipolar depression differs from unipolar depression in several ways, including more rapid onset, more frequent episodes, and shorter duration. Rapid cycling is a qualifier that can be applied to bipolar I of bipolar II disorder and is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode.

      The management of bipolar disorder involves acute and long-term interventions. Acute management of mania or hypomania may involve stopping antidepressants and offering antipsychotics of mood stabilizers. Long-term management may involve psychological interventions and pharmacological treatments such as lithium, valproate, of olanzapine.

      It is important to note that valproate should not be offered to women of girls of childbearing potential for long-term bipolar disorder unless other options are ineffective of not tolerated and a pregnancy prevention program is in place. Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder.

      Overall, the diagnosis and management of bipolar disorder require a comprehensive approach that takes into account the individual’s symptoms, history, and preferences.

    • This question is part of the following fields:

      • General Adult Psychiatry
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SESSION STATS - PERFORMANCE PER SPECIALTY

Child And Adolescent Psychiatry (7/10) 70%
General Adult Psychiatry (25/38) 66%
Old Age Psychiatry (7/10) 70%
Research Methods, Statistics, Critical Review And Evidence-Based Practice (8/16) 50%
Substance Misuse/Addictions (8/10) 80%
Forensic Psychiatry (2/4) 50%
Organisation And Delivery Of Psychiatric Services (5/5) 100%
Learning Disability (3/3) 100%
Psychotherapy (3/4) 75%
Passmed