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Question 1
Correct
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Which of the following best describes the use of antidepressant medication for preventing relapse?
Your Answer: Tertiary Prevention
Explanation:In essence, the most appropriate term to describe this intervention is tertiary prevention since universal, indicated, and selective prevention strategies target individuals before the onset of a full-blown illness.
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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 2
Correct
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In the 2010 'Count me in Census', which ethnic group had admission rates below the average?
Your Answer: Indian
Explanation:Institutional Racism in Psychiatry
There has been growing concern that institutional racism may be contributing to the overrepresentation of Black patients in mental health settings. Despite ethnic minorities making up only 9% of the UK population, the 2010 ‘Count me in Census’ found that 23% of inpatients and those on CTOs were from Black and minority ethnic groups. Black minority groups also had higher rates of admission, detention, and seclusion.
While patient factors, such as higher rates of mental illness in Black minority groups, may contribute to these findings, there is also a suggestion of inherent racism within psychiatry. This may manifest in perceptions of Black and minority ethnic patients being at greater risk, as well as systemic factors that disadvantage these groups.
It is important to address these issues and work towards a more equitable and just mental health system for all patients, regardless of their ethnicity.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 3
Incorrect
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What is the most common negative effect experienced with deep brain stimulation (DBS)?
Your Answer: Aggression
Correct Answer: Ataxic gait
Explanation:DBS can lead to various complications, such as intracranial bleeding (which occurs in around 2.0-2.5% of implants), dislocation, lead fracture, and infection. Additionally, stimulation-induced adverse side effects may include paraesthesia, tonic muscle contractions, dyskinesia, and gait ataxia. While less common, some individuals may experience side effects such as aggression, mirthful laughter, depression, penile erection, of mania.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 4
Incorrect
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The initial application of deep brain stimulation (DBS) was for the treatment of which condition?
Your Answer: Epilepsy
Correct Answer: Chronic pain
Explanation:The human cortex was first directly stimulated in 1874, followed by the use of frontal tract stimulation for chronic pain in 1948. Thalamic stimulation for tremor was introduced in 1960, and basal ganglia stimulation for Parkinson’s tremor in 1968. The effectiveness of stimulation in treating epilepsy was discovered in 1973, and for depression in 1987.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 5
Correct
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How can the ethnic differences observed in psychiatry in the UK be accurately described?
Your Answer: People from Black minorities have the highest rate of mental illness in UK
Explanation:Institutional Racism in Psychiatry
There has been growing concern that institutional racism may be contributing to the overrepresentation of Black patients in mental health settings. Despite ethnic minorities making up only 9% of the UK population, the 2010 ‘Count me in Census’ found that 23% of inpatients and those on CTOs were from Black and minority ethnic groups. Black minority groups also had higher rates of admission, detention, and seclusion.
While patient factors, such as higher rates of mental illness in Black minority groups, may contribute to these findings, there is also a suggestion of inherent racism within psychiatry. This may manifest in perceptions of Black and minority ethnic patients being at greater risk, as well as systemic factors that disadvantage these groups.
It is important to address these issues and work towards a more equitable and just mental health system for all patients, regardless of their ethnicity.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 6
Incorrect
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What factors have been linked to a higher seizure threshold in individuals receiving right unilateral ECT treatment?
Your Answer: Lorazepam use in 48 hours prior to treatment
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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 7
Correct
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Which element is not considered essential in the CPA process?
Your Answer: HCR-20
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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 8
Incorrect
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What percentage of alcoholic beverages were estimated to be sold at a price lower than their cost before the ban was implemented in 2014?
Your Answer: 23%
Correct Answer:
Explanation:In May 2014, the UK implemented a ban on selling alcohol below the cost of duty and VAT, known as below-cost selling. Prior to the ban, only 0.7% of all units sold were estimated to be sold below duty plus VAT. A recent study by the University of Sheffield suggests that the ban will prevent 14 deaths and 500 hospital admissions annually in England. However, if the ban had been set at a higher price point, between 40 pence and 50 pence per unit, the impact would have been much greater, preventing 624 deaths and 23,700 admissions, and affecting almost a quarter (23.2%) of all alcohol units sold.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 9
Incorrect
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What is a significant obstacle for individuals to participate in mental health services?
Your Answer: Service users may become more isolated from their peers
Correct 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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 10
Correct
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In adapted ECT, what does the term 'adapted' refer to in terms of its implementation?
Your Answer: Anaesthetic and muscle relaxant
Explanation:The use of both an anaesthetic induction agent and muscle relaxant characterizes ‘Modified’ ECT, while ‘Unmodified’ ECT is no longer employed. Anticholinergics may be administered to reduce parasympathetic stimulation, and beta-blockers can be used to decrease sympathetic stimulation. EEG monitoring is a requirement when administering ECT.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 11
Correct
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What condition of situation would make rTMS inappropriate of unsafe to use?
Your Answer: Cochlear implant
Explanation: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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 12
Incorrect
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An economic analysis conducted in 2011 on the Rapid Assessment Interface and Discharge (RAID) psychiatric liaison service at City Hospital in Birmingham revealed what benefit-to-cost ratio?
Your Answer: 2
Correct Answer: 4
Explanation:The Rapid Assessment Interface and Discharge (RAID) psychiatric liaison service at Birmingham’s City Hospital was evaluated by the London School of Economics, which found that the benefit:cost ratio was over 4:1. The evaluation showed that the service resulted in savings of £3.55 million per year in general hospital bed use, at a cost of £0.8 million.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 13
Correct
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You are seeing a 45-year-old patient in clinic with treatment-resistant anxiety of over three years' duration. She has been treated with a range of pharmacological treatments, including multiple anxiolytics alone and in combination. She has also had two separate courses of time-limited psychological treatment (CBT and DBT) in the past year. One month ago she suffered a panic attack. The patient asks you about non-pharmacological physical treatments for her anxiety and is keen to minimise any side effects.
What would be the most appropriate intervention?Your Answer: rTMS
Explanation:Non-Pharmacological Interventions for Treatment-Resistant Depression
One non-pharmacological intervention for treatment-resistant depression is repetitive transcranial magnetic stimulation (rTMS). This outpatient procedure involves using an electromagnetic coil to induce electric currents in the cerebral cortex without the need for anesthesia. It is typically used for patients who have not responded to antidepressant medication of for whom antidepressants are not suitable. Treatment can be delivered unilaterally or bilaterally and lasts for 2 to 6 weeks.
Electroconvulsive therapy (ECT) is another option for treatment-resistant depression, but it is associated with adverse effects such as autobiographical retrograde memory loss. It is not recommended for patients who have recently had a heart attack and are keen to avoid side effects.
Psychosurgery is rarely used and only as a last resort for severely debilitating mental illness. It is associated with seizures and permanent cognitive impairment.
Deep brain stimulation (DBS) is a controversial option for treatment-resistant depression. It involves targeting specific areas of the brain, such as the subcallosal cingulate and medial forebrain bundle. However, it is not currently recommended by NICE and is more commonly used for Parkinson’s disorder.
Lithium may also be an option, but the question specifically asks for non-pharmacological interventions.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 14
Incorrect
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How can we best demonstrate 'Rose's paradox'?
Your Answer: A trend that appears in different groups of data disappears when these groups are combined
Correct Answer: A situation where the majority of cases of a disease come from a population at low of moderate risk of that disease, and only a minority of cases come from the high risk population
Explanation: -
This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 15
Correct
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A child is scheduled to undergo ECT. The nurse presents you with their medication list. Which medication should be stopped before ECT?
Your Answer: Diazepam
Explanation:ECT and Seizure Duration: Effect of Psychotropics
On the whole, most drugs do not interfere with ECT. However, it is important to note the effect of psychotropics on seizure duration. The table below summarizes the effect of important psychotropics and their advice:
Psychotropic class: Benzodiazepine
Effect on seizure duration: Reduced
Advice: Avoid where possiblePsychotropic class: SSRIs
Effect on seizure duration: Minimal effectPsychotropic class: Venlafaxine
Effect on seizure duration: Minimal effectPsychotropic class: TCAs
Effect on seizure duration: Possibly increased
Advice: TCAs are associated with arrhythmia following ECT in the elderly and those with cardiac disease, so they should be avoided in ECT in these groups.Psychotropic class: MAOIs
Effect on seizure duration: Minimal effectPsychotropic class: Lithium
Effect on seizure duration: Possibly increased
Advice: Generally used in ECT without significant problems.Psychotropic class: Antipsychotics
Effect on seizure duration: Some potential increase in clozapine and phenothiazines, other antipsychotics considered ok
Advice: Limited data.Psychotropic class: Anticonvulsants
Effect on seizure duration: Reduced
Advice: If used as a mood stabilizer, continue but be prepared to use higher energy stimulus.(Source: Maudsley Guidelines 10th Edition, p.187)
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 16
Incorrect
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Which of the following exceeds the weekly alcohol limit recommended for women, which is no more than 21 units per week?
Your Answer: 12 × 330ml bottles of 5% ABV lager
Correct Answer: 12 × 500 ml bottles of 4% ABV 'alcopop'
Explanation:– ABV indicates the number of units of alcohol per litre of a liquid.
– The total number of alcoholic units in any given amount of liquid may be calculated by multiplying the volume of liquid (ml) by the ABV and dividing by 1000.
– A 1L bottle of 20% ABV port contains 20 units of alcohol.
– 6 large (250 ml) glasses of 12% ABV wine contain 18 units of alcohol.
– 12 330ml bottles of 5% ABV lager contain 20 units of alcohol.
– 12 500 ml bottles of 4% ABV ‘alcopop’ contain 24 units of alcohol.
– 20 standard (25 ml) measures of 40% ABV whiskey contain 20 units of alcohol. -
This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 17
Correct
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A 45-year-old individual with a long-standing history of bipolar disorder has been an inpatient on an acute admission ward for four months detained under section 2 of the Mental Health Act. Their manic episodes have subsided to their chronic baseline level. Periods of escorted leave have been associated with substance misuse and impulsive behavior including shoplifting and suspected vandalism. What would be the most suitable course of action for their treatment plan?
Your Answer: Transfer to rehabilitation unit
Explanation:Given the patient’s improved psychotic symptoms, an extended stay in an acute ward would not be beneficial. However, due to ongoing substance misuse and challenging behaviors, discharge from the hospital is not yet possible. While an addictions admission of transfer to a forensic ward is not necessary, a rehabilitation psychiatry ward would be the most appropriate next step. This would provide the patient with the necessary support to address their substance misuse and challenging behaviors, while also promoting their skills and independence for a successful return to community living.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 18
Correct
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What is a true statement about the NICE Guidelines for rTMS?
Your 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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 19
Incorrect
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A previous truck driver has been effectively treated with olanzapine after being diagnosed with schizophrenia and hopes to eventually go back to his former job. According to the DVLA, how long must the individual be in good and stable condition before they can resume driving?
Your Answer: 12 months
Correct Answer: 36 months
Explanation:For individuals diagnosed with chronic psychosis, the DVLA mandates a minimum of 3 months of stability before they can resume driving standard cars and motorcycles. However, for those driving LGVs of PCVs, this period is extended to 3 years. Similar guidelines apply to those with acute psychotic disorders and hypomania/mania. In the case of severe anxiety of depression, LGV/PCV drivers may be allowed to resume driving after 6 months of stability.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 20
Correct
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What is the Royal College of Psychiatrists' recommended maximum frequency for administering ECT, except in emergency situations?
Your Answer: Twice weekly
Explanation:The ECTAS Guidelines 2019 recommend a frequency of two times per week.
ECT (Treatment) – Summary of Effectiveness and Recommendations
ECT (Electroconvulsive Therapy) is a treatment that induces a therapeutic seizure through the application of electrical current under general anesthesia and muscle relaxation. It is prescribed as a course and is usually administered twice weekly for 6 to 12 treatments. ECT is the most effective short-term treatment for major depression, with remission rates of around 60-80% when used as first-line treatment in a severe depressive episode. However, without maintenance treatment, the relapse rate is extremely high (over 80%) in the 6 months after successful ECT.
Cognitive effects are the main limitation to the wider use of ECT, particularly acute confusion shortly after the treatment, retrograde amnesia, and some losses in autobiographical memory longer term. The current state of evidence does not allow the general use of ECT in the management of schizophrenia. Bilateral ECT is more effective than unilateral ECT but may cause more cognitive impairment. With unilateral ECT, a higher stimulus dose is associated with greater efficacy but also increased cognitive impairment compared with a lower stimulus dose.
NICE (National Institute for Health and Care Excellence) recommends that ECT is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/of when the condition is considered to be potentially life-threatening. ECT is recommended for individuals with severe depression (that is life-threatening and when a rapid response is required, of when other treatments have failed), moderate depression (consider it if their depression has not responded to multiple drug treatments and psychological treatment), catatonia, and a prolonged of severe manic episode.
The RCPsych (Royal College of Psychiatrists) position on ECT recommends it as a first-line treatment for individuals with high suicidal risk, severe psychomotor retardation and associated problems of compromised eating and drinking and/of physical deterioration, treatment-resistant depression that has responded to ECT in a previous episode of illness, pregnant individuals with severe depression, of severe mixed affective states, mania of catatonia and whose physical health of that of the fetus is at serious risk, and those who prefer this form of treatment. ECT is recommended as a second-line treatment for individuals with treatment-resistant depression, severe side-effects from medication, and persistent of life-threatening symptoms in severe of prolonged mania. ECT is indicated in some circumstances for individuals with bipolar depression, postnatal psychosis, treatment-resistant schizophrenia, treatment-resistant catatonia, and frequent relapses and recurrences of depression (maintenance).
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 21
Correct
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What surgical procedure would be the most suitable for managing OCD that is unresponsive to other treatments?
Your Answer: Anterior capsulotomy
Explanation:Capsulotomy is a procedure that creates lesions on both sides of the anterior limb of the internal capsule and is commonly used to treat OCD and depression. Cingulotomy is another procedure used to treat refractory anxiety, pain, depression, and OCD. SST is primarily used for depression but can also be used for anxiety and OCD. Limbic leucopathy is a combination of SST and cingulotomy and is used to treat depression, anxiety, and OCD. Although amygdalotomy was originally developed to treat aggression, it is now rarely used.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 22
Correct
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What term replaced 'key worker' after the modernisation of the CPA process?
Your 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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 23
Incorrect
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Who among these psychosurgeons received the Nobel Prize in medicine?
Your Answer: Kluver and Bucy
Correct Answer: Moniz
Explanation:The History of Psychosurgery
Psychosurgery, the surgical treatment of mental illness, has a long and controversial history. The modern era of psychosurgery began in the late 19th century with the pioneering work of Swiss neurosurgeon Burckhardt, who removed areas of cortex from the frontal and parietal regions of six patients.
In 1910, Russian neurosurgeon Puseep ablated the frontoparietal tracts of three bipolar patients. However, it was Egas Moniz who refined psychosurgical techniques and was awarded the Nobel Prize for Medicine in 1949 for his work in the treatment of psychiatric disorders.
American neurosurgeon Freeman also developed similar procedures and advocated for psychosurgery as a first-line treatment for mental illness. Luver and Bucy described the effect of temporal lobectomy on aggression, further advancing the field of psychosurgery. Despite its controversial history, psychosurgery continues to be used today in select cases as a treatment option for severe mental illness.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 24
Incorrect
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A 70-year-old patient with cognitive impairment, who was discharged from section 2 of the Mental Health Act a month ago and was under Deprivation of Liberty Safeguards, has been discovered deceased in her care home with an empty bottle of opioids beside her bed. Why is it necessary to notify the coroner?
Your Answer: Because the patient was subject to DOLS
Correct Answer: Because the death appears to be due to self-inflicted poisoning
Explanation:Guidance for Registered Medical Practitioners on the Notification of Deaths Regulations 2019
If there is reason to suspect that the deceased died from self-inflicted poisoning, the coroner should be informed. The Notification of Deaths Regulations 2019 provides national guidance for registered medical practitioners on reporting deaths. This guidance supersedes any local protocols. There are several causes of death that must be referred to the coroner, including death from poisoning, violence of trauma, self-harm, neglect, medical procedures, employment-related injury of disease, unnatural death, unknown cause of death, death in state detention, and unidentified individuals. This does not include patients recently detained under the Mental Health Act of subject to DOLS, unless one of the above reasons applies.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 25
Incorrect
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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: Selective prevention
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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 26
Correct
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How can we best describe a primary prevention approach for suicide among older adults?
Your Answer: Development of social networks
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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 27
Incorrect
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For which conditions is rTMS recommended?
Your Answer: Anxiety
Correct Answer: Unipolar depression
Explanation: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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 28
Correct
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What has research shown about the provision of services for individuals with eating disorders?
Your Answer: Outpatient services are more cost effective compared to in-patient care
Explanation:Research has consistently shown that out-patient services, whether they are general of specialized eating disorder clinics, are more likely to be cost-effective than in-patient care. The majority of patients with eating disorders can be effectively managed in out-patient clinics, with only a small percentage requiring in-patient care. When comparing outpatient treatment models, including general child and adolescent mental health services, with in-patient treatment, there were significant improvements in all groups at different points during follow-up, with no significant differences between the two types of treatment. The availability of out-patient care is associated with a lower rate of admission to inpatient units. Clinically and economically, lengthy in-patient stays are not recommended, as they are associated with worse outcomes, particularly when they disrupt the patient’s life, such as their work, studies, of time away from family.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 29
Correct
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What is the most appropriate term to describe a national initiative that focuses on enhancing community support systems to prevent individuals from developing depression?
Your Answer: Primary
Explanation:This intervention is designed to prevent depression in a broad population, making it applicable to everyone and can be categorized as either a universal of primary prevention strategy.
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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 30
Incorrect
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What is considered a prolonged seizure during electroconvulsive therapy (ECT)?
Your Answer: >30 seconds
Correct 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.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 31
Correct
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During which decade was electroconvulsive therapy (ECT) first developed?
Your Answer: 1930s
Explanation:History of ECT
ECT, of electroconvulsive therapy, was first developed in Italy in 1938. Prior to this, convulsive therapy had been used in various forms throughout the 1930s. However, it was not until Ugo Cerletti’s invention of ECT that a more controlled and effective method of inducing convulsions was developed. Cerletti’s first successful use of ECT involved producing a convulsion in a man in 1938. Since then, ECT has been used as a treatment for various mental health conditions, although its use has been controversial and subject to debate.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 32
Incorrect
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Considering the recovery model, which of the following is an example of a user-based recovery definition?
Your Answer: Being involved in work
Correct Answer: Overcoming the effects of being a patient
Explanation:The recovery model raises questions about how to define recovery from a mental health problem. Mental health services tend to define recovery based on measures such as symptom remission, hospitalization, independence, and involvement in work of school. However, people with mental health problems define recovery differently, placing importance on factors such as overcoming the effects of being a patient, establishing a fulfilling life and positive identity, and discovering how to live well with enduring symptoms.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 33
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What category of preventive approach does the initiative promoting physical activity to decrease depression fall under?
Your Answer: Primary
Explanation:Principles of Prevention for Depression
Depression can be prevented through various principles of prevention. According to an article on depression prevention, there are different levels of prevention that aim to reduce the incidence, prevalence, and associated disability of depression.
Primary prevention focuses on reducing the occurrence of depression in the general population. This can be achieved through public health campaigns, education, and awareness programs.
Secondary prevention targets subgroups of the population who are identified as at risk for depression. This can include individuals with a family history of depression, those who have experienced traumatic events, of those with chronic illnesses.
Tertiary prevention aims to reduce the disability associated with depression. This can involve providing support and treatment to individuals who have already developed depression, in order to prevent further complications and improve their quality of life.
Universal prevention targets the entire population, while selective prevention targets specific subgroups. Indicated prevention targets individuals who are at a prodromal stage of depression, meaning they are showing early signs of the illness.
By implementing these principles of prevention, it is possible to reduce the incidence, prevalence, and disability associated with depression.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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