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  • Question 1 - 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: Borderline personality disorder

      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 2 - What are the characteristics of the detachment trait as outlined in the ICD-11...

    Correct

    • What are the characteristics of the detachment trait as outlined in the ICD-11 diagnostic criteria for personality disorders?

      Your Answer: Avoidance of intimacy

      Explanation:

      Personality Disorder: Avoidant

      Avoidant Personality Disorder (AVPD) is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. According to the DSM-5, individuals with AVPD exhibit at least four of the following symptoms: avoidance of occupational activities that involve interpersonal contact, unwillingness to be involved unless certain of being liked, restraint in intimate relationships due to fear of ridicule, preoccupation with being criticized of rejected in social situations, inhibition in new interpersonal situations due to feelings of inadequacy, viewing oneself as inept and inferior to others, and reluctance to take personal risks of engage in new activities due to potential embarrassment.

      In contrast, the ICD-11 does not have a specific category for AVPD but instead uses the qualifier of detachment trait. The Detachment trait domain is characterized by a tendency to maintain interpersonal and emotional distance. Common manifestations of Detachment include social detachment (avoidance of social interactions, lack of friendships, and avoidance of intimacy) and emotional detachment (reserve, aloofness, and limited emotional expression and experience). It is important to note that not all individuals with Detachment will exhibit all of these symptoms at all times.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 3 - A 50 year old man, with a long history of alcohol dependence and...

    Correct

    • A 50 year old man, with a long history of alcohol dependence and has a history of ascites and jaundice within the previous year, begins an alcohol detoxification and experiences withdrawal symptoms. What is the most suitable medication for him?

      Your Answer: Oxazepam

      Explanation:

      Patients with impaired liver function, such as those with liver failure of elderly individuals, are recommended to use oxazepam and lorazepam.

      Alcohol withdrawal is characterized by overactivity of the autonomic nervous system, resulting in symptoms such as agitation, tremors, sweating, nausea, vomiting, fever, and tachycardia. These symptoms typically begin 3-12 hours after drinking stops, peak between 24-48 hours, and can last up to 14 days. Withdrawal seizures may occur before blood alcohol levels reach zero, and a small percentage of people may experience delirium tremens (DT), which can be fatal if left untreated. Risk factors for DT include abnormal liver function, old age, severity of withdrawal symptoms, concurrent medical illness, heavy alcohol use, self-detox, previous history of DT, low potassium, low magnesium, and thiamine deficiency.

      Pharmacologically assisted detox is often necessary for those who regularly consume more than 15 units of alcohol per day, and inpatient detox may be needed for those who regularly consume more than 30 units per day. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) can be used to assess the severity of withdrawal symptoms and guide treatment decisions. Benzodiazepines are the mainstay of treatment, as chronic alcohol exposure results in decreased overall brain excitability and compensatory decrease of GABA-A neuroreceptor response to GABA. Chlordiazepoxide is a good first-line agent, while oxazepam, temazepam, and lorazepam are useful in patients with liver disease. Clomethiazole is effective but carries a high risk of respiratory depression and is not recommended. Thiamine should be offered to prevent Wernicke’s encephalopathy, and long-acting benzodiazepines can be used as prophylaxis for withdrawal seizures. Haloperidol is the treatment of choice if an antipsychotic is required.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 4 - What is the accurate statement about the issue of alcohol misuse in the...

    Correct

    • What is the accurate statement about the issue of alcohol misuse in the United Kingdom?

      Your Answer: The highest levels of binge drinking occur in people aged 16-24

      Explanation:

      Prevalence of Substance Misuse, with a Focus on Alcohol Misuse

      Alcohol misuse is a major issue, particularly in the UK, where it is among the highest rates in Europe. Men are more likely to experience both alcohol dependence and binge drinking than women. Specifically, 6% of men and 2% of women experience alcohol dependence, while 21% of men and 9% of women engage in binge drinking. It is worth noting that this figure contradicts the findings from the NPMS in 2000.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      20.6
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  • Question 5 - 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: Psychotherapy

      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 6 - A 27-year-old police officer presents following a recent traumatic incident where a fellow...

    Incorrect

    • A 27-year-old police officer presents following a recent traumatic incident where a fellow officer was killed in the line of duty. She describes recurrent nightmares and flashbacks which have been present for the past 3 months. A diagnosis of post-traumatic stress disorder is suspected. What is the most appropriate first-line treatment?

      Your Answer: Graded exposure therapy

      Correct Answer: Cognitive behavioural therapy

      Explanation:

      The recommended initial treatment approach is cognitive-behavioral therapy that specifically targets trauma.

      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 7 - 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
      21.5
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  • Question 8 - What is the best course of action for a pregnant patient who regularly...

    Incorrect

    • What is the best course of action for a pregnant patient who regularly attends clinic for moderate to severe depression and is taking paroxetine, but is unwilling to consider psychological options?

      Your Answer: Half the dose of paroxetine and continue until the end of the first trimester

      Correct Answer: Continue the paroxetine

      Explanation:

      If the patient’s depression history was only mild to moderate, NICE would suggest considering stopping paroxetine and using facilitated self-help. However, since the patient’s depression history is more severe, it would not be wise to discontinue antidepressant treatment. The Maudsley recommends continuing with the same antidepressant if it is effective, except for MAOIs, to prevent relapse. Although some studies have linked paroxetine to cardiac malformations, other studies have not replicated this finding and have implicated other SSRIs. While paroxetine may increase the likelihood of neonatal withdrawal effects compared to alternatives with a longer half-life, these effects are typically mild and self-limiting.

      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 9 - Which principle was not mentioned by Yalom as a therapeutic aspect of group...

    Correct

    • Which principle was not mentioned by Yalom as a therapeutic aspect of group therapy?

      Your Answer: Autonomy

      Explanation:

      Group Psychotherapy: Yalom’s Therapeutic Principles

      Group psychotherapy involves a trained therapist and a group of individuals. Yalom, a prominent figure in group therapy, outlined the therapeutic principles of group psychotherapy. These principles include universality, altruism, instillation of hope, imparting information, corrective recapitulation of the primary family experience, development of socializing techniques, imitative behavior, cohesiveness, existential factors, catharsis, interpersonal learning, and self-understanding. Psychodrama, a specific form of group therapy, involves examining relationships and problems through drama.

      Bion and Basic Assumption Groups

      Bion, a psychoanalyst interested in group dynamics, believed that groups had a collective unconscious that operated similarly to an individual’s. He distinguished between two types of groups: working groups and basic assumption groups. Basic assumption groups act out primitive fantasies and prevent things from getting done. Bion described different types of basic assumption groups, including dependency, fight-flight, and pairing. Dependency involves the group turning to a leader to protect them from anxiety. Fight-flight involves the group acting as if there is an enemy who must be attacked of avoided. Pairing involves the group acting as if the answer lies in the pairing of two members.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 10 - In a healthy right-handed man, which structure is typically larger in the left...

    Incorrect

    • In a healthy right-handed man, which structure is typically larger in the left hemisphere compared to the right hemisphere?

      Your Answer: Frontal lobe

      Correct Answer: Planum temporale

      Explanation:

      Cerebral Asymmetry in Planum Temporale and its Implications in Language and Auditory Processing

      The planum temporale, a triangular region in the posterior superior temporal gyrus, is a highly lateralized brain structure involved in language and music processing. Studies have shown that the planum temporale is up to ten times larger in the left cerebral hemisphere than the right, with this asymmetry being more prominent in men. This asymmetry can be observed in gestation and is present in up to 70% of right-handed individuals.

      Recent research suggests that the planum temporale also plays an important role in auditory processing, specifically in representing the location of sounds in space. However, reduced planum temporale asymmetry has been observed in individuals with dyslexia, stuttering, and schizophrenia. These findings highlight the importance of cerebral asymmetry in the planum temporale and its implications in language and auditory processing.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 11 - What study design would be most suitable for investigating the potential correlation between...

    Correct

    • What study design would be most suitable for investigating the potential correlation between the use of pacifiers in infants and sudden infant death syndrome?

      Your Answer: Case-control study

      Explanation:

      A case-control design is more suitable than a cohort study for studying sudden infant death syndrome due to its low incidence.

      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
      20
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  • Question 12 - You are requested to prepare a Court report for a client of yours...

    Incorrect

    • You are requested to prepare a Court report for a client of yours who is charged with grievous bodily harm, having stabbed a teacher at his school. The client is a 16-year-old boy, diagnosed with paranoid schizophrenia. Following his arrest for the stabbing, he informed the police that he attacked the victim as he had been hearing the victim's voice threatening to harm him. He also believed that the victim had been spying on him and spreading rumors about him. He tells you that he's happy that he stabbed the victim, but knew that what he was doing when he stabbed him was against the law.

      You assess him in a juvenile detention center, where he is being held. He discusses these experiences, and they appear to be auditory and visual hallucinations. He admits that he had been non-compliant with his oral risperidone for the past two months and had also been using £50 worth of cannabis a week.

      The defense attorney asks for your professional opinion as to whether the client could make a defense of Not Guilty by Reason of Insanity (NGRI).

      What would you advise?

      Your Answer: He can make a defence of NGRI as he was suffering from a defect of reason caused by disease of the mind

      Correct Answer: He cannot make a defence of NGRI as he knew his actions were legally wrong

      Explanation:

      The defendant can only plead Not Guilty by Reason of Insanity (NGRI) if they have a defect of reason caused by a disease of the mind, which resulted in them not knowing the nature of their actions of not knowing that their actions were wrong. The causes of this defect of reason are broad, but acute intoxication is not included. However, if the defendant believed their actions were morally justified, this does not qualify as a defence of NGRI as the legal test only considers whether the defendant knew their actions were legally wrong. Despite feeling provoked and morally justified, the defendant still knew that stabbing someone was against the law. NGRI is a rare defence, used in less than 1% of cases, and is successful in only one in four of these cases.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 13 - What is the estimated global prevalence of ADHD in children? ...

    Correct

    • What is the estimated global prevalence of ADHD in children?

      Your Answer: 7%

      Explanation:

      ADHD is a prevalent disorder worldwide, with a prevalence of 7% in those under 18 and 3.5% in those over 18. It is more common in males, with a male to female ratio of 2:1 in children and 1.6:1 in adults. While some improvement in symptoms is seen over time, the majority of those diagnosed in childhood continue to struggle with residual symptoms and impairments through at least young adulthood, with an estimated persistence rate of 50%.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 14 - What is the minimum time interval required after a suspected paracetamol overdose before...

    Incorrect

    • What is the minimum time interval required after a suspected paracetamol overdose before levels can be measured?

      Your Answer: 2

      Correct Answer: 4

      Explanation:

      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
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  • Question 15 - A new medication is being developed to treat hypertension in elderly patients. Several...

    Incorrect

    • A new medication is being developed to treat hypertension in elderly patients. Several different drugs are being considered for their efficacy in reducing blood pressure. Which study design would require the largest number of participants to achieve a significant outcome?

      Your Answer: Non-inferiority trial

      Correct Answer: Superiority trial

      Explanation:

      Since a superiority trial involves comparing a new drug with an already existing treatment that can also reduce HbA1c levels, a substantial sample size is necessary to establish a significant distinction.

      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 16 - Which of the following checklists would be most helpful in preparing the manuscript...

    Incorrect

    • Which of the following checklists would be most helpful in preparing the manuscript of a survey analyzing the opinions of college students on mental health, as evaluated through a set of questionnaires?

      Your Answer: CONSORT

      Correct Answer: COREQ

      Explanation:

      There are several reporting guidelines available for different types of research studies. The COREQ checklist, consisting of 32 items, is designed for reporting qualitative research that involves interviews and focus groups. The CONSORT Statement provides a 25-item checklist to aid in reporting randomized controlled trials (RCTs). For reporting the pooled findings of multiple studies, the QUOROM and PRISMA guidelines are useful. The STARD statement includes a checklist of 30 items and is designed for reporting diagnostic accuracy studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      515.5
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  • Question 17 - What is the correct statement about the psychiatric care provided to individuals with...

    Correct

    • What is the correct statement about the psychiatric care provided to individuals with HIV?

      Your Answer: Efavirenz is associated with depression and mania

      Explanation:

      HIV and Mental Health: Understanding the Relationship and Treatment Options

      Human immunodeficiency virus (HIV) is a blood-borne virus that causes cellular immune deficiency, resulting in a decrease in the number of CD4+ T-cells. People with severe mental illness are at increased risk of contracting and transmitting HIV, and the prevalence of HIV infection among them is higher than in the general population. Antiretroviral drugs are used to manage HIV, but they are not curative.

      Depression is the most common mental disorder in the HIV population, and it can result from HIV of the psycho-social consequences of having the condition. HIV-associated neurocognitive disorder (HAND) is the umbrella term for the spectrum of neurocognitive impairment induced by HIV, ranging from mild impairment through to dementia. Poor episodic memory is the most frequently reported cognitive difficulty in HIV-positive individuals.

      Treatment options for mental health issues in people with HIV include atypical antipsychotics for psychosis, SSRIs for depression and anxiety, valproate for bipolar disorder, and antiretroviral therapy for HAND. It is important to avoid benzodiazepines for delirium and MAOIs for depression. Understanding the relationship between HIV and mental health and providing appropriate treatment options can improve the quality of life for people living with HIV.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 18 - What test would be the most effective in verifying the suitability of using...

    Correct

    • What test would be the most effective in verifying the suitability of using a parametric test on a given dataset?

      Your Answer: Lilliefors test

      Explanation:

      Normality Testing in Statistics

      In statistics, parametric tests are based on the assumption that the data set follows a normal distribution. On the other hand, non-parametric tests do not require this assumption but are less powerful. To check if a distribution is normally distributed, there are several tests available, including the Kolmogorov-Smirnov (Goodness-of-Fit) Test, Jarque-Bera test, Wilk-Shapiro test, P-plot, and Q-plot. However, it is important to note that if a data set is not normally distributed, it may be possible to transform it to make it follow a normal distribution, such as by taking the logarithm of the values.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      26.4
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  • Question 19 - Which of the following statements accurately describes the normal distribution? ...

    Incorrect

    • Which of the following statements accurately describes the normal distribution?

      Your Answer: 99.7% of values lie within 2 standard deviations of the mean

      Correct Answer: Mean = mode = median

      Explanation:

      The Normal distribution is a probability distribution that is continuous in nature.

      Standard Deviation and Standard Error of the Mean

      Standard deviation (SD) and standard error of the mean (SEM) are two important statistical measures used to describe data. SD is a measure of how much the data varies, while SEM is a measure of how precisely we know the true mean of the population. The normal distribution, also known as the Gaussian distribution, is a symmetrical bell-shaped curve that describes the spread of many biological and clinical measurements.

      68.3% of the data lies within 1 SD of the mean, 95.4% of the data lies within 2 SD of the mean, and 99.7% of the data lies within 3 SD of the mean. The SD is calculated by taking the square root of the variance and is expressed in the same units as the data set. A low SD indicates that data points tend to be very close to the mean.

      On the other hand, SEM is an inferential statistic that quantifies the precision of the mean. It is expressed in the same units as the data and is calculated by dividing the SD of the sample mean by the square root of the sample size. The SEM gets smaller as the sample size increases, and it takes into account both the value of the SD and the sample size.

      Both SD and SEM are important measures in statistical analysis, and they are used to calculate confidence intervals and test hypotheses. While SD quantifies scatter, SEM quantifies precision, and both are essential in understanding and interpreting data.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      51.5
      Seconds
  • Question 20 - What statistical test would be appropriate to compare the mean blood pressure measurements...

    Correct

    • What statistical test would be appropriate to compare the mean blood pressure measurements of a group of individuals before and after exercise?

      Your Answer: Paired t-test

      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
      12.6
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  • Question 21 - Which condition is primarily associated with cortical dementia rather than subcortical dementia? ...

    Correct

    • Which condition is primarily associated with cortical dementia rather than subcortical dementia?

      Your Answer: Pick's disease

      Explanation:

      Distinguishing Cortical and Subcortical Dementia: A Contested Area

      Attempts have been made to differentiate between cortical and subcortical dementia based on clinical presentation, but this remains a contested area. Some argue that the distinction is not possible. Cortical dementia is characterized by impaired memory, visuospatial ability, executive function, and language. Examples of cortical dementias include Alzheimer’s disease, Pick’s disease, and Creutzfeldt-Jakob disease. On the other hand, subcortical dementia is characterized by general slowing of mental processes, personality changes, mood disorders, and abnormal movements. Examples of subcortical dementias include Binswanger’s disease, dementia associated with Huntington’s disease, AIDS, Parkinson’s disease, Wilson’s disease, and progressive supranuclear palsy. Despite ongoing debate, questions on this topic may appear in exams.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 22 - Which of the following would be the most appropriate first-line treatment for a...

    Correct

    • Which of the following would be the most appropriate first-line treatment for a 12 year old boy with mild depression that has failed to respond to group based CBT despite 3 months of therapy?

      Your Answer: Individual CBT

      Explanation:

      Depression in Young People: NICE Guidelines

      The NICE Guidelines for depression in young people are limited to those between the ages of 5-18. For mild depression without significant comorbid problems of active suicidal ideas of plans, watchful waiting is recommended, along with digital CBT, group CBT, group IPT, of group non-directive supportive therapy. For moderate to severe depression, family-based IPT, family therapy, psychodynamic psychotherapy, individual CBT, and fluoxetine may be used for 5-11 year olds, while individual CBT and fluoxetine may be used for 12-18 year olds. Antidepressant medication should not be used for initial treatment of mild depression, and should only be used in combination with concurrent psychological therapy for moderate to severe depression. Fluoxetine is the only antidepressant for which clinical trial evidence shows that the benefits outweigh the risks, and should be used as the first-line treatment. Paroxetine, venlafaxine, tricyclic antidepressants, and St John’s wort should not be used for the treatment of depression in children and young people. Second generation antipsychotics may be used for depression with psychotic symptoms, and ECT should only be considered for those with very severe depression and life-threatening symptoms.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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      Seconds
  • Question 23 - Which statement lacks evidence to support it? ...

    Incorrect

    • Which statement lacks evidence to support it?

      Your Answer: Higher doses of electrical stimulus lead to greater reductions in depressive symptoms

      Correct Answer: ECT is more effective if given three times a week than when given twice a week

      Explanation:

      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).

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 24 - What is the classification of the prevention strategy being used for a group...

    Incorrect

    • What is the classification of the prevention strategy being used for a group of children who are identified as at risk of self-harm due to factors such as parental divorce and academic attainment, and are referred to a support program to prevent self-harm?

      Your Answer: Indicated

      Correct Answer: Selective

      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
      121
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  • Question 25 - Which medication is not recommended by NICE for individuals with panic disorder? ...

    Correct

    • Which medication is not recommended by NICE for individuals with panic disorder?

      Your Answer: Diazepam

      Explanation:

      Prescribing benzodiazepines for individuals with panic disorder is not recommended as it is linked to a poorer long-term outcome.

      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
      8
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  • Question 26 - According to Gottesman (1982), what is the risk of a child developing schizophrenia...

    Incorrect

    • According to Gottesman (1982), what is the risk of a child developing schizophrenia if they have an affected parent?

      Your Answer: 48%

      Correct Answer: 13%

      Explanation:

      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
      13.4
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  • Question 27 - What standardized mortality ratio indicates a lower mortality rate in a sample group...

    Correct

    • What standardized mortality ratio indicates a lower mortality rate in a sample group compared to a reference group?

      Your Answer: 0.5

      Explanation:

      A negative SMR is not possible. An SMR less than 1.0 suggests that there were fewer deaths than expected in the study population, while an SMR of 1.0 indicates that the observed and expected deaths were equal. An SMR greater than 1.0 indicates that there were excess deaths in the study population.

      Calculation of Standardised Mortality Ratio (SMR)

      To calculate the SMR, age and sex-specific death rates in the standard population are obtained. An estimate for the number of people in each category for both the standard and study populations is needed. The number of expected deaths in each age-sex group of the study population is calculated by multiplying the age-sex-specific rates in the standard population by the number of people in each category of the study population. The sum of all age- and sex-specific expected deaths gives the expected number of deaths for the whole study population. The observed number of deaths is then divided by the expected number of deaths to obtain the SMR.

      The SMR can be standardised using the direct of indirect method. The direct method is used when the age-sex-specific rates for the study population and the age-sex-structure of the standard population are known. The indirect method is used when the age-specific rates for the study population are unknown of not available. This method uses the observed number of deaths in the study population and compares it to the number of deaths that would be expected if the age distribution was the same as that of the standard population.

      The SMR can be interpreted as follows: an SMR less than 1.0 indicates fewer than expected deaths in the study population, an SMR of 1.0 indicates the number of observed deaths equals the number of expected deaths in the study population, and an SMR greater than 1.0 indicates more than expected deaths in the study population (excess deaths). It is sometimes expressed after multiplying by 100.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 28 - Which of the following is not considered a characteristic of anorexia nervosa? ...

    Incorrect

    • Which of the following is not considered a characteristic of anorexia nervosa?

      Your Answer: Macrocytic anemia

      Correct Answer: Hyperkalaemia

      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
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  • Question 29 - A new drug which may reduce the chance of elderly patients developing arthritis...

    Correct

    • A new drug which may reduce the chance of elderly patients developing arthritis is introduced. In one study of 2,000 elderly patients, 1,200 received the new drug and 120 patients developed arthritis. The remaining 800 patients received a placebo and 200 developed arthritis. What is the absolute risk reduction of developing arthritis?

      Your Answer: 15%

      Explanation:

      To calculate the ARR, we first need to find the CER and EER. The CER is the conversion rate of the control group, which is 200 out of 800, of 0.25. The EER is the conversion rate of the experimental group, which is 120 out of 1,200, of 0.1.

      To find the ARR, we subtract the EER from the CER:

      ARR = CER – EER
      ARR = 0.25 – 0.1
      ARR = 0.15

      Therefore, the ARR is 0.15 of 15%.

      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
      115.1
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  • Question 30 - 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
      45.1
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SESSION STATS - PERFORMANCE PER SPECIALTY

General Adult Psychiatry (3/11) 27%
Substance Misuse/Addictions (2/2) 100%
Child And Adolescent Psychiatry (3/3) 100%
Psychotherapy (1/1) 100%
Research Methods, Statistics, Critical Review And Evidence-Based Practice (6/9) 67%
Forensic Psychiatry (0/1) 0%
Old Age Psychiatry (1/1) 100%
Organisation And Delivery Of Psychiatric Services (0/2) 0%
Passmed