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Question 1
Incorrect
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What is the term used to describe a drug that remains inactive until it is converted into its active metabolite?
Your Answer: A prototype
Correct Answer: A prodrug
Explanation:The Significance of Active Metabolites in Drug Discovery and Development
Certain drugs are classified as prodrugs, which means that they are inactive when administered and require metabolism to become active. These drugs are converted into an active form, which is referred to as an active metabolite. Some drugs have important active metabolites, such as diazepam, dothiepin, fluoxetine, imipramine, risperidone, amitriptyline, and codeine, which are desmethyldiazepam, dothiepin sulfoxide, norfluoxetine, desipramine, 9-hydroxyrisperidone, nortriptyline, and morphine, respectively.
The role of pharmacologically active metabolites in drug discovery and development is significant. Understanding the active metabolites of a drug can help in the development of more effective and safer drugs. Active metabolites can also provide insights into the pharmacokinetics and pharmacodynamics of a drug, which can aid in the optimization of dosing regimens. Additionally, active metabolites can have different pharmacological properties than the parent drug, which can lead to the discovery of new therapeutic uses for a drug. Therefore, the study of active metabolites is an important aspect of drug discovery and development.
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This question is part of the following fields:
- Psychopharmacology
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Question 2
Incorrect
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Who is the individual that put forth a theory regarding cognitive development?
Your Answer: Kohlberg
Correct Answer: Piaget
Explanation:Developmental Stages
There are four main developmental models that are important to understand: Freud’s theory of psychosexual development, Erikson’s theory of psychosocial development, Piaget’s theory of cognitive development, and Kohlberg’s theory of moral development.
Freud’s theory of psychosexual development includes five stages: oral, anal, phallic, latency, and genital. These stages occur from birth to adulthood and are characterized by different areas of focus and pleasure.
Erikson’s theory of psychosocial development includes eight stages, each with a specific crisis to be resolved. These stages occur from infancy to old age and are focused on developing a sense of self and relationships with others.
Piaget’s theory of cognitive development includes four stages: sensorimotor, preoperational, concrete operational, and formal operational. These stages occur from birth to adulthood and are focused on the development of cognitive abilities such as perception, memory, and problem-solving.
Kohlberg’s theory of moral development includes three stages: preconventional, conventional, and postconventional. These stages occur from childhood to adulthood and are focused on the development of moral reasoning and decision-making.
Understanding these developmental models can help individuals better understand themselves and others, as well as provide insight into how to support healthy development at each stage.
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This question is part of the following fields:
- Psychological Development
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Question 3
Incorrect
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Which statement accurately describes the FAST questionnaire for alcohol misuse?
Your Answer: The maximum score is 20
Correct Answer: May be stopped after first question depending on the answer
Explanation:Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 4
Incorrect
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Which cognitive function is the Stroop test intended to detect difficulties with?
Your Answer: Self-awareness
Correct Answer: Response inhibition
Explanation:The Stroop test involves presenting words to the subject that spell a color but are written in a different color. The subject is required to identify the color of the text as quickly as possible, rather than reading the word itself. This test assesses the subject’s ability to make an appropriate response when presented with conflicting signals. This ability is believed to originate from the anterior cingulate, which is located between the left and right frontal lobes.
Frontal Lobe Tests
The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.
Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.
Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.
Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.
Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.
Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 5
Incorrect
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What is true about the discontinuation syndrome of antidepressants?
Your Answer: Treatment must be resumed immediately if symptoms of the discontinuation syndrome emerge
Correct Answer: Symptoms rapidly disappear upon readministration of the drug
Explanation:Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).
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This question is part of the following fields:
- Psychopharmacology
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Question 6
Incorrect
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What is the most common cause of hyponatremia in an elderly patient?
Your Answer: Mirtazapine
Correct Answer: Citalopram
Explanation:Hyponatremia in Psychiatric Patients
Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.
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This question is part of the following fields:
- Psychopharmacology
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Question 7
Incorrect
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A college student experiencing heightened anxiety, difficulty sleeping, and trouble focusing has been using self-prescribed medication to cope with academic stress. What is the most probable diagnosis?
Your Answer: Cannabis misuse
Correct Answer: Benzodiazepine dependence
Explanation:It is less common for individuals to use amphetamine abuse as a form of self-medication compared to benzodiazepines. Cannabis use is also less likely to result in the symptoms associated with benzodiazepine dependence. Codeine dependence is not as likely to cause significant anxiety and sleep disturbance as benzodiazepine misuse. Practicing doctors are unlikely to use GHB, an illegal drug, as a means of self-medication.
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This question is part of the following fields:
- Psychopharmacology
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Question 8
Incorrect
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A woman who experiences frequent headaches tells her doctor that whenever she has a migraine, when her husband speaks to her it feels like he is yelling directly into her ear. What symptom is she displaying?
Your Answer: Lilliputian hallucinations
Correct Answer: Hyperacusis
Explanation:Gedankenlautwerden pertains to thoughts that can be heard.
Sensory Distortions of Sound
Hyperacusis is a condition where an individual experiences an increased sensitivity to noise. This condition is commonly observed in people with anxiety and depressive disorders, as well as during a hangover of migraine. On the other hand, hypoacusis is a condition where an individual experiences a reduced sensitivity to sound. This condition is commonly observed in people with delirium and depression, where it is often accompanied by hyperacusis.
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This question is part of the following fields:
- Classification And Assessment
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Question 9
Incorrect
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What can be said about alterations in dopamine transporter levels observed in individuals with ADHD?
Your Answer: Elevated due to pathophysiology of disorder
Correct Answer: Elevated due to psychostimulant treatment
Explanation:The density of striatal dopamine transporters in individuals with ADHD is influenced by their prior exposure to psychostimulants. ADHD is a complex disorder that involves dysfunction in multiple neurotransmitter systems, including dopamine, adrenergic, cholinergic, and serotonergic systems. Dopamine systems have received significant attention due to their role in regulating psychomotor activity, motivation, inhibition, and attention. Psychostimulants increase dopamine availability by blocking striatal dopamine transporters. Individuals with untreated ADHD have lower levels of dopamine transporters, while those who have received psychostimulants have higher levels.
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This question is part of the following fields:
- Neurosciences
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Question 10
Incorrect
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What is the primary mechanism by which valproate stabilizes mood?
Your Answer: 5HT1A partial agonist
Correct Answer: GABA agonism
Explanation:Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 11
Incorrect
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What is a true statement about the genetics of Huntington's disease?
Your Answer: It is caused by a mutation of a gene on the long arm of chromosome 4
Correct Answer: It is caused by an abnormal number of CAG repeats
Explanation:Huntington’s Disease: Genetics and Pathology
Huntington’s disease is a genetic disorder that follows an autosomal dominant pattern of inheritance. It is caused by a mutation in the Huntington gene, which is located on chromosome 4. The mutation involves an abnormal expansion of a trinucleotide repeat sequence (CAG), which leads to the production of a toxic protein that damages brain cells.
The severity of the disease and the age of onset are related to the number of CAG repeats. Normally, the CAG sequence is repeated less than 27 times, but in Huntington’s disease, it is repeated many more times. The disease shows anticipation, meaning that it tends to worsen with each successive generation.
The symptoms of Huntington’s disease typically begin in the third of fourth decade of life, but in rare cases, they can appear in childhood of adolescence. The most common symptoms include involuntary movements (chorea), cognitive decline, and psychiatric disturbances.
The pathological hallmark of Huntington’s disease is the gross bilateral atrophy of the head of the caudate and putamen, which are regions of the brain involved in movement control. The EEG of patients with Huntington’s disease shows a flattened trace, indicating a loss of brain activity.
Macroscopic pathological findings include frontal atrophy, marked atrophy of the caudate and putamen, and enlarged ventricles. Microscopic findings include neuronal loss and gliosis in the cortex, neuronal loss in the striatum, and the presence of inclusion bodies in the neurons of the cortex and striatum.
In conclusion, Huntington’s disease is a devastating genetic disorder that affects the brain and causes a range of motor, cognitive, and psychiatric symptoms. The disease is caused by a mutation in the Huntington gene, which leads to the production of a toxic protein that damages brain cells. The pathological changes in the brain include atrophy of the caudate and putamen, neuronal loss, and the presence of inclusion bodies.
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This question is part of the following fields:
- Genetics
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Question 12
Incorrect
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Which class of antidepressants share a molecular structure similar to carbamazepine?
Your Answer: MAOIs
Correct Answer: Tricyclics
Explanation:Carbamazepine mechanism of action involves decreasing the metabolism of dopamine and noradrenaline, which is similar to tricyclic antidepressants due to their comparable molecular structure.
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This question is part of the following fields:
- Psychopharmacology
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Question 13
Incorrect
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What kind of memory is necessary to recall the details of when and where you observed an incident?
Your Answer: Iconic
Correct Answer: Episodic
Explanation:Memory Forms
Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.
Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).
Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.
Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).
Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.
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This question is part of the following fields:
- Social Psychology
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Question 14
Incorrect
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What is the theory that suggests emotions and physiological responses happen at the same time called?
Your Answer: Papez Circuit
Correct Answer: Cannon-Bard theory
Explanation:Theories and Concepts in Psychology
The field of psychology has developed various theories and concepts to explain human behavior and emotions. One of these is the Cannon-Bard theory, which proposes that emotions and physiological reactions occur simultaneously in response to a stimulus. However, this theory has been criticized for disregarding the influence of bodily functions on emotions.
Another theory is the James-Lange theory, which suggests that physiological reactions precede emotions. However, studies have shown that emotions can still be felt even when somatic signals are removed, challenging this theory.
The Thurstone Scale is a technique used to measure attitudes, while Maslow’s hierarchy of needs proposes that basic needs must be met before higher ones can be achieved. This hierarchy is often represented as a pyramid, with physiological needs at the base and self-actualization at the top.
The Papez circuit, on the other hand, is a precursor to the limbic system, which is responsible for emotions, motivation, and memory. These theories and concepts continue to shape our understanding of human behavior and emotions in psychology.
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This question is part of the following fields:
- Basic Psychological Processes
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Question 15
Incorrect
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What is the lowest amount of fluoxetine that can effectively treat adults?
Your Answer: 5 mg
Correct Answer: 20 mg
Explanation:Adults require a minimum effective dose of 20 mg of fluoxetine.
Antidepressants: Minimum Effective Doses
According to the Maudsley 13th, the following are the minimum effective doses for various antidepressants:
– Citalopram: 20 mg/day
– Fluoxetine: 20 mg/day
– Fluvoxamine: 50 mg/day
– Paroxetine: 20 mg/day
– Sertraline: 50 mg/day
– Mirtazapine: 30 mg/day
– Venlafaxine: 75 mg/day
– Duloxetine: 60 mg/day
– Agomelatine: 25 mg/day
– Moclobemide: 300 mg/day
– Trazodone: 150 mg/dayNote that these are minimum effective doses and may vary depending on individual factors and response to treatment. It is important to consult with a healthcare professional before starting of changing any medication regimen.
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This question is part of the following fields:
- Psychopharmacology
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Question 16
Incorrect
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What factor is most likely to result in a notable increase in a patient's prolactin levels?
Your Answer: Clozapine
Correct Answer: Risperidone
Explanation:Hyperprolactinemia is a potential side effect of antipsychotic medication, but it is rare with antidepressants. Dopamine inhibits prolactin, so dopamine antagonists, such as antipsychotics, can increase prolactin levels. The degree of prolactin elevation is dose-related, and some antipsychotics cause more significant increases than others. Hyperprolactinemia can cause symptoms such as galactorrhea, menstrual difficulties, gynecomastia, hypogonadism, and sexual dysfunction. Long-standing hyperprolactinemia in psychiatric patients can increase the risk of osteoporosis and breast cancer, although there is no conclusive evidence that antipsychotic medication increases the risk of breast malignancy and mortality. Some antipsychotics, such as clozapine and aripiprazole, have a low risk of causing hyperprolactinemia, while typical antipsychotics and risperidone have a high risk. Monitoring of prolactin levels is recommended before starting antipsychotic therapy and at three months and annually thereafter. Antidepressants rarely cause hyperprolactinemia, and routine monitoring is not recommended. Symptomatic hyperprolactinemia has been reported with most antidepressants, except for a few, such as mirtazapine, agomelatine, bupropion, and vortioxetine.
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This question is part of the following fields:
- Psychopharmacology
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Question 17
Correct
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How can we describe the act of believing in a negative stereotype about one's own group and applying those beliefs to oneself?
Your Answer: Self-stigma
Explanation:Self stigma is when an individual adopts negative societal beliefs about their condition. On the other hand, courtesy stigma (also known as stigma by association) is a form of stigma directed towards individuals such as family members and healthcare professionals who are associated with those who have mental health issues.
Stigma is a term used to describe the negative attitudes and beliefs that people hold towards individuals who are different from them. There are several types of stigma, including discredited and discreditable stigma, felt stigma, enacted stigma, and courtesy stigma. Discredited stigma refers to visible stigmas such as race, gender, of physical disability, while discreditable stigma refers to concealable stigmas such as mental illness of HIV infection. Felt stigma is the shame and fear of discrimination that prevents people from seeking help, while enacted stigma is the experience of unfair treatment by others. Finally, courtesy stigma refers to the stigma that attaches to those who are associated with a stigmatized person.
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This question is part of the following fields:
- Social Psychology
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Question 18
Incorrect
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Whilst walking through the park, a teenager makes a hurtful comment towards their friend. The friend feels too upset to confront them but points out the beautiful flowers in the garden. What defense mechanism is being demonstrated in this scenario?
Your Answer: Sublimation
Correct Answer: Projection
Explanation:This scenario highlights the distinction between projection and projective identification. The woman is projecting her own sadness onto the cows, as she is unable to acknowledge of process her emotions. In projective identification, the recipient of the projection internalizes and identifies with the projected feelings. However, since it is impossible for the cows to experience human emotions, the correct term for this situation is projection.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 19
Correct
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What is a true statement about antidepressant medications that are not taken orally?
Your Answer: Compared to orally administered antidepressants, those given intravenously tend to require lower doses
Explanation:Intravenous formulations bypass the initial metabolism in the liver, resulting in increased concentrations of the drug in the bloodstream.
Alternative Routes of Administration for Antidepressants
While most antidepressants are taken orally, there are a few alternative routes of administration available. However, it is important to note that these non-oral preparations should only be used when absolutely necessary, as they may not have a UK licence.
One effective alternative route is sublingual administration of fluoxetine liquid. Buccal administration of selegiline is also available. Crushed amitriptyline has been shown to be effective when administered via this route.
Intravenous administration is another option, with several antidepressants available in IV preparations, including citalopram, escitalopram, mirtazapine, amitriptyline, clomipramine, and allopregnanolone (which is licensed in the US for postpartum depression). Ketamine has also been shown to be effective when administered intravenously.
Intramuscular administration of flupentixol has been shown to have a mood elevating effect, but amitriptyline was discontinued as an IM preparation due to the high volumes required.
Transdermal administration of selegiline is available, and suppositories containing amitriptyline, clomipramine, imipramine, and trazodone have been manufactured by pharmacies, although there is no clear data on their effectiveness. Sertraline tablets and doxepin capsules have also been given rectally.
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This question is part of the following fields:
- Psychopharmacology
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Question 20
Incorrect
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Among the listed antipsychotics, which one has the greatest likelihood of causing extrapyramidal side effects?
Your Answer: Olanzapine
Correct Answer: Haloperidol
Explanation:Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
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This question is part of the following fields:
- Psychopharmacology
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Question 21
Incorrect
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Which of the following neuropathological findings in young individuals with HIV infection is also seen in the brains of drug users who do not have HIV?
Your Answer: Microglial activation
Correct Answer: Axonal damage
Explanation:Axonal damage is present in the brains of both individuals with early HIV infection and those who do not have HIV but use drugs. Pre-symptomatic HIV infection has been linked to various neurological changes, including lymphocytic leptomeningitis, perivascular lymphocytic cuffing, and infiltration of T and B lymphocytes in brain tissue, as well as subtle gliosis and microglial activation. While axonal damage has been observed in early HIV infection, it may also be caused by factors such as inflammation, trauma, and hypoxia.
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This question is part of the following fields:
- Neurosciences
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Question 22
Incorrect
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A teenager hears the sound of his neighbours car exhaust and suddenly believes his girlfriend is cheating on him. Which of the following best describes his experience?
Your Answer: Delusional memory
Correct Answer: Primary delusion
Explanation:This is an instance of a primary delusion known as delusional perception.
Borderline Learning Disability
Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.
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This question is part of the following fields:
- Classification And Assessment
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Question 23
Incorrect
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You encounter a 32-year-old female patient during an outpatient visit to the community mental health team. Based on her history and mental state examination, she appears to have emotionally unstable personality disorder (borderline type) as her primary diagnosis. She engages in daily self-harm through scratching and believes that reducing this behavior is crucial. What is the most effective therapeutic approach for this patient?
Your Answer: 8-12 sessions of individual interpersonal therapy
Correct Answer: A one year programme of dialectical behavioural therapy
Explanation:The recommended treatment for emotionally unstable personality disorder (borderline type) does not involve a single psychological therapy of drug treatment as a first line of defense. However, for women who prioritize reducing self-harm, DBT is recommended. Drug treatments may be considered for comorbid conditions. According to NICE guidelines on Borderline personality disorder (BPD) (CG78), a comprehensive dialectical behaviour therapy programme should be considered for women with borderline personality disorder who prioritize reducing recurrent self-harm. Brief psychological interventions of less than 3 months’ duration should not be used specifically for borderline personality disorder of for the individual symptoms of the disorder. Drug treatment should not be used specifically for borderline personality disorder of for the individual symptoms of behavior associated with the disorder, such as repeated self-harm, marked emotional instability, risk-taking behavior, and transient psychotic symptoms. If sedatives are used for crisis intervention in a patient with EUPD, they should be prescribed for a maximum period of one week.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 24
Incorrect
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Can you explain the mechanism of action of lofexidine?
Your Answer: NMDA antagonist
Correct Answer: Alpha 2 agonist
Explanation:Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 25
Correct
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Which enzyme is affected by presenilin mutations in individuals with early-onset Alzheimer's disease?
Your Answer: Îł Secretase
Explanation:The gamma secretase complex, consisting of four key proteins including presenilin, plays a crucial role in converting Amyloid Precursor Protein to Amyloid β-protein. Amyloid β-peptides are the primary components of the amyloid plaques found in the brains of individuals with Alzheimer’s disease. In the brain, APP is primarily cleaved by β-secretase, while in other tissues it is cleaved by α-secretase, followed by Îł-secretase. The presence of the APOE4 allele is associated with a higher likelihood of developing Alzheimer’s dementia later in life.
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This question is part of the following fields:
- Basic Psychological Processes
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Question 26
Incorrect
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Which of the following is not an example of delusional misidentification?
Your Answer: Subjective doubles
Correct Answer: Cotard's syndrome
Explanation:Cotard’s syndrome is a condition where an individual has a false belief that they are deceased of do not exist.
Delusional Misidentification Syndrome
Delusional misidentification syndrome refers to a group of disorders where individuals believe that the identity of a person, object, of place has been altered of changed. There are several subtypes of this syndrome, including Capgras syndrome, Fregoli syndrome, intermetamorphosis, subjective doubles, reduplicative paramnesia, mirrored self, delusional companions, and clonal pluralisation of the self. Each subtype is characterised by a specific delusion, such as believing that a loved one has been replaced by an exact double of that a place has been duplicated. These delusions can have a significant impact on an individual’s daily life and require appropriate treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 27
Correct
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What is a true statement about lithium?
Your Answer: Lithium citrate is available in liquid form
Explanation:Both lithium carbonate and citrate are used for the treatment and prevention of various mental health conditions, including mania, bipolar disorder, recurrent depression, and aggressive of self-harming behavior. Lithium carbonate is available in tablet form, while lithium citrate is a liquid medication.
Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 28
Correct
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Which of the following is classified as a phenothiazine?
Your Answer: Pipotiazine
Explanation:Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.
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This question is part of the following fields:
- Psychopharmacology
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Question 29
Incorrect
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A 40-year-old individual who has been struggling with opioid addiction is experiencing symptoms of opioid dependence. What electroencephalographic alterations are commonly observed in cases of opioid dependence?
Your Answer: Increased alpha activity
Correct Answer: Decreased alpha activity
Explanation:Opioid dependence is characterized by a decrease in alpha activity on electroencephalography (EEG). Other drugs have distinct EEG changes, such as increased beta activity with benzodiazepines, decreased alpha activity and increased theta activity with alcohol, and increased beta activity with barbiturates. Marijuana use is associated with increased alpha activity in the frontal area of the brain and overall slow alpha activity. During opioid overdose, slow waves may be observed on EEG, while barbiturate withdrawal may result in generalized paroxysmal activity and spike discharges.
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This question is part of the following fields:
- Neurosciences
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Question 30
Incorrect
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What is the BMI of a girl who visited the clinic due to concerns from her GP about her lack of eating, and has a weight of 50 kg and a height of 165cm?
Your Answer:
Correct Answer: 18 of above
Explanation:Assessment and Management of Obesity
Obesity is a condition that can increase the risk of various health problems, including type 2 diabetes, coronary heart disease, some types of cancer, and stroke. The body mass index (BMI) is a commonly used tool to assess obesity, calculated by dividing a person’s weight in kilograms by their height in meters squared. For adults over 20 years old, BMI falls into one of the following categories: underweight, normal of healthy weight, pre-obesity/overweight, obesity class I, obesity class II, and obesity class III.
Waist circumference can also be used in combination with BMI to guide interventions. Diet and exercise are the main interventions up to a BMI of 35, unless there are comorbidities such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidemia, and sleep apnea. Physical activity recommendations suggest that adults should accumulate at least 150 minutes of moderate intensity activity of 75 minutes of vigorous intensity activity per week. Dietary recommendations suggest diets that have a 600 kcal/day deficit.
Pharmacological options such as Orlistat of Liraglutide may be considered for those with a BMI of 30 kg/m2 of more, of 28 if associated risk factors. Surgical options such as bariatric surgery may be considered for those with a BMI of 40 kg/m2 of more, of between 35 kg/m2 and 40 kg/m2 with other significant diseases that could be improved with weight loss.
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This question is part of the following fields:
- Classification And Assessment
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