00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - What is the most probable condition of a patient referred by cardiologists who...

    Correct

    • What is the most probable condition of a patient referred by cardiologists who persists in believing that he has heart disease despite multiple normal tests and reassurances from several cardiologists?

      Your Answer: Hypochondriacal disorder

      Explanation:

      There is often confusion between hypochondriasis and somatisation disorder, which have been renamed illness anxiety disorder and somatic symptom disorder in the DSM-5. Hypochondriasis involves a preoccupation with a specific condition, while somatisation disorder is characterized by a focus on symptoms rather than a particular illness.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      893.5
      Seconds
  • Question 2 - A man in his 50s with breast cancer has developed moderate depression. He...

    Incorrect

    • A man in his 50s with breast cancer has developed moderate depression. He is on tamoxifen treatment. Which antidepressant should be avoided?

      Your Answer: Amitriptyline

      Correct Answer: Fluoxetine

      Explanation:

      The use of tamoxifen should not be combined with paroxetine and fluoxetine as it may decrease its effectiveness.

      Tamoxifen and Antidepressant Interactions

      Tamoxifen is a medication used to treat breast cancer by reducing relapse rates and increasing overall survival. It works by antagonizing estrogen in the breast, with its anti-estrogen affinity depending on its primary metabolite, endoxifen. However, tamoxifen is metabolized to endoxifen through the liver enzyme CYP2D6, and any drug that inhibits this enzyme can reduce the conversion of tamoxifen to endoxifen.

      Women taking tamoxifen for breast cancer treatment of prevention may also take antidepressants for psychiatric disorders of hot flushes. Some antidepressants have been found to inhibit the metabolism of tamoxifen to its more active metabolites by the CYP2D6 enzyme, thereby decreasing its anticancer effect. Strong CYP2D6 inhibitors include paroxetine, fluoxetine, bupropion, and duloxetine, while moderate inhibitors include sertraline, escitalopram, and doxepin, and venlafaxine is a weak inhibitor.

      Therefore, it is important for healthcare providers to consider potential drug interactions when prescribing antidepressants to women taking tamoxifen for breast cancer treatment of prevention.

    • This question is part of the following fields:

      • General Adult Psychiatry
      170.1
      Seconds
  • Question 3 - What is typically avoided during alcohol withdrawal because of the increased likelihood of...

    Incorrect

    • What is typically avoided during alcohol withdrawal because of the increased likelihood of respiratory depression?

      Your Answer: Diazepam

      Correct Answer: Clomethiazole

      Explanation:

      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
      9.5
      Seconds
  • Question 4 - Which of the following factors does not increase the risk of suicide? ...

    Correct

    • Which of the following factors does not increase the risk of suicide?

      Your Answer: Being female

      Explanation:

      Suicide Risk Factors

      Risk factors for completed suicide are numerous and include various demographic, social, and psychological factors. Men are at a higher risk than women, with the risk peaking at age 45 for men and age 55 for women. Being unmarried and unemployed are also risk factors. Concurrent mental disorders are present in about 90% of people who commit suicide, with depression being the most commonly associated disorder. Previous suicide attempts and substance misuse are also significant risk factors. Co-existing serious medical conditions and personality factors such as rigid thinking, pessimism, and perfectionism also increase the risk of suicide. It is important to identify and address these risk factors in order to prevent suicide.

    • This question is part of the following fields:

      • General Adult Psychiatry
      425.4
      Seconds
  • Question 5 - What is the recommended duration of bed rest per day for a patient...

    Correct

    • What is the recommended duration of bed rest per day for a patient with anorexia nervosa and a BMI below 13?

      Your Answer: 24 hours

      Explanation:

      According to the MARSIPAN guidelines, individuals with anorexia and a BMI below 13 should be placed on 24-hour bed rest and given careful consideration for prophylaxis against deep vein thrombosis. This recommendation is outlined in the October 2010 College Report CR 162, which was jointly produced by the Royal College of Psychiatrists and the Royal College of Physicians in London.

      Anorexia is a serious mental health condition that can have severe physical complications. These complications can affect various systems in the body, including the cardiac, skeletal, hematologic, reproductive, metabolic, gastrointestinal, CNS, and dermatological systems. Some of the recognized physical complications of anorexia nervosa include bradycardia, hypotension, osteoporosis, anemia, amenorrhea, hypothyroidism, delayed gastric emptying, cerebral atrophy, and lanugo.

      The Royal College of Psychiatrists has issued advice on managing sick patients with anorexia nervosa, recommending hospital admission for those with high-risk items. These items include a BMI of less than 13, a pulse rate of less than 40 bpm, a SUSS test score of less than 2, a sodium level of less than 130 mmol/L, a potassium level of less than 3 mmol/L, a serum glucose level of less than 3 mmol/L, and a QTc interval of more than 450 ms. The SUSS test involves assessing the patient’s ability to sit up and squat without using their hands. A rating of 0 indicates complete inability to rise, while a rating of 3 indicates the ability to rise without difficulty. Proper management and treatment of anorexia nervosa are crucial to prevent of manage these physical complications.

    • This question is part of the following fields:

      • General Adult Psychiatry
      4.4
      Seconds
  • Question 6 - What was the degree of increase in the incidence of schizophrenia among Afro-Caribbeans...

    Correct

    • What was the degree of increase in the incidence of schizophrenia among Afro-Caribbeans in the AESOP study?

      Your Answer: 9

      Explanation:

      The AESOP study is a first-presentation study of schizophrenia and other psychotic disorders that identified all people presenting to services with psychotic symptoms in well-defined catchment areas in South London, Nottingham and Bristol. The study aimed to elucidate the overall rates of psychotic disorder in the 3 centres, confirm and extend previous findings of raised rates of psychosis in certain migrant groups in the UK, and explore in detail the biological and social risk factors in these populations and their possible interactions. The study found that the incidence of all psychoses was higher in African-Caribbean and Black African populations, particularly in schizophrenia and manic psychosis. These groups were also more likely to be compulsorily admitted to hospital and come to the attention of mental health services via police of other criminal justice agencies, and less likely to come via the GP.

    • This question is part of the following fields:

      • General Adult Psychiatry
      6.5
      Seconds
  • Question 7 - What is the conventional cutoff for a p-value of 0.05 and what does...

    Incorrect

    • What is the conventional cutoff for a p-value of 0.05 and what does it mean in terms of the likelihood of detecting a difference by chance?

      Your Answer: 1 in 140 times

      Correct Answer: 1 in 14 times

      Explanation:

      The probability of detecting a difference by chance is 1 in 20 times when the p-value is 0.05, which is the conventional cutoff. In this case, the answer is 1 in 14 times, which is equivalent to a p-value of 0.07.

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      12.7
      Seconds
  • Question 8 - What is the classification of dysthymic disorder according to the ICD-11? ...

    Incorrect

    • What is the classification of dysthymic disorder according to the ICD-11?

      Your Answer: A duration of at least 1 year of symptoms is required for a diagnosis in adults

      Correct Answer: Brief periods of normal mood may occur, but these cannot exceed two months to be consistent with a diagnosis

      Explanation:

      Dysthymia is a type of mood disorder characterized by persistent low-grade depressive symptoms that last for at least two years. Although there may be brief periods without symptoms, there has never been a prolonged period of two months of more without symptoms since the onset of the disorder. While treatment for dysthymia can be effective, the results may be modest and short-lived, and the course of the disorder can be challenging. Dysthymia often begins in childhood of adolescence and is associated with a higher likelihood of substance misuse and co-occurring personality disorders, particularly when onset occurs before the age of 21. Co-occurring disorders are common in individuals with dysthymia.

      Depression is diagnosed using different criteria in the ICD-11 and DSM-5. The ICD-11 recognizes single depressive episodes, recurrent depressive disorder, dysthymic disorder, and mixed depressive and anxiety disorder. The DSM-5 recognizes disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder, and premenstrual dysphoric disorder.

      For a diagnosis of a single depressive episode, the ICD-11 requires the presence of at least five characteristic symptoms occurring most of the day, nearly every day during a period lasting at least 2 weeks. The DSM-5 requires the presence of at least five symptoms during the same 2-week period, with at least one of the symptoms being either depressed mood of loss of interest of pleasure.

      Recurrent depressive disorder is characterized by a history of at least two depressive episodes separated by at least several months without significant mood disturbance, according to the ICD-11. The DSM-5 requires at least two episodes with an interval of at least 2 consecutive months between separate episodes in which criteria are not met for a major depressive episode.

      Dysthymic disorder is diagnosed when a person experiences persistent depressed mood lasting 2 years of more, according to the ICD-11. The DSM-5 requires depressed mood for most of the day, for more days than not, for at least 2 years, along with the presence of two or more additional symptoms.

      Mixed depressive and anxiety disorder is recognized as a separate code in the ICD-11, while the DSM-5 uses the ‘with anxious distress’ qualifier. The ICD-11 requires the presence of both depressive and anxiety symptoms for most of the time during a period of 2 weeks of more, while the DSM-5 requires the presence of both depressive and anxious symptoms during the same 2-week period.

      Overall, the criteria for diagnosing depression vary between the ICD-11 and DSM-5, but both require the presence of characteristic symptoms that cause significant distress of impairment in functioning.

    • This question is part of the following fields:

      • General Adult Psychiatry
      10
      Seconds
  • Question 9 - How would you describe the typical of ongoing prevalence of a disease within...

    Correct

    • How would you describe the typical of ongoing prevalence of a disease within a specific population?

      Your Answer: Endemic

      Explanation:

      Epidemiology Key Terms

      – Epidemic (Outbreak): A rise in disease cases above the anticipated level in a specific population during a particular time frame.
      – Endemic: The regular of anticipated level of disease in a particular population.
      – Pandemic: Epidemics that affect a significant number of individuals across multiple countries, regions, of continents.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      9.2
      Seconds
  • Question 10 - In the UK, what is the schedule classification for non-benzodiazepine hypnotics such as...

    Correct

    • In the UK, what is the schedule classification for non-benzodiazepine hypnotics such as zopiclone?

      Your Answer: 4

      Explanation:

      Drug Misuse (Law and Scheduling)

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      3.1
      Seconds
  • Question 11 - What is the approximate occurrence rate of schizophrenia among individuals under the age...

    Incorrect

    • What is the approximate occurrence rate of schizophrenia among individuals under the age of 15?

      Your Answer: 1 in 10000

      Correct Answer: 1 in 2000

      Explanation:

      Schizophrenia in children is rare compared to adults, with a prevalence estimate of 0.05% for those under 15 years old. There are two classifications based on age of onset: early onset schizophrenia (EOS) when symptoms appear between 13-18 years old, and very early onset schizophrenia (VEOS) when symptoms appear at of before 13 years old. EOS and VEOS have atypical features compared to adult-onset schizophrenia, including insidious onset, more severe neurodevelopmental abnormalities, terrifying visual hallucinations, constant inappropriate of blunted effects, higher rates of familial psychopathology, minor response to treatment, and poorer outcomes. Preliminary data suggests that VEOS and EOS may be due to greater familial vulnerability from genetic, psychosocial, and environmental factors. Poor outcomes are most reliably linked to a positive history of premorbid difficulties, greater symptom severity (especially negative symptoms) at baseline, and longer duration of untreated psychosis. Age at psychosis onset and sex are not consistent predictors of outcome.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      5.2
      Seconds
  • Question 12 - What is a true statement about transient global amnesia? ...

    Incorrect

    • What is a true statement about transient global amnesia?

      Your Answer: Anterograde amnesia is not usually present

      Correct Answer: Repetitive questioning is a common feature

      Explanation:

      Transient Global Amnesia: Definition, Diagnostic Criteria, and Possible Causes

      Transient global amnesia (TGA) is a clinical syndrome characterized by sudden and severe amnesia, often accompanied by repetitive questioning, that lasts for several hours. The term was first coined in 1964 by Fisher and Adams. To diagnose TGA, the following criteria have been established: (1) the attack must be witnessed, (2) there must be clear anterograde amnesia, (3) clouding of consciousness and loss of personal identity must be absent, (4) there should be no accompanying focal neurological symptoms, (5) epileptic features must be absent, (6) attacks must resolve within 24 hours, and (7) patients with recent head injury of known active epilepsy are excluded.

      Epidemiological studies have shown that thromboembolic cerebrovascular disease does not play a role in the causation of TGA. However, the incidence of migraine in patients with TGA is higher than in the general population. A small minority of cases with unusually brief and recurrent attacks eventually manifest temporal lobe epilepsy. EEG recording is typically normal after an attack, even when performed during the attack.

      Possible causes of TGA include venous congestion with Valsalva-like activities before symptom onset, arterial thromboembolic ischemia, and vasoconstriction due to hyperventilation. Precipitants of TGA often include exertion, cold, pain, emotional stress, and sexual intercourse.

    • This question is part of the following fields:

      • Old Age Psychiatry
      394.3
      Seconds
  • Question 13 - What is a characteristic of enuresis that is not related to organic causes?...

    Correct

    • What is a characteristic of enuresis that is not related to organic causes?

      Your Answer: The most important predictor of the condition is a positive family history

      Explanation:

      The diagnosis of non-organic enuresis is typically not made until a child reaches the age of 5, rather than 3.

      Elimination Disorders

      Elimination disorders refer to conditions that affect a child’s ability to control their bladder of bowel movements. Enuresis, of lack of control over the bladder, typically occurs between the ages of 1-3, while control over the bowel usually occurs before that of the bladder for most toddlers. Toilet training can be influenced by various factors, including intellectual capacity, cultural determinants, and psychological interactions between the child and their parents.

      Enuresis is characterized by involuntary voiding of urine, by day and/of by night, which is abnormal in relation to the individual’s age and is not a result of any physical abnormality. It is not normally diagnosed before age 5 and may be primary (the child never having achieved continence) of secondary. Treatment options include reassurance, enuresis alarms, and medication.

      Encopresis refers to repeated stool evacuation in inappropriate places in children over the age of four. The behavior can be either involuntary of intentional and may be due to unsuccessful toilet training (primary encopresis) of occur after a period of normal bowel control (secondary encopresis). Treatment generally involves bowel clearance, prevention of impaction, and behavioral therapy.

      Before a diagnosis of encopresis is made, organic causes must be excluded. Hirschsprung’s disease is a condition that results from an absence of parasympathetic ganglion cells in the rectum, colon, and sometimes the small intestine. It leads to a colonic obstruction and is diagnosed in at least half of all cases in the first year of life. It is twice as common in boys than in girls.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      11.6
      Seconds
  • Question 14 - What is the term used to describe the rate at which new cases...

    Correct

    • What is the term used to describe the rate at which new cases of a disease are appearing, calculated by dividing the number of new cases by the total time that disease-free individuals are observed during a study period?

      Your Answer: Incidence rate

      Explanation:

      Measures of Disease Frequency: Incidence and Prevalence

      Incidence and prevalence are two important measures of disease frequency. Incidence measures the speed at which new cases of a disease are emerging, while prevalence measures the burden of disease within a population. Cumulative incidence and incidence rate are two types of incidence measures, while point prevalence and period prevalence are two types of prevalence measures.

      Cumulative incidence is the average risk of getting a disease over a certain period of time, while incidence rate is a measure of the speed at which new cases are emerging. Prevalence is a proportion and is a measure of the burden of disease within a population. Point prevalence measures the number of cases in a defined population at a specific point in time, while period prevalence measures the number of identified cases during a specified period of time.

      It is important to note that prevalence is equal to incidence multiplied by the duration of the condition. In chronic diseases, the prevalence is much greater than the incidence. The incidence rate is stated in units of person-time, while cumulative incidence is always a proportion. When describing cumulative incidence, it is necessary to give the follow-up period over which the risk is estimated. In acute diseases, the prevalence and incidence may be similar, while for conditions such as the common cold, the incidence may be greater than the prevalence.

      Incidence is a useful measure to study disease etiology and risk factors, while prevalence is useful for health resource planning. Understanding these measures of disease frequency is important for public health professionals and researchers in order to effectively monitor and address the burden of disease within populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      53949.4
      Seconds
  • Question 15 - What is the primary benefit of conducting non-inferiority trials in the evaluation of...

    Incorrect

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

      Your Answer: Useful for conditions where there is no proven drug treatment

      Correct Answer: Small sample size is required

      Explanation:

      Study Designs for New Drugs: Options and Considerations

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      746
      Seconds
  • Question 16 - Which of the following would make the use of the unpaired t-test inappropriate...

    Correct

    • Which of the following would make the use of the unpaired t-test inappropriate for comparing the mean ages of two groups of participants?

      Your Answer: Non-normal distribution of data

      Explanation:

      The t test is limited to parametric data that follows a normal distribution. However, inadequate statistical power due to a small sample size does not necessarily invalidate the t test results. While it is likely that a small sample size may not reveal any significant differences, it is still possible that large differences may be observed regardless of prior power calculations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      325
      Seconds
  • Question 17 - In which brain region is a lesion most commonly observed on an MRI...

    Correct

    • In which brain region is a lesion most commonly observed on an MRI of a patient with Wernicke's encephalopathy?

      Your Answer: Mammillary bodies

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      29.3
      Seconds
  • Question 18 - Which of the following is an example of secondary evidence? ...

    Incorrect

    • Which of the following is an example of secondary evidence?

      Your Answer: A case report on sudden-onset catatonia following clozapine withdrawal

      Correct Answer: A Cochrane review on the evidence of exercise for reducing the duration of depression relapses

      Explanation:

      Scientific literature can be classified into two main types: primary and secondary sources. Primary sources are original research studies that present data and analysis without any external evaluation of interpretation. Examples of primary sources include randomized controlled trials, cohort studies, case-control studies, case-series, and conference papers. Secondary sources, on the other hand, provide an interpretation and analysis of primary sources. These sources are typically removed by one of more steps from the original event. Examples of secondary sources include evidence-based guidelines and textbooks, meta-analyses, and systematic reviews.

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      10.7
      Seconds
  • Question 19 - You are seeing a 70-year-old woman and her husband in a memory clinic....

    Incorrect

    • You are seeing a 70-year-old woman and her husband in a memory clinic. She reports subjective memory difficulties, but her daily functioning is not affected. Her MMSE score is 28/30, with a loss of two points on recall. Her husband asks you about the likelihood of her developing dementia within the next year. What advice do you give them?

      Your Answer: 20%

      Correct Answer: 10%

      Explanation:

      Mild cognitive impairment (MCI) is a diagnosis that encompasses a diverse group of individuals, some of whom may be in the early stages of dementia. To diagnose MCI, there must be a reported concern about changes in cognitive functioning, impairment in one of more cognitive domains, preservation of functional abilities, and a score above the cut-off for dementia on cognitive tests. While some patients with MCI may return to normal cognition, approximately 10% of patients progress to dementia per year, with 85% of cases being Alzheimer’s and 15% being vascular dementia. The exact number of patients with MCI who will develop dementia is difficult to determine due to challenges in long-term follow-up.

    • This question is part of the following fields:

      • Old Age Psychiatry
      24.3
      Seconds
  • Question 20 - What is a true statement about bodily distress disorder? ...

    Correct

    • What is a true statement about bodily distress disorder?

      Your Answer: A diagnosis can be made even when a diagnosis is medically explained

      Explanation:

      Unsightly skin changes are not a typical symptom of bodily distress disorder as the condition is usually characterized by subjective symptoms that are difficult to measure objectively, such as pain, fatigue, and gastrointestinal of respiratory issues.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      2193.3
      Seconds
  • Question 21 - What is the recommended duration of antidepressant treatment for children diagnosed with OCD...

    Correct

    • What is the recommended duration of antidepressant treatment for children diagnosed with OCD according to NICE guidelines?

      Your Answer: 6 months following remission

      Explanation:

      For children and young individuals diagnosed with OCD of BDD, medication should be gradually discontinued if they have achieved remission, meaning their symptoms are no longer clinically significant and they are functioning normally, and this has been maintained for a minimum of 6 months. For adults, the recommended duration of remission before medication withdrawal is 12 months.

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      4.1
      Seconds
  • Question 22 - Which of the following would be the most appropriate first-line treatment for a...

    Incorrect

    • 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: Intensive psychological therapy + fluoxetine

      Correct 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
      9.5
      Seconds
  • Question 23 - What percentage of values fall within a range of 3 standard deviations above...

    Correct

    • What percentage of values fall within a range of 3 standard deviations above and below the mean?

      Your Answer: 99.70%

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      3
      Seconds
  • Question 24 - Salvador Minuchin is associated with which model of family therapy? ...

    Incorrect

    • Salvador Minuchin is associated with which model of family therapy?

      Your Answer: Systemic

      Correct Answer: Structural

      Explanation:

      Family Therapy Models

      Family therapy emerged in the 1950s, shifting the focus from individual problems to the context of the environment. There are five main models of family therapy: structural, strategic, systemic, transgenerational, and solution-focused.

      Structural therapy, developed by Salvador Minuchin, assumes that the family’s structure is wrong and aims to establish clear boundaries and no coalitions. Dysfunctional families are marked by impaired boundaries, inappropriate alignments, and power imbalances.

      Strategic therapy, associated with Jay Haley and Cloe Madanes, claims that difficulties in families arise due to distorted hierarchies. Dysfunctional families communicate in problematic repetitive patterns that kept them dysfunctional. Key terms include task setting and goal setting.

      Systemic therapy, associated with Mara Selvini-Palazzoli, sees the family as a self-regulating system that controls itself according to rules formed over time. The focus is on exploring differences between family members’ behaviors, emotional responses, and beliefs at different points in time. Key terms include hypothesizing, neutrality, positive connotation, paradox and counterparadox, circular and interventive questioning, and the use of reflecting teams.

      Transgenerational family therapy aims to understand how families, across generations, develop patterns of behaving and responding to stress in ways that prevent health development and lead to problems. Seven interlocking concepts make up the theory.

      Solution-focused therapy emphasizes solutions over problems and collaborates with the family through in-depth questioning to focus on the solutions already being used by the clients. The therapist is non-interventionist, and the focus is on the present and the future. Blame, shame, and conflict are seen as issues that impede people from realizing these solutions.

    • This question is part of the following fields:

      • Psychotherapy
      4.2
      Seconds
  • Question 25 - Which term is not related to Cognitive Analytic Therapy? ...

    Incorrect

    • Which term is not related to Cognitive Analytic Therapy?

      Your Answer: Reciprocal role procedures

      Correct Answer: Dichotomous thinking

      Explanation:

      Dichotomous thinking is a type of negative thought pattern that is associated with cognitive behavioral therapy.

      Understanding Cognitive Analytic Therapy

      Cognitive Analytic Therapy (CAT) is a form of therapy that combines psychodynamic and cognitive approaches. It is a brief therapy that typically lasts between 16-24 sessions. Developed by Anthony Ryle, CAT aims to identify the useful parts of psychotherapy and make it more efficient. It also aims to create a therapy that can be easily researched.

      CAT focuses on identifying key issues early on and conceptualizing them as repeated unsuccessful strategies. These strategies are categorized into traps, dilemmas, and snags. Traps are flawed thinking patterns that result in a vicious cycle of negative assumptions and actions. Dilemmas occur when a person believes their choices are restricted to opposite actions, neither of which is satisfactory. Snags are thinking patterns that restrict actions due to a perception of potential harm of failure.

      CAT follows a procedural sequence model, where the problem is appraised, options are discussed, a plan is created and put into place, and consequences are evaluated. The therapist often summarizes the problem and plan in a letter to the client.

      CAT also identifies reciprocal role procedures (RRPs), which are patterns observed in the way we related to others. These patterns are visually presented using a sequential diagrammatic reformulation. For example, a client who rebelled against a stern, dominating father may be dismissive of therapy because they see the therapist as a demanding authority figure.

      Overall, CAT is a useful therapy that combines psychodynamic and cognitive approaches to identify and address maladaptive patterns. Its procedural sequence model and use of RRPs make it an efficient and effective therapy.

    • This question is part of the following fields:

      • Psychotherapy
      6.5
      Seconds
  • Question 26 - A 45-year-old individual with a long-standing history of bipolar disorder has been an...

    Incorrect

    • A 45-year-old individual with a long-standing history of bipolar disorder has been an inpatient on an acute admission ward for four months detained under section 2 of the Mental Health Act. Their manic episodes have subsided to their chronic baseline level. Periods of escorted leave have been associated with substance misuse and impulsive behavior including shoplifting and suspected vandalism. What would be the most suitable course of action for their treatment plan?

      Your Answer: Transfer to addictions inpatient unit

      Correct Answer: Transfer to rehabilitation unit

      Explanation:

      Given the patient’s improved psychotic symptoms, an extended stay in an acute ward would not be beneficial. However, due to ongoing substance misuse and challenging behaviors, discharge from the hospital is not yet possible. While an addictions admission of transfer to a forensic ward is not necessary, a rehabilitation psychiatry ward would be the most appropriate next step. This would provide the patient with the necessary support to address their substance misuse and challenging behaviors, while also promoting their skills and independence for a successful return to community living.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      16
      Seconds
  • Question 27 - During which decade was electroconvulsive therapy (ECT) first developed? ...

    Incorrect

    • During which decade was electroconvulsive therapy (ECT) first developed?

      Your Answer: 1970s

      Correct Answer: 1930s

      Explanation:

      History of ECT

      ECT, of electroconvulsive therapy, was first developed in Italy in 1938. Prior to this, convulsive therapy had been used in various forms throughout the 1930s. However, it was not until Ugo Cerletti’s invention of ECT that a more controlled and effective method of inducing convulsions was developed. Cerletti’s first successful use of ECT involved producing a convulsion in a man in 1938. Since then, ECT has been used as a treatment for various mental health conditions, although its use has been controversial and subject to debate.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      1.8
      Seconds
  • Question 28 - What is the prognosis for individuals diagnosed with anorexia nervosa? ...

    Incorrect

    • What is the prognosis for individuals diagnosed with anorexia nervosa?

      Your Answer: Approximately 20% will be dead within 30 years

      Correct Answer: About half will have recovered within 30 years

      Explanation:

      Anorexia Prognosis

      The long-term outcomes of anorexia are difficult to determine due to high drop-out rates from follow-up. However, one study found that over a 29 year period, half of patients recovered completely, a third recovered partially, 20% had a chronic eating disorder, and 5% died. Factors associated with a poor prognosis include a long duration of hospital care, psychiatric comorbidity, being adopted, growing up in a one-parent household, and having a young mother. Other factors that have been found to contribute to a poor prognosis include lower minimum weight, poor family relationships, failed treatment, late age of onset, and social problems.

    • This question is part of the following fields:

      • General Adult Psychiatry
      10.4
      Seconds
  • Question 29 - Which of the following is not considered a characteristic of anorexia nervosa? ...

    Correct

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

      Your 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
      9.9
      Seconds
  • Question 30 - What is known to result in incorrect positive results during benzodiazepine misuse testing?...

    Correct

    • What is known to result in incorrect positive results during benzodiazepine misuse testing?

      Your Answer: Efavirenz

      Explanation:

      Drug Testing

      There are two main approaches to testing for illicit substances: immunoassays and lab testing. Immunoassays are a cheap and quick screening method, but not very specific. Lab testing is more accurate but time-consuming and expensive. Drug testing can be done through urine, saliva, blood, hair, and sweat, although hair and sweat are rarely used in mental health settings.

      False positives can occur when testing for illicit substances, so it’s important to check that patients are not taking other medications that could produce a false positive result. For example, common medications that can lead to false positive results include dimethylamylamine, ofloxacin, bupropion, phenothiazines, trazodone, and methylphenidate for amphetamines/methamphetamines; sertraline and efavirenz for benzodiazepines and cannabis; topical anesthetics for cocaine; codeine, dihydrocodeine, and methadone for opioids; lamotrigine, tramadol, and venlafaxine for PCP; and amitriptyline, bupropion, buspirone, chlorpromazine, fluoxetine, sertraline, and verapamil for LSD.

      In summary, drug testing is an important tool in mental health settings, but it’s crucial to consider potential false positives and medication interactions when interpreting results.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      22.5
      Seconds
  • Question 31 - What is a factor that increases the likelihood of someone completing suicide? ...

    Correct

    • What is a factor that increases the likelihood of someone completing suicide?

      Your Answer: Poor physical health

      Explanation:

      Suicide Risk Factors

      Risk factors for completed suicide are numerous and include various demographic, social, and psychological factors. Men are at a higher risk than women, with the risk peaking at age 45 for men and age 55 for women. Being unmarried and unemployed are also risk factors. Concurrent mental disorders are present in about 90% of people who commit suicide, with depression being the most commonly associated disorder. Previous suicide attempts and substance misuse are also significant risk factors. Co-existing serious medical conditions and personality factors such as rigid thinking, pessimism, and perfectionism also increase the risk of suicide. It is important to identify and address these risk factors in order to prevent suicide.

    • This question is part of the following fields:

      • General Adult Psychiatry
      29.3
      Seconds
  • Question 32 - Which of the following scenarios demonstrates information bias? ...

    Incorrect

    • Which of the following scenarios demonstrates information bias?

      Your Answer: Neyman bias

      Correct Answer: Lead Time bias

      Explanation:

      Types of Bias in Statistics

      Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.

      There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      5.2
      Seconds
  • Question 33 - What is the purpose of using bracketing as a method in qualitative research?...

    Incorrect

    • What is the purpose of using bracketing as a method in qualitative research?

      Your Answer: Structuring interview questions

      Correct Answer: Assessing validity

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      9.3
      Seconds
  • Question 34 - According to Gottesman (1982), what is the risk of a parent developing schizophrenia...

    Correct

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

      Your Answer: 6%

      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
      4
      Seconds
  • Question 35 - A young woman with a history of violence is characterized by her probation...

    Correct

    • A young woman with a history of violence is characterized by her probation officer as impulsive and irresponsible. She has been detained for domestic violence against her partner and has several convictions for theft-related crimes. What is the most probable diagnosis?

      Your Answer: Antisocial personality disorder

      Explanation:

      Personality Disorder (Antisocial / Dissocial)

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

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

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

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

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      9.3
      Seconds
  • Question 36 - Which statement is false regarding an individual's ability to plead fitness? ...

    Incorrect

    • Which statement is false regarding an individual's ability to plead fitness?

      Your Answer: A person's fitness to plead is decided by a judge

      Correct Answer: Someone is unfit to plead if they cannot recall the alleged crime

      Explanation:

      Fitness to Plead: Criteria and Process

      Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.

    • This question is part of the following fields:

      • Forensic Psychiatry
      6.7
      Seconds
  • Question 37 - What is a true statement about the content analysis model used in dream...

    Incorrect

    • What is a true statement about the content analysis model used in dream interpretation?

      Your Answer: It divided into three steps consisting of exploration, insight, and action

      Correct Answer: It is used as a systematic way of categorizing dreams for research purposes

      Explanation:

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

    • This question is part of the following fields:

      • Psychotherapy
      12.4
      Seconds
  • Question 38 - What scenario would be eligible for a sane automatism defense? ...

    Correct

    • What scenario would be eligible for a sane automatism defense?

      Your Answer: Concussion

      Explanation:

      Concussion is categorized as a sane automatism since it is caused by an external factor.

      Criminal Responsibility and Age Limits

      To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

      Not Guilty by Reason of Insanity and Other Defenses

      A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.

    • This question is part of the following fields:

      • Forensic Psychiatry
      4.8
      Seconds
  • Question 39 - How do the odds of excessive drinking differ between patients with liver cirrhosis...

    Incorrect

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

      Your Answer: 4

      Correct Answer: 16

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      3.7
      Seconds
  • Question 40 - A 62-year-old woman is referred to your clinic. Her daughter has noticed a...

    Incorrect

    • A 62-year-old woman is referred to your clinic. Her daughter has noticed a slight change in her mother's behavior and increased forgetfulness over the past six months. This started after she had a transient ischemic attack and has since worsened. She has type 1 diabetes mellitus and is on insulin. You perform cognitive testing and refer the woman for an EEG.
      What is the most probable EEG result?

      Your Answer: Increased delta waves

      Correct Answer: Asymmetrical pattern of waves

      Explanation:

      The individual is exhibiting symptoms consistent with vascular dementia, which is supported by minor changes in behavior, a medical history of transient ischaemic attacks and diabetes mellitus. An EEG scan reveals an uneven pattern caused by infarctions in the brain due to small vessel disease.

    • This question is part of the following fields:

      • Old Age Psychiatry
      34.4
      Seconds
  • Question 41 - How would you define the term 'containment'? ...

    Correct

    • How would you define the term 'containment'?

      Your Answer: Therapists ability to modify and return the patient's difficult material in a way that they can tolerate

      Explanation:

      The Significance of Containment in Therapeutic Relationships

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
      18.2
      Seconds
  • Question 42 - What is the term used to describe the decrease in anxiety that occurs...

    Correct

    • What is the term used to describe the decrease in anxiety that occurs during flooding therapy?

      Your Answer: Habituation

      Explanation:

      Flooding as a Treatment for Phobias

      Flooding is a treatment method for phobias that involves directly confronting the fear and remaining in the situation until the anxiety subsides. This process is called habituation and is different from systematic desensitization. However, flooding can be challenging for patients as it produces high levels of anxiety, which can cause them to leave the situation before the fear response is extinguished. As a result, desensitization is generally preferred over flooding as a treatment method for phobias.

    • This question is part of the following fields:

      • Psychotherapy
      7.7
      Seconds
  • Question 43 - What level of kappa score indicates complete agreement between two observers? ...

    Correct

    • What level of kappa score indicates complete agreement between two observers?

      Your Answer: 1

      Explanation:

      Understanding the Kappa Statistic for Measuring Interobserver Variation

      The kappa statistic, also known as Cohen’s kappa coefficient, is a useful tool for quantifying the level of agreement between independent observers. This measure can be applied in any situation where multiple observers are evaluating the same thing, such as in medical diagnoses of research studies. The kappa coefficient ranges from 0 to 1, with 0 indicating complete disagreement and 1 indicating perfect agreement. By using the kappa statistic, researchers and practitioners can gain insight into the level of interobserver variation present in their data, which can help to improve the accuracy and reliability of their findings. Overall, the kappa statistic is a valuable tool for understanding and measuring interobserver variation in a variety of contexts.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      12.9
      Seconds
  • Question 44 - What is a known factor that can lead to inaccurate positive results for...

    Incorrect

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

      Your Answer: Venlafaxine

      Correct Answer: Atomoxetine

      Explanation:

      Drug Screening

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      7.2
      Seconds
  • Question 45 - What is the most frequent genetic factor that leads to learning disabilities? ...

    Correct

    • What is the most frequent genetic factor that leads to learning disabilities?

      Your Answer: Fragile X syndrome

      Explanation:

      Aetiology of Intellectual Disability

      Intellectual disability (ID), previously known as learning disability, affects between 1% and 3% of the global population. The severity of ID varies, with mild cases being the most common, affecting around 85% of those with the condition. Moderate, severe, and profound cases affect 10%, 4%, and 2% of the population, respectively. The cause of ID can be attributed to environmental and/of genetic factors, although up to 60% of cases have no identifiable cause. Genetic factors are responsible for 25-50% of cases, with the likelihood increasing with the severity of the condition. Down Syndrome is the most common genetic cause of ID, while Fragile X syndrome is the most common X-linked cause and the second most common genetic cause of learning difficulty. Foetal alcohol syndrome is the most common acquired form of ID.

    • This question is part of the following fields:

      • Learning Disability
      15.8
      Seconds
  • Question 46 - Which cluster B personality disorder is most prevalent among prisoners aged 50 and...

    Correct

    • Which cluster B personality disorder is most prevalent among prisoners aged 50 and above in prisons located in England and Wales?

      Your Answer: Antisocial

      Explanation:

      Prisoner Mental Health: Focus on Older Adults

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      9.5
      Seconds
  • Question 47 - What is the meaning of the C in the PICO model utilized in...

    Correct

    • What is the meaning of the C in the PICO model utilized in evidence-based medicine?

      Your Answer: Comparison

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      2.6
      Seconds
  • Question 48 - Out of the 5 trials included in a meta-analysis comparing the effects of...

    Correct

    • Out of the 5 trials included in a meta-analysis comparing the effects of depot olanzapine and depot risperidone on psychotic symptoms (measured by PANSS), which trial showed a statistically significant difference between the two treatments at a significance level of 5%?

      Your Answer: Trial 2 shows a reduction of 2 on the PANSS (p=0.001)

      Explanation:

      The results of Trial 4 indicate a decrease of 10 points on the PANSS scale, with a p-value of 0.9.

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      8750
      Seconds
  • Question 49 - You are asked to write a court report for a man convicted of...

    Correct

    • You are asked to write a court report for a man convicted of a sexual assault, which of the following is most likely to increase his risk of subsequent sexual offending?:

      Your Answer: Phallometric evidence of sexual interest in children

      Explanation:

      Hanson & Bussiere (1998) conducted a thorough analysis on this topic and found that the most significant indicators of sexual offense recidivism are factors associated with sexual deviance, including deviant sexual preferences, previous sexual offenses, early onset of sexual offending, and the variety of sexual crimes committed. The most powerful predictor was determined to be sexual attraction to children, as measured by phallometric assessment.

      Methods of Risk Assessment

      Methods of risk assessment are important in determining the potential harm that an individual may pose to others. There are three main methods for assessing risk to others: unstructured clinical approach, actuarial risk assessment, and structured professional judgment. The unstructured clinical approach is based solely on professional experience and does not involve any specific framework. Actuarial risk assessment uses tools that are based on statistical models of weighted factors supported by research as being predictive for future risk. Structured professional judgment combines professional judgment with a consideration of static and dynamic risk factors. Following this, the risk is formulated, and a plan is devised. There are various tools available for each method, such as the Historical-Clinical-Risk Management-20 (HCR-20) for violence, the Risk of Sexual Violence Protocol (RSVP) for sexual risk, and the Hare Psychopathy Checklist (PCL-R) for violence. It is important to use a multidisciplinary approach and consider all relevant risk factors in the formulation.

    • This question is part of the following fields:

      • Forensic Psychiatry
      6.1
      Seconds
  • Question 50 - In psychodynamic theory, what are the two defences that are thought to be...

    Incorrect

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

      Your Answer: Isolation and reaction formation

      Correct Answer: Repression and displacement

      Explanation:

      Defense Mechanisms in Specific Conditions

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

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

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

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
      10.5
      Seconds
  • Question 51 - What factor is most likely to trigger a seizure in a patient with...

    Incorrect

    • What factor is most likely to trigger a seizure in a patient with epilepsy?

      Your Answer: Lithium

      Correct Answer: Amitriptyline

      Explanation:

      Out of the given options, Amitriptyline (TCA) is classified as high risk while the others are categorized as either moderate of low risk.

      Psychotropics and Seizure Threshold in People with Epilepsy

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      3.3
      Seconds
  • Question 52 - Which statement accurately describes Wernicke's area? ...

    Correct

    • Which statement accurately describes Wernicke's area?

      Your Answer: Horizontal rather than vertical nystagmus is more common

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      45.2
      Seconds
  • Question 53 - Regarding inaccuracies in epidemiological research, which of the following statements is accurate? ...

    Incorrect

    • Regarding inaccuracies in epidemiological research, which of the following statements is accurate?

      Your Answer: Maximising validity reduces random error

      Correct Answer: Precision may be optimised by the utilisation of an adequate sample size and maximisation of the accuracy of any measures

      Explanation:

      In order to achieve accurate results, epidemiological studies strive to increase both precision and validity. Precision can be improved by using a sufficient sample size and ensuring that measurements are as accurate as possible, which helps to reduce random error caused by sampling and measurement errors. Validity, on the other hand, aims to minimize non-random error caused by bias and confounding. Overall, both precision and validity are crucial in producing reliable findings in epidemiological research. This information is based on Prince’s (2012) chapter on epidemiology in the book Core Psychiatry, edited by Wright, Stern, and Phelan.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      7.9
      Seconds
  • Question 54 - Which symptom is not considered a sign of PTSD in individuals with learning...

    Correct

    • Which symptom is not considered a sign of PTSD in individuals with learning disabilities?

      Your Answer: Auditory hallucinations

      Explanation:

      Post Traumatic Stress Disorder in People with Learning Difficulties

      Post traumatic stress disorder (PTSD) can present differently in people with learning difficulties compared to those without. While nightmares, jumpiness, and sleep disturbance are common in the general population, aggression and behavioral disturbance are more common in those with learning disabilities. Other symptoms may include disruptive of defiant behavior, self-harm, agitation, distractibility, and depressed mood.

      The most common cause of PTSD in people with learning difficulties is abuse. Treatment for PTSD in this population is similar to that for those without learning difficulties, including trauma-focused cognitive behavioral therapy of eye movement desensitization and reprocessing (EMDR) with selective serotonin reuptake inhibitors (SSRIs) of venlafaxine as an alternative of combined. However, the therapy must be tailored to the individual’s ability to understand and communicate.

    • This question is part of the following fields:

      • Learning Disability
      11.9
      Seconds
  • Question 55 - How can a diagnosis of mania be distinguished from depression? ...

    Correct

    • How can a diagnosis of mania be distinguished from depression?

      Your Answer: Increased libido

      Explanation:

      While an irritable mood can be present in both mania and depression, the symptom of increased libido is more indicative of mania. Therefore, selecting increased libido as the answer is the most appropriate choice.

      Mania: Features and Characteristics

      Mania is a mental state characterized by a range of symptoms that can significantly impact an individual’s behavior, thoughts, and emotions. Some of the key features of mania include an elated of irritable mood, restlessness, and overactivity. People experiencing mania may also exhibit disinhibited and reckless behavior, such as excessive spending of engaging in risky activities. They may have over-ambitious plans for the future and experience a flight of ideas and pressured speech. Additionally, mania can involve mood congruent delusions, increased libido, and a decreased need for sleep. Overall, mania can be a challenging and disruptive condition that requires professional treatment and support.

    • This question is part of the following fields:

      • General Adult Psychiatry
      5.8
      Seconds
  • Question 56 - A 9-year-old girl is being seen in the Enuresis clinic. She continues to...

    Correct

    • A 9-year-old girl is being seen in the Enuresis clinic. She continues to experience bedwetting at night despite utilizing an enuresis alarm for the last three months. She has no issues with urination during the day and has a daily bowel movement. What treatment option is most probable to be recommended?

      Your Answer: Oral desmopressin 200 micrograms once daily

      Explanation:

      Desmopressin, a man-made version of vasopressin, is approved for treating bedwetting in children aged 5 to 17. The recommended dosage is a single daily dose of 200 mcg.

      Elimination Disorders

      Elimination disorders refer to conditions that affect a child’s ability to control their bladder of bowel movements. Enuresis, of lack of control over the bladder, typically occurs between the ages of 1-3, while control over the bowel usually occurs before that of the bladder for most toddlers. Toilet training can be influenced by various factors, including intellectual capacity, cultural determinants, and psychological interactions between the child and their parents.

      Enuresis is characterized by involuntary voiding of urine, by day and/of by night, which is abnormal in relation to the individual’s age and is not a result of any physical abnormality. It is not normally diagnosed before age 5 and may be primary (the child never having achieved continence) of secondary. Treatment options include reassurance, enuresis alarms, and medication.

      Encopresis refers to repeated stool evacuation in inappropriate places in children over the age of four. The behavior can be either involuntary of intentional and may be due to unsuccessful toilet training (primary encopresis) of occur after a period of normal bowel control (secondary encopresis). Treatment generally involves bowel clearance, prevention of impaction, and behavioral therapy.

      Before a diagnosis of encopresis is made, organic causes must be excluded. Hirschsprung’s disease is a condition that results from an absence of parasympathetic ganglion cells in the rectum, colon, and sometimes the small intestine. It leads to a colonic obstruction and is diagnosed in at least half of all cases in the first year of life. It is twice as common in boys than in girls.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      4
      Seconds
  • Question 57 - Which statement accurately describes bar charts? ...

    Correct

    • Which statement accurately describes bar charts?

      Your Answer: The height of the bar indicates the frequency

      Explanation:

      The frequency of each category of characteristic is displayed through the height of the bars in a bar chart. When dealing with discrete data, it is typically organized into distinct categories and presented in a bar chart. On the other hand, continuous data covers a range and the categories are not separate but rather blend into one another. This type of data is best represented through a histogram, which is similar to a bar chart but with bars that are connected.

      Differences between Bar Charts and Histograms

      Bar charts and histograms are both used to represent data, but they differ in their application and design. Bar charts are used to summarize nominal of ordinal data, while histograms are used for quantitative data. In a bar chart, the x-axis represents categories without a scale, and the y-axis represents frequencies. The columns are of equal width, and the height of the bar indicates the frequency. On the other hand, histograms have a scale on both axes, with the y-axis representing the relative frequency of frequency density. The width of the columns in a histogram can vary, and the area of the column indicates the true frequency. Overall, bar charts and histograms are useful tools for visualizing data, but their differences in design and application make them better suited for different types of data.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      8.9
      Seconds
  • Question 58 - What is a distinguishing trait of the initial phase of Alzheimer's disease? ...

    Correct

    • What is a distinguishing trait of the initial phase of Alzheimer's disease?

      Your Answer: Impaired short term memory

      Explanation:

      Dementia: Types and Clinical Characteristics

      Dementia is a progressive impairment of cognitive functions occurring in clear consciousness. There are over 100 different causes of dementia, and a detailed knowledge is required for the more common types. The following are some of the subtypes of dementia, along with their early features, neuropathology, and proportion:

      – Alzheimer’s disease: Impaired memory, apathy, and depression; gradual onset; cortical amyloid plaques and neurofibrillary tangles; 50-75% proportion.
      – Vascular dementia: Similar to AD, but memory less affected, and mood fluctuations more prominent; physical frailty; stepwise onset; cerebrovascular disease; single infarcts in critical regions, of more diffuse multi-infarct disease; 20-30% proportion.
      – Frontotemporal dementia: Personality changes, mood changes, disinhibition, language difficulties; no single pathology – damage limited to frontal and temporal lobes; 5-10% proportion.
      – Dementia with Lewy Bodies: Marked fluctuation in cognitive ability, visual hallucinations, Parkinsonism (tremor and rigidity); cortical Lewy bodies (alpha-synuclein); <5% proportion. Other types of dementia include Pick’s disease, Huntington’s disease, pseudodementia, and progressive supranuclear palsy. Each subtype has its own unique clinical characteristics and neuropathology. It is important to accurately diagnose the type of dementia in order to provide appropriate treatment and care.

    • This question is part of the following fields:

      • Old Age Psychiatry
      2297
      Seconds
  • Question 59 - What is the classification of binge eating disorder in the ICD-11? ...

    Incorrect

    • What is the classification of binge eating disorder in the ICD-11?

      Your Answer: Binge eating disorder can be diagnosed alongside a diagnosis of bulimia nervosa

      Correct Answer: Binge eating disorder has a higher rate of remission than other eating disorders

      Explanation:

      Binge eating disorder has a higher rate of remission compared to other eating disorders, and remission can occur spontaneously of as a result of treatment. The disorder is characterized by frequent episodes of binge eating, which can be assigned as a diagnosis after a shorter period if they occur multiple times a week and cause significant distress. Onset typically occurs during adolescence of young adulthood but can also begin in later adulthood. Binge eating episodes can be objective of subjective, but the core feature is the experience of loss of control overeating. If an individual engages in inappropriate compensatory behaviors following binge eating episodes, the diagnosis of bulimia nervosa should be assigned instead of binge eating disorder, as the two diagnoses cannot coexist.

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      353.1
      Seconds
  • Question 60 - Which statement accurately describes alcohol withdrawal? ...

    Correct

    • Which statement accurately describes alcohol withdrawal?

      Your Answer: For hallucinations associated with delirium tremens, haloperidol is the preferred antipsychotic

      Explanation:

      For individuals experiencing delirium tremens, the initial treatment option should be oral lorazepam. If symptoms persist of the individual declines oral medication, alternative options such as parenteral lorazepam of haloperidol should be offered, as recommended by NICE CG100.

      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
      18.9
      Seconds
  • Question 61 - Which of the following is classified as class B under the Misuse of...

    Incorrect

    • Which of the following is classified as class B under the Misuse of Drugs Act?

      Your Answer: Injected ketamine

      Correct Answer: Cannabis

      Explanation:

      Class B substances are elevated to the status of Class A when they are administered through injection.

      Drug Misuse (Law and Scheduling)

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      3.1
      Seconds
  • Question 62 - A trainee who appeared to have extraordinary potential as a psychotherapist, experienced continued...

    Incorrect

    • A trainee who appeared to have extraordinary potential as a psychotherapist, experienced continued strong irritation in the early part of her treatment with a 25-year-old male patient. She reacted to the patient in a controlled, muted manner.

      The patient was an angry, obsessional young man suffering from many borderline features. He negated the therapist's attempts to help him understand how his conflicts might be contributing to his ongoing problems with women, and he usually negated the therapist's observations about what he might be feeling.

      Through exploration within supervision, it emerged that unresolved anxieties from within the trainee about not being good enough, about fearing that she could not take care of others sufficiently, and about fears of her supervisor's evaluation of her were clearly implicated in her irritation and her muted reaction to the patient.

      Which of the following best describes the trainee’s behaviour towards the patient?:

      Your Answer: Projection

      Correct Answer: Countertransference

      Explanation:

      Transference and Countertransference

      Transference is the unconscious transfer of feelings, attitudes, thoughts, desires, fantasies, of behaviors from past significant relationships to a current interpersonal relationship. It is often observed in therapy, and the therapist interprets its meaning and source to help the patient understand how their past experiences affect their current relationships. Factors that increase transference include anxiety, frequent contact with a key worker, and borderline personality disorder. Effective management of transference involves recognizing the importance of the relationship to the patient, maintaining professional boundaries, interpreting the transference, and being a reliable therapist.

      Countertransference, on the other hand, refers to the therapist’s emotional, cognitive, of behavioral response to the patient, triggered by some characteristic of the patient but ultimately resulting from unresolved conflicts within the therapist. There are different conceptions of countertransference, including the classical definition, the totalistic conception, the complementary conception, and the relational perspective. However, a working definition suggests that countertransference is a response to the patient triggered by unresolved conflicts within the therapist. Effective management of countertransference involves understanding the patient’s interpersonal style of relating and framing therapeutic interventions accordingly.

    • This question is part of the following fields:

      • Psychotherapy
      27.8
      Seconds
  • Question 63 - A 55-year-old male is admitted with fatigue, nausea and weight loss. He has...

    Correct

    • A 55-year-old male is admitted with fatigue, nausea and weight loss. He has a history of heavy alcohol use and has experienced delirium tremens in the past. He has abstained from alcohol for the past two days.
      During examination, he appears thin, alert and oriented. He displays signs of chronic liver disease, but there is no evidence of a flapping tremor. His pulse is regular at 88 bpm, his blood pressure is 106/74 mmHg, and his temperature is 37°C.
      What medication would be recommended for preventing acute alcohol withdrawal in this patient?

      Your Answer: Oral lorazepam

      Explanation:

      This patient, who exhibits signs of chronic liver disease due to alcohol consumption, is at high risk of experiencing acute alcohol withdrawal, especially considering her history of delirium tremens. To prevent this, benzodiazepines are appropriate agents, with oral medications like lorazepam and diazepam being recommended. While benzodiazepines can cause hepatic encephalopathy in patients with liver cirrhosis, it is not yet known if this patient has cirrhosis, and the risk of alcohol withdrawal is significant. Therefore, she should be given benzodiazepines and closely monitored for any signs of encephalopathy. In cases of hepatic impairment, benzodiazepines with a shorter half-life, such as lorazepam and oxazepam, are preferred.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      8.7
      Seconds
  • Question 64 - A 60-year-old construction worker presents to the hospital with complaints of muscle aches,...

    Correct

    • A 60-year-old construction worker presents to the hospital with complaints of muscle aches, poor memory, and malaise for the past four weeks. During the physical examination, a 5 cm well-defined lesion is observed on the right flank. What is the most probable diagnosis?

      Your Answer: Lyme Disease

      Explanation:

      Lyme disease, which is caused by ticks carrying the infection (Lyme borreliosis), is typically found in the Northern Hemisphere. A distinctive ‘bulls-eye’ rash appears in around two thirds of patients.
      Although the symptoms of Lyme disease can be vague, other conditions such as Chronic Fatigue Syndrome, hypothyroidism and SLE may be considered as possible diagnoses. The crucial factor in identifying Lyme disease is the presence of the characteristic skin lesion.

    • This question is part of the following fields:

      • General Adult Psychiatry
      10
      Seconds
  • Question 65 - What test is the most supportive in diagnosing PANDAS? ...

    Correct

    • What test is the most supportive in diagnosing PANDAS?

      Your Answer: Anti DNAse-B

      Explanation:

      PANDAS: A Disorder Linked to Streptococcal Infections

      PANDAS, of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a condition that affects children who develop sudden onset of obsessive-compulsive disorder (OCD) and/of tic disorders like Tourette’s Syndrome after contracting strep infections such as Strep throat of Scarlet Fever. The National Institute of Mental Health (NIMH) has identified five criteria for diagnosing PANDAS, including the presence of OCD and/of tic disorder, pediatric onset of symptoms, episodic course of symptom severity, association with group A Beta-hemolytic streptococcal infection, and association with neurological abnormalities. The anti streptococcal DNAse B (Anti DNAse-B) titre is commonly used to determine if there is immunologic evidence of a previous strep infection. PANDAS is linked to basal ganglia dysfunction.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      3.2
      Seconds
  • Question 66 - If a man consumes alcohol daily and increases his intake on weekends, but...

    Correct

    • If a man consumes alcohol daily and increases his intake on weekends, but abstains on Monday due to a crucial work meeting, and then experiences a seizure during the meeting, what would you suspect?

      Your Answer: Alcohol withdrawal

      Explanation:

      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
      573.1
      Seconds
  • Question 67 - A 56 year-old man attends the out-patient clinic. He was started on fluoxetine...

    Incorrect

    • A 56 year-old man attends the out-patient clinic. He was started on fluoxetine eight weeks ago for depression and is now requesting to stop his medication as he feels so well. Your assessment indicates that he is now in remission. What should be recommended regarding his treatment?

      Your Answer: It should be continued for at least another 6 weeks

      Correct Answer: It should be continued for at least another 6 months

      Explanation:

      To minimize the likelihood of relapse, it is recommended to maintain treatment for at least 6 months after achieving remission. It is important to note that antidepressants are not habit-forming, and patients should be reassured of this fact.

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      20.5
      Seconds
  • Question 68 - What is the relationship between suicide and deliberate self-harm (DSH)? ...

    Correct

    • What is the relationship between suicide and deliberate self-harm (DSH)?

      Your Answer: DSH is the strongest risk factor for suicide

      Explanation:

      Patients who have a history of repeated DSH are at a significantly higher risk for suicide. While high suicidal intent is associated with greater risk of suicide, it is not a reliable predictor for individual patients, particularly in the first year following DSH. DSH remains the strongest risk factor for suicide.

      Suicide Rates Following Self-Harm

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      67.2
      Seconds
  • Question 69 - A 65 year old woman has been suffering from depression for many months,...

    Incorrect

    • A 65 year old woman has been suffering from depression for many months, she is experiencing low mood and anhedonia but there is no evidence of psychotic symptoms. She has shown no response to trials of sertraline and venlafaxine (both used at full doses). Although very depressed you are reassured by her dietary and fluid intake. Which of the following would be the most appropriate next step?

      Your Answer: Try an MAOI

      Correct Answer: Add in lithium

      Explanation:

      Electroconvulsive therapy may be considered for severe depression if the patient presents with attempted suicide, strong suicidal ideation of plans, life-threatening illness due to refusal of food of fluids, stupor, marked psychomotor retardation, of depressive delusions of hallucinations. However, in the case of refractory depression, the Maudsley Guidelines suggest that lithium of ECT are the only options, and ECT may not be indicated at this stage based on the patient’s overall presentation.

      Depression (Refractory)

      Refractory depression is a term used when two successive attempts at treatment have failed despite good compliance and adequate doses. There is no accepted definition of refractory depression. The following options are recommended as the first choice for refractory depression, with no preference implied by order:

      – Add lithium
      – Combined use of olanzapine and fluoxetine
      – Add quetiapine to SSRI/SNRI
      – Add aripiprazole to antidepressant
      – Bupropion + SSRI
      – SSRI (of venlafaxine) + mianserin (of mirtazapine)

      These recommendations are taken from the 13th edition of the Maudsley Guidelines.

    • This question is part of the following fields:

      • General Adult Psychiatry
      17.2
      Seconds
  • Question 70 - What is the correct approach to treating Wernicke's encephalopathy? ...

    Correct

    • What is the correct approach to treating Wernicke's encephalopathy?

      Your Answer: Parenteral thiamine is suggested rather than an oral route

      Explanation:

      To ensure prompt treatment, thiamine 200 mg should be administered three times daily before any carbohydrate intake, preferably through intravenous administration. It is recommended to avoid delaying treatment by relying solely on imaging for diagnosis. Intravenous administration is preferred over oral administration, as there is a risk of anaphylaxis with intranasal administration. Therefore, intranasal administration should only be considered if facilities are available to manage potential anaphylactic reactions.

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      11.6
      Seconds
  • Question 71 - What is the maximum duration of psychotic symptoms required for a diagnosis of...

    Incorrect

    • What is the maximum duration of psychotic symptoms required for a diagnosis of acute and transient psychotic disorder according to the ICD-11?

      Your Answer: 1 month

      Correct Answer: 3 months

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      33.3
      Seconds
  • Question 72 - Which statement about confounding is incorrect? ...

    Incorrect

    • Which statement about confounding is incorrect?

      Your Answer: A confounding factor obscures the relationship between an exposure and an outcome

      Correct Answer: In the analytic stage of a study confounding can be controlled for by randomisation

      Explanation:

      In the analytic stage of a study, confounding cannot be controlled for by the technique of stratification. (This is false, as stratification is a technique commonly used to control for confounding in observational studies.)

      Stats Confounding

      A confounding factor is a factor that can obscure the relationship between an exposure and an outcome in a study. This factor is associated with both the exposure and the disease. For example, in a study that finds a link between coffee consumption and heart disease, smoking could be a confounding factor because it is associated with both drinking coffee and heart disease. Confounding occurs when there is a non-random distribution of risk factors in the population, such as age, sex, and social class.

      To control for confounding in the design stage of an experiment, researchers can use randomization, restriction, of matching. Randomization aims to produce an even distribution of potential risk factors in two populations. Restriction involves limiting the study population to a specific group to ensure similar age distributions. Matching involves finding and enrolling participants who are similar in terms of potential confounding factors.

      In the analysis stage of an experiment, researchers can control for confounding by using stratification of multivariate models such as logistic regression, linear regression, of analysis of covariance (ANCOVA). Stratification involves creating categories of strata in which the confounding variable does not vary of varies minimally.

      Overall, controlling for confounding is important in ensuring that the relationship between an exposure and an outcome is accurately assessed in a study.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      5
      Seconds
  • Question 73 - What is the purpose of using the Kolmogorov-Smirnov and Jarque-Bera tests? ...

    Correct

    • What is the purpose of using the Kolmogorov-Smirnov and Jarque-Bera tests?

      Your Answer: Normality

      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
      3
      Seconds
  • Question 74 - A 62-year-old woman is referred to your clinic. Her daughter has noticed a...

    Incorrect

    • A 62-year-old woman is referred to your clinic. Her daughter has noticed a slight change in her mother's behavior and increased forgetfulness over the past six months. This started after she had a minor stroke and has since worsened. She is currently taking insulin for type 2 diabetes mellitus. You perform cognitive testing and refer the woman for an MRI scan of her head. What is the most probable result on T2 weighted MRI?

      Your Answer: Periventricular lucency

      Correct Answer: White matter hyperintensities

      Explanation:

      The individual in question is exhibiting symptoms consistent with vascular dementia, which can be confirmed through T2 weighted MRI scans that reveal white matter hyperintensities (WMH) caused by small vessel disease-related infarcts in the brain. Additionally, recent research has shown that WMH can also be present in older individuals with depression, and their presence may be linked to greater challenges in treating these individuals effectively.

    • This question is part of the following fields:

      • Old Age Psychiatry
      19.5
      Seconds
  • Question 75 - What is the risk factor that the selection drift hypothesis aims to explain...

    Correct

    • What is the risk factor that the selection drift hypothesis aims to explain in relation to schizophrenia?

      Your Answer: Social class

      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
      26.6
      Seconds
  • Question 76 - Which value of r indicates the highest degree of correlation? ...

    Correct

    • Which value of r indicates the highest degree of correlation?

      Your Answer: -0.8

      Explanation:

      It is important to distinguish between the direction of the correlation (the slope of the line) and its strength (the spread of the data). To emphasize this difference, the correct answer to this question is a negative value.

      Stats: Correlation and Regression

      Correlation and regression are related but not interchangeable terms. Correlation is used to test for association between variables, while regression is used to predict values of dependent variables from independent variables. Correlation can be linear, non-linear, of non-existent, and can be strong, moderate, of weak. The strength of a linear relationship is measured by the correlation coefficient, which can be positive of negative and ranges from very weak to very strong. However, the interpretation of a correlation coefficient depends on the context and purposes. Correlation can suggest association but cannot prove of disprove causation. Linear regression, on the other hand, can be used to predict how much one variable changes when a second variable is changed. Scatter graphs are used in correlation and regression analyses to visually determine if variables are associated and to detect outliers. When constructing a scatter graph, the dependent variable is typically placed on the vertical axis and the independent variable on the horizontal axis.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      3.4
      Seconds
  • Question 77 - What type of generalized seizure is induced during ECT? ...

    Correct

    • What type of generalized seizure is induced during ECT?

      Your Answer: Tonic-clonic

      Explanation:

      The process of ECT includes creating a widespread seizure that results in stiffness and rigidity of muscles, followed by repetitive jerking movements. Absence seizures cause a brief period of unconsciousness, while atonic seizures lead to a loss of muscle tone.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      3.2
      Seconds
  • Question 78 - In the Epidemiological catchment area study, which anxiety disorder was discovered to have...

    Incorrect

    • In the Epidemiological catchment area study, which anxiety disorder was discovered to have the highest occurrence rate?

      Your Answer: Mixed anxiety and depression

      Correct Answer: Phobia

      Explanation:

      In the ECA, phobias were the prevalent form of anxiety disorder.

      Epidemiological Catchment Area Study: A Landmark Community-Based Survey

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      8.2
      Seconds
  • Question 79 - As a healthcare provider, you are discussing the possibility of ECT treatment with...

    Incorrect

    • As a healthcare provider, you are discussing the possibility of ECT treatment with a middle-aged patient who has treatment-resistant depression. The patient is concerned about potential cognitive side effects of the treatment. Which cognitive side effect should you prioritize in your counseling with this patient?

      Your Answer: The chance of anterograde amnesia during the treatment period

      Correct Answer: The possibility of retrograde amnesia affecting all parts of long term memory

      Explanation:

      ECT can result in permanent memory loss for at least one third of patients, with more recent events being more affected. Anterograde amnesia during ECT treatment is common, but unlikely to cause long term disability. Both implicit and explicit memory can be affected by ECT, although some patients may experience memory improvement if they respond well to the treatment. It is important for patients to be informed about the possibility of long term memory impairment as a significant side effect of ECT.

    • This question is part of the following fields:

      • General Adult Psychiatry
      11.5
      Seconds
  • Question 80 - A 16-year-old male is caught spying on his neighbour whilst she is undressing....

    Correct

    • A 16-year-old male is caught spying on his neighbour whilst she is undressing. The police report that this is the fifth time he has been caught doing this in the past 6 months. He is assessed by a psychiatrist and discloses a six-month history of intense urges to watch females undressing in their homes. He denies feeling distressed by these urges.

      Which of the following conclusion would be most appropriate in this case according to the DSM-5?

      Your Answer: A diagnosis of ‘Voyeuristic Disorder’ should not be made as the individual is under the age of 18

      Explanation:

      Voyeuristic disorder is typically observed in adult males who develop a sexual interest in secretly observing individuals without their knowledge. While this interest may first arise during adolescence, a diagnosis of voyeuristic disorder is only made after the age of 18 due to challenges in distinguishing it from normal sexual curiosity during puberty. The DSM-5 identifies voyeuristic behavior as a disorder when it causes harm, which can manifest as either personal distress of engaging in non-consensual acts.

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      21.6
      Seconds
  • Question 81 - The Camberwell Family Interview assesses mainly which of the following? ...

    Correct

    • The Camberwell Family Interview assesses mainly which of the following?

      Your Answer: Expressed emotion

      Explanation:

      The Camberwell Family Interview for Measuring Expressed Emotion

      The Camberwell Family Interview is a tool designed to assess the level of expressed emotion within families. This interview was created with the aim of identifying the emotional climate within a family, particularly in relation to individuals with mental health issues. The interview is structured and standardized, with a set of questions that are asked to each family member separately. The questions are designed to elicit information about the family’s emotional atmosphere, including levels of criticism, hostility, and emotional over-involvement.

      The Camberwell Family Interview is a valuable tool for mental health professionals, as it can help them to identify families that may be at risk of exacerbating mental health issues in their loved ones. By measuring expressed emotion, mental health professionals can gain insight into the family’s emotional dynamics and work with them to create a more supportive and positive environment. The interview can also be used to track changes in the family’s emotional climate over time, allowing mental health professionals to monitor progress and adjust treatment plans accordingly. Overall, the Camberwell Family Interview is an important tool for understanding and addressing the emotional needs of families affected by mental health issues.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      3.5
      Seconds
  • Question 82 - How can grounded theory be applied as an analytic technique? ...

    Correct

    • How can grounded theory be applied as an analytic technique?

      Your Answer: Constant comparison

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      4.3
      Seconds
  • Question 83 - What is the classification of reactive attachment disorder in the ICD-11? ...

    Incorrect

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

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

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

      Explanation:

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      33.3
      Seconds
  • Question 84 - What is a true statement about cost-benefit analysis? ...

    Incorrect

    • What is a true statement about cost-benefit analysis?

      Your Answer: It involves the use of the QALY

      Correct Answer: Benefits are valued in monetary terms

      Explanation:

      The net benefit of a proposed scheme is calculated by subtracting the costs from the benefits in a CBA. For instance, if the benefits of the scheme are valued at £140 k and the costs are £10 k, then the net benefit would be £130 k.

      Methods of Economic Evaluation

      There are four main methods of economic evaluation: cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), cost-utility analysis (CUA), and cost-minimisation analysis (CMA). While all four methods capture costs, they differ in how they assess health effects.

      Cost-effectiveness analysis (CEA) compares interventions by relating costs to a single clinical measure of effectiveness, such as symptom reduction of improvement in activities of daily living. The cost-effectiveness ratio is calculated as total cost divided by units of effectiveness. CEA is typically used when CBA cannot be performed due to the inability to monetise benefits.

      Cost-benefit analysis (CBA) measures all costs and benefits of an intervention in monetary terms to establish which alternative has the greatest net benefit. CBA requires that all consequences of an intervention, such as life-years saved, treatment side-effects, symptom relief, disability, pain, and discomfort, are allocated a monetary value. CBA is rarely used in mental health service evaluation due to the difficulty in converting benefits from mental health programmes into monetary values.

      Cost-utility analysis (CUA) is a special form of CEA in which health benefits/outcomes are measured in broader, more generic ways, enabling comparisons between treatments for different diseases and conditions. Multidimensional health outcomes are measured by a single preference- of utility-based index such as the Quality-Adjusted-Life-Years (QALY). QALYs are a composite measure of gains in life expectancy and health-related quality of life. CUA allows for comparisons across treatments for different conditions.

      Cost-minimisation analysis (CMA) is an economic evaluation in which the consequences of competing interventions are the same, and only inputs, i.e. costs, are taken into consideration. The aim is to decide the least costly way of achieving the same outcome.

      Costs in Economic Evaluation Studies

      There are three main types of costs in economic evaluation studies: direct, indirect, and intangible. Direct costs are associated directly with the healthcare intervention, such as staff time, medical supplies, cost of travel for the patient, childcare costs for the patient, and costs falling on other social sectors such as domestic help from social services. Indirect costs are incurred by the reduced productivity of the patient, such as time off work, reduced work productivity, and time spent caring for the patient by relatives. Intangible costs are difficult to measure, such as pain of suffering on the part of the patient.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      2.5
      Seconds
  • Question 85 - In Korsakoff syndrome, which aspect of memory is most significantly impacted? ...

    Incorrect

    • In Korsakoff syndrome, which aspect of memory is most significantly impacted?

      Your Answer: Working

      Correct Answer: Episodic

      Explanation:

      Korsakoff’s Syndrome

      Korsakoff’s Syndrome, also known as amnesic syndrome, is a chronic condition that affects recent and anterograde memory in an alert and responsive patient. It is caused by prolonged thiamine (vitamin B1) deficiency and often follows Wernicke’s encephalopathy. The syndrome is characterized by a lack of insight, apathy, and confabulation. Thiamine is essential for glucose metabolism in the brain, and its deficiency leads to a toxic buildup of glucose, causing neuronal loss. The Mammillary bodies are the main areas affected in Korsakoff’s syndrome.

      While intelligence on the WAIS is preserved, episodic memory is severely affected in Korsakoff’s syndrome. Semantic memory is variably affected, but implicit aspects of memory, such as response to priming and procedural memory, are preserved. Immediate memory tested with the digit span is normal, but information can only be retained for a few minutes at most. Patients with Korsakoff’s syndrome often display apathy, lack of initiative, and profound lack of insight.

      Source: Kopelman M (2009) The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol and Alcoholism 44 (2): 148-154.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      3
      Seconds
  • Question 86 - For what purpose is the GRADE approach used in the field of evidence...

    Incorrect

    • For what purpose is the GRADE approach used in the field of evidence based medicine?

      Your Answer: Adjusting for bias in qualitative research

      Correct Answer: Assessing the quality of evidence

      Explanation:

      Levels and Grades of Evidence in Evidence-Based Medicine

      To evaluate the quality of evidence on a subject of question, levels of grades are used. The traditional hierarchy approach places systematic reviews of randomized control trials at the top and case-series/report at the bottom. However, this approach is overly simplistic as certain research questions cannot be answered using RCTs. To address this, the Oxford Centre for Evidence-Based Medicine introduced their 2011 Levels of Evidence system, which separates the type of study questions and gives a hierarchy for each.

      The grading approach to be aware of is the GRADE system, which classifies the quality of evidence as high, moderate, low, of very low. The process begins by formulating a study question and identifying specific outcomes. Outcomes are then graded as critical of important. The evidence is then gathered and criteria are used to grade the evidence, with the type of evidence being a significant factor. Evidence can be promoted of downgraded based on certain criteria, such as limitations to study quality, inconsistency, uncertainty about directness, imprecise of sparse data, and reporting bias. The GRADE system allows for the promotion of observational studies to high-quality evidence under the right circumstances.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      7.8
      Seconds
  • Question 87 - What symptom is commonly observed in individuals with bipolar disorder and psychosis? ...

    Incorrect

    • What symptom is commonly observed in individuals with bipolar disorder and psychosis?

      Your Answer: Systematised delusions

      Correct Answer: Prominent affective symptoms and mood congruent delusions

      Explanation:

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      13.1
      Seconds
  • Question 88 - A 35-year-old female patient of yours is hesitant to accept her recent diagnosis...

    Incorrect

    • A 35-year-old female patient of yours is hesitant to accept her recent diagnosis of bipolar disorder and does not believe she needs to inform the DMV. She declines to give consent for you to speak with her family.
      What is the most suitable next step for you to take?

      Your Answer: Contact the DVLA yourself, having informed the patient in advance

      Correct Answer: Arrange for a second opinion assessment and advise the patient not to drive in the interim

      Explanation:

      If there is a dispute regarding the recent diagnosis, it would be best for the patient to seek a second opinion assessment. During this time, it is recommended that the patient refrains from driving. It is the responsibility of the license holder to inform the DVLA of any changes in their medical condition that may affect their ability to drive safely. Patients should be informed of any conditions that may impact their driving ability and their legal obligation to inform the DVLA. The GMC has provided clear guidance for situations where a license holder is unwilling or unable to inform the DVLA. If a doctor is unable to convince a patient to stop driving of discovers that the patient is driving against their advice, they should immediately contact the DVLA and provide any relevant information in confidence to the medical adviser. Before contacting the DVLA, the patient should be advised and informed in writing after contact has been made. It is not appropriate to breach confidentiality by speaking to the patient’s family without their consent.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      6.5
      Seconds
  • Question 89 - 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
      12.5
      Seconds
  • Question 90 - Which statement accurately describes the epidemiology of conduct disorder in the UK? ...

    Correct

    • Which statement accurately describes the epidemiology of conduct disorder in the UK?

      Your Answer: Prevalence of conduct disorder is higher in 11-16 year olds than in those aged 5-10

      Explanation:

      Disruptive Behaviour of Dissocial Disorders

      Conduct disorders are the most common reason for referral of young children to mental health services. These disorders are characterized by a repetitive and persistent pattern of antisocial, aggressive, of defiant conduct that goes beyond ordinary childish mischief of adolescent rebelliousness. Oppositional defiant disorder (ODD) shares some negative attributes but in a more limited fashion.

      ICD-11 terms the disorder as ‘Conduct-dissocial disorder’, while DSM-5 recognizes three separate conditions related to emotional/behavioral problems seen in younger people: conduct disorder, oppositional defiant disorder, and intermittent explosive disorder. Conduct disorder is about poorly controlled behavior, intermittent explosive disorder is about poorly controlled emotions, and ODD is in between. Conduct disorders are further divided into childhood onset (before 10 years) and adolescent onset (10 years of older).

      The behavior pattern of conduct disorders must be persistent and recurrent, including multiple incidents of aggression towards people of animals, destruction of property, deceitfulness of theft, and serious violations of rules. The pattern of behavior must result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      Oppositional defiant disorder represents a less severe form of conduct disorder, where there is an absence of more severe dissocial of aggressive acts. The behavior pattern of ODD includes persistent difficulty getting along with others, provocative, spiteful, of vindictive behavior, and extreme irritability of anger.

      The prevalence of conduct disorders increases throughout childhood and is more common in boys than girls. The most frequent comorbid problem seen with conduct disorder is hyperactivity. The conversion rate from childhood conduct disorder to adult antisocial personality disorder varies from 40 to 70% depending on the study.

      NICE recommends group parent-based training programs of parent and child training programs for children with complex needs for ages 3-11, child-focused programs for ages 9-14, and multimodal interventions with a family focus for ages 11-17. Medication is not recommended in routine practice, but risperidone can be used where other approaches fail and they are seriously aggressive.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      9.7
      Seconds
  • Question 91 - In the context of Criminal law, what is the age at which an...

    Correct

    • In the context of Criminal law, what is the age at which an individual is considered an adult in England?

      Your Answer: 18

      Explanation:

      Criminal Responsibility and Age Limits

      To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

      Not Guilty by Reason of Insanity and Other Defenses

      A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.

    • This question is part of the following fields:

      • Forensic Psychiatry
      2.4
      Seconds
  • Question 92 - A nationwide study on mental health found that the incidence of depression is...

    Incorrect

    • A nationwide study on mental health found that the incidence of depression is significantly higher among elderly individuals living in suburban areas compared to those residing in urban environments. What factors could explain this disparity?

      Your Answer: Urban drift' of those with psychotic illnesses

      Correct Answer: Reduced incidence in urban areas

      Explanation:

      The prevalence of schizophrenia may be higher in urban areas due to the social drift phenomenon, where individuals with severe and enduring mental illnesses tend to move towards urban areas. However, a reduced incidence of schizophrenia in urban areas could explain why there is an increased prevalence of the condition in rural settings. It is important to note that prevalence is influenced by both incidence and duration of illness, and can be reduced by increased recovery rates of death from any cause.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      160.1
      Seconds
  • Question 93 - Which of the following experiences lower rates during pregnancy? ...

    Incorrect

    • Which of the following experiences lower rates during pregnancy?

      Your Answer: Depression

      Correct Answer: Suicide

      Explanation:

      While depression and anxiety rates tend to rise during pregnancy, rates of bipolar disorder and schizophrenia remain unchanged. However, individuals who stop taking medication during pregnancy are more likely to experience a relapse. Interestingly, pregnancy appears to be a protective factor against suicide, with decreased rates observed.

      Suicide Risk Factors

      Risk factors for completed suicide are numerous and include various demographic, social, and psychological factors. Men are at a higher risk than women, with the risk peaking at age 45 for men and age 55 for women. Being unmarried and unemployed are also risk factors. Concurrent mental disorders are present in about 90% of people who commit suicide, with depression being the most commonly associated disorder. Previous suicide attempts and substance misuse are also significant risk factors. Co-existing serious medical conditions and personality factors such as rigid thinking, pessimism, and perfectionism also increase the risk of suicide. It is important to identify and address these risk factors in order to prevent suicide.

    • This question is part of the following fields:

      • General Adult Psychiatry
      5.3
      Seconds
  • Question 94 - A 65 kg male patient is brought to the emergency department after taking...

    Correct

    • A 65 kg male patient is brought to the emergency department after taking an overdose of paracetamol. He estimates that he took 20 paracetamol tablets over a two hour period approximately 3 hours ago. Which of the following would be the most appropriate course of action?

      Your Answer: Administer IV acetylcysteine without delay

      Explanation:

      If someone ingests more than 75 mg/kg of paracetamol, serious toxicity can occur. This means that a 75 kg male would need to ingest approximately 5.5 g (equivalent to 11-12 tablets) for significant harm to occur. Immediate action is necessary in this case. If someone ingests more than 150 mg/kg, they require immediate treatment. In cases of staggered overdoses, IV acetylcysteine should be administered regardless of the plasma paracetamol level.

      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
      61740.1
      Seconds
  • Question 95 - A worldwide epidemic of influenza is known as a: ...

    Correct

    • A worldwide epidemic of influenza is known as a:

      Your Answer: Pandemic

      Explanation:

      Epidemiology Key Terms

      – Epidemic (Outbreak): A rise in disease cases above the anticipated level in a specific population during a particular time frame.
      – Endemic: The regular of anticipated level of disease in a particular population.
      – Pandemic: Epidemics that affect a significant number of individuals across multiple countries, regions, of continents.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      2.3
      Seconds
  • Question 96 - The patient inquires about the potential memory impairment caused by ECT. Which specific...

    Correct

    • The patient inquires about the potential memory impairment caused by ECT. Which specific type of memory is impacted by this procedure?

      Your Answer: Retrograde and anterograde

      Explanation:

      Electroconvulsive therapy (ECT) is known to cause retrograde amnesia, which is the most persistent cognitive side effect (Lisanby, 2000). Patients often experience memory gaps for events that occurred around the time of ECT, and sometimes even for events that happened months of years prior. While retrograde amnesia typically improves within a few months after treatment, some patients may not fully recover and may have permanent memory loss for events close to the time of treatment. Additionally, anterograde amnesia may also be a possible side effect.

      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
      7.5
      Seconds
  • Question 97 - A 28 year old woman discloses that her 4 month old daughter passed...

    Correct

    • A 28 year old woman discloses that her 4 month old daughter passed away from sudden infant death syndrome 2 years ago. Since then, she has developed a heightened sense of protectiveness towards her family. She engages in repetitive checking behaviors and experiences distress, anxiety, and agitation when unable to do so. Although she recognizes that her checking behavior is unhelpful, she struggles to resist it. What is the most suitable form of psychological intervention for her?

      Your Answer: Exposure and response prevention

      Explanation:

      Maudsley Guidelines

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

      Second line:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      352.5
      Seconds
  • Question 98 - What statement accurately describes measures of dispersion? ...

    Incorrect

    • What statement accurately describes measures of dispersion?

      Your Answer: The mean is the a measure of dispersion used in skewed data

      Correct Answer: The standard error indicates how close the statistical mean is to the population mean

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      704
      Seconds
  • Question 99 - Under the Misuse of Drugs Act, which new psychoactive substance is categorized as...

    Incorrect

    • Under the Misuse of Drugs Act, which new psychoactive substance is categorized as Class C?

      Your Answer: Gamma Butyrolactone

      Correct Answer: Piperazines

      Explanation:

      New Psychoactive Substances, previously known as ‘legal highs’, are synthetic compounds designed to mimic the effects of traditional illicit drugs. They became popular due to their ability to avoid legislative control, but the introduction of the Psychoactive Substances Act 2016 changed this. There is no standard for clinical classification, but some common legal highs include Mephedrone, Piperazines, GBL, Synthetic cannabinoids, and Benzofuran compounds. These substances have effects similar to ecstasy, amphetamines, and cannabis, and are classified as either Class B of Class C drugs in the UK.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      6.5
      Seconds
  • Question 100 - What methods have been proven to be successful in addressing problem gambling? ...

    Correct

    • What methods have been proven to be successful in addressing problem gambling?

      Your Answer: Naltrexone

      Explanation:

      Problem Gambling: Screening and Interventions

      Problem gambling, also known as pathological gambling, refers to gambling that causes harm to personal, family, of recreational pursuits. The prevalence of problem gambling in adults ranges from 7.3% to 0.7%, while in psychiatric patients, it ranges from 6% to 12%. Problem gambling typically starts in early adolescence in males and runs a chronic, progressive course with periods of abstinence and relapses.

      Screening for problem gambling is done using various tools, including the NODS-CLiP and the South Oaks Gambling Screen (SOGS). Brief interventions have been successful in decreasing gambling, with motivational enhancement therapy (MET) being the most effective. Pharmacological interventions, such as selective serotonin reuptake inhibitors (SSRIs), naltrexone, and mood stabilizers, have also been effective, but the choice of drug depends on the presence of comorbidity. Psychological interventions, particularly cognitive-behavioral treatments, show promise, but long-term follow-up and high drop-out rates are major limitations. Studies comparing psychological and pharmacological interventions are needed.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      5.4
      Seconds
  • Question 101 - What is the significance of the cut off of 5 on the MDQ...

    Incorrect

    • What is the significance of the cut off of 5 on the MDQ in diagnosing depression?

      Your Answer: The area under the curve (AUC)

      Correct Answer: The optimal threshold

      Explanation:

      The threshold score that results in the lowest misclassification rate, achieved by minimizing both false positive and false negative rates, is known as the optimal threshold. Based on the findings of the previous study, the ideal cut off for identifying caseness on the MDQ is five, making it the optimal threshold.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      3.2
      Seconds
  • Question 102 - Which of the following statements accurately describes the concept of study power? ...

    Incorrect

    • Which of the following statements accurately describes the concept of study power?

      Your Answer: Is equal to 1 - (the probability of a type I error)

      Correct Answer: Is the probability of rejecting the null hypothesis when it is false

      Explanation:

      The Importance of Power in Statistical Analysis

      Power is a crucial concept in statistical analysis as it helps researchers determine the number of participants needed in a study to detect a clinically significant difference of effect. It represents the probability of correctly rejecting the null hypothesis when it is false, which means avoiding a Type II error. Power values range from 0 to 1, with 0 indicating 0% and 1 indicating 100%. A power of 0.80 is generally considered the minimum acceptable level.

      Several factors influence the power of a study, including sample size, effect size, and significance level. Larger sample sizes lead to more precise parameter estimations and increase the study’s ability to detect a significant effect. Effect size, which is determined at the beginning of a study, refers to the size of the difference between two means that leads to rejecting the null hypothesis. Finally, the significance level, also known as the alpha level, represents the probability of a Type I error. By considering these factors, researchers can optimize the power of their studies and increase the likelihood of detecting meaningful effects.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      39.8
      Seconds
  • Question 103 - How can disinhibited social engagement disorder be distinguished from reactive attachment disorder based...

    Correct

    • How can disinhibited social engagement disorder be distinguished from reactive attachment disorder based on their respective features?

      Your Answer: Cuddliness with strangers

      Explanation:

      Both reactive attachment disorder and disinhibited social engagement disorder are associated with poor school performance, making it an unreliable factor for distinguishing between the two conditions. However, children with reactive attachment disorder typically exhibit more inhibited behavior similar to those with autism spectrum disorder, while children with disinhibited social engagement disorder tend to display more disinhibited behavior similar to those with attention deficit hyperactivity disorder.

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      4.5
      Seconds
  • Question 104 - A 40-year-old man visits his doctor requesting to discontinue his long-term use of...

    Incorrect

    • A 40-year-old man visits his doctor requesting to discontinue his long-term use of diazepam. If he discontinues the medication, what is the most probable outcome he will encounter?

      Your Answer: Flu-like symptoms

      Correct Answer: Insomnia

      Explanation:

      The most prevalent indication of benzodiazepine withdrawal is insomnia.

      Benzodiazepines and Addiction

      Benzodiazepines are known to be addictive and should only be prescribed as a hypnotic or anxiolytic for a maximum of 4 weeks. Withdrawal symptoms can be physical of psychological, including stiffness, weakness, GI disturbance, paraesthesia, flu-like symptoms, visual disturbance, anxiety, insomnia, nightmares, depersonalisation, decreased memory and concentration, delusions, and hallucinations. Patients who wish to withdraw from short-acting benzodiazepines should first be converted to diazepam, which has a longer half-life and produces less severe withdrawal. The table provides approximate equivalent doses for different benzodiazepines. These guidelines are from the Maudsley Guidelines 10th Edition.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      7.6
      Seconds
  • Question 105 - Which condition is believed to be linked to puerperal psychosis? ...

    Incorrect

    • Which condition is believed to be linked to puerperal psychosis?

      Your Answer: Borderline personality disorder

      Correct Answer: Bipolar affective disorder

      Explanation:

      Psychiatric Issues in the Postpartum Period

      The period following childbirth, known as the postpartum period, can be a time of significant psychiatric challenges for women. Many women experience a temporary mood disturbance called baby blues, which is characterized by emotional instability, sadness, and tearfulness. This condition typically resolves within two weeks.

      However, a minority of women (10-15%) experience postpartum depression, which is similar to major depression in its clinical presentation. In contrast, a very small number of women (1-2 per 1000) experience postpartum psychosis, also known as puerperal psychosis. This is a severe form of psychosis that occurs in the weeks following childbirth.

      Research suggests that there may be a link between puerperal psychosis and mood disorders, as approximately 50% of women who develop the condition have a family history of mood disorder. Puerperal psychosis typically begins within the first two weeks following delivery. It is important for healthcare providers to be aware of these potential psychiatric issues and to provide appropriate support and treatment to women during the postpartum period.

    • This question is part of the following fields:

      • General Adult Psychiatry
      13
      Seconds
  • Question 106 - Which term is used to refer to the alternative hypothesis in hypothesis testing?...

    Correct

    • Which term is used to refer to the alternative hypothesis in hypothesis testing?

      a) Research hypothesis
      b) Statistical hypothesis
      c) Simple hypothesis
      d) Null hypothesis
      e) Composite hypothesis

      Your Answer: Research hypothesis

      Explanation:

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      7.2
      Seconds
  • Question 107 - Which statement accurately describes Freud's topographical model? ...

    Correct

    • Which statement accurately describes Freud's topographical model?

      Your Answer: The unconscious system has no concept of time

      Explanation:

      Freud’s Topographical Model of the Mind

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

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

    • This question is part of the following fields:

      • Psychotherapy
      8
      Seconds
  • Question 108 - Which of the following symptoms would not be indicative of PTSD in a...

    Correct

    • Which of the following symptoms would not be indicative of PTSD in a soldier who has been referred by their GP due to concerns about mental health issues resulting from their experience in the Iraq war?

      Your Answer: He is planning to return to Iraq to seek revenge

      Explanation:

      It is typical for individuals with PTSD to try to steer clear of circumstances that trigger memories of the traumatic event.

      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
      6.3
      Seconds
  • Question 109 - What is a true statement about Kleine-Levin syndrome? ...

    Correct

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

      Your Answer: It is associated with hyperphagia

      Explanation:

      Kleine-Levin Syndrome: A Mysterious Condition

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      66.2
      Seconds
  • Question 110 - What is the most prevalent personality disorder among women incarcerated in England and...

    Correct

    • What is the most prevalent personality disorder among women incarcerated in England and Wales?

      Your Answer: Antisocial

      Explanation:

      Prisoner Mental Health: Epidemiological Data from the UK

      The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.

      Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.

    • This question is part of the following fields:

      • Forensic Psychiatry
      5.4
      Seconds
  • Question 111 - You receive a call from a doctor in the emergency department regarding a...

    Correct

    • You receive a call from a doctor in the emergency department regarding a middle-aged female patient with a history of depression under psychiatric care who has presented with a gastrointestinal bleed. The doctor is inquiring about the potential contribution of any medications to the bleed. Which medication would you consider as the most likely culprit?

      Your Answer: Fluoxetine

      Explanation:

      SSRI and Bleeding Risk: Management Strategies

      SSRIs have been linked to an increased risk of bleeding, particularly in vulnerable populations such as the elderly, those with a history of bleeding, and those taking medications that predispose them to bleeding. The risk of bleeding is further elevated in patients with comorbidities such as liver of renal disease, smoking, and alcohol of drug misuse.

      To manage this risk, the Maudsley recommends avoiding SSRIs in patients receiving NSAIDs, aspirin, of oral anticoagulants, of those with a history of cerebral of GI bleeds. If SSRI use cannot be avoided, close monitoring and prescription of gastroprotective proton pump inhibitors are recommended. The degree of serotonin reuptake inhibition varies among antidepressants, with some having weaker of no inhibition, which may be associated with a lower risk of bleeding.

      NICE recommends caution when using SSRIs in patients taking aspirin and suggests considering alternative antidepressants such as trazodone, mianserin, of reboxetine. In patients taking warfarin of heparin, SSRIs are not recommended, but mirtazapine may be considered with caution.

      Overall, healthcare providers should carefully weigh the risks and benefits of SSRI use in patients at risk of bleeding and consider alternative antidepressants of gastroprotective measures when appropriate.

    • This question is part of the following fields:

      • Old Age Psychiatry
      8.1
      Seconds
  • Question 112 - Which of the following is not a key value of therapeutic communities? ...

    Incorrect

    • Which of the following is not a key value of therapeutic communities?

      Your Answer: Reality-confrontation

      Correct Answer: Conflict avoidance

      Explanation:

      Conflict can serve as a valuable tool in a therapeutic community, as it can facilitate group sessions. Honesty and open communication are encouraged among members, allowing for constructive feedback.

      Therapeutic Communities: A Brief Overview

      Therapeutic communities have been a popular form of treatment since the 1960s, with Tom Maine and Maxwell Jones being two of the most well-known names associated with this approach. In these communities, patients reside with staff and engage in group therapy sessions where they discuss community issues. This allows therapists to guide the group therapy process.

      Therapeutic communities are based on four core values: democratisation, permissiveness, communalism, and reality-confrontation. The first value emphasizes that all members of the community, including staff, should be considered equal. The second value stresses the importance of tolerance towards others’ behavior. The third value encourages members to socialize and share facilities, rather than isolating themselves in their rooms. Finally, the fourth value involves continuously providing feedback to members on their comments and behaviors to prevent them from distorting reality.

      Overall, therapeutic communities offer a unique approach to treatment that emphasizes community and group therapy. By promoting these core values, therapeutic communities aim to create a supportive and healing environment for all members.

    • This question is part of the following fields:

      • Psychotherapy
      7
      Seconds
  • Question 113 - What antidepressant is recommended by NICE for the treatment of PTSD? ...

    Incorrect

    • What antidepressant is recommended by NICE for the treatment of PTSD?

      Your Answer: Imipramine

      Correct Answer: Venlafaxine

      Explanation:

      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
      4
      Seconds
  • Question 114 - Based on the patient's symptoms and examination findings, the most likely diagnosis is...

    Incorrect

    • Based on the patient's symptoms and examination findings, the most likely diagnosis is unclear. The patient presents with haemoptysis, abdominal pain, and pyrexia for the past 2 months, and has numerous bizarre-shaped lesions on both forearms with various stages of healing. Blood tests have come back as normal, and a dermatologist has concluded that the skin lesions are not compatible with any known dermatological disorder. Further investigation is needed to determine the underlying cause of the patient's symptoms and skin lesions.

      Your Answer: Wegener's granulomatosis

      Correct Answer: Factitious disorder

      Explanation:

      The unusual scratches and blisters present on the forearms indicate the possibility of dermatitis artefacta, a type of dermatitis that is intentionally self-inflicted. This is a common symptom of factitious disorder.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      731.4
      Seconds
  • Question 115 - What is the recommended course of action when a patient with psychotic depression...

    Correct

    • What is the recommended course of action when a patient with psychotic depression cannot tolerate a tricyclic antidepressant?

      Your Answer: SSRI with antipsychotic augmentation

      Explanation:

      Psychotic Depression

      Psychotic depression is a type of depression that is characterized by the presence of delusions and/of hallucinations in addition to depressive symptoms. This condition is often accompanied by severe anhedonia, loss of interest, and psychomotor retardation. People with psychotic depression are tormented by hallucinations and delusions with typical themes of worthlessness, guilt, disease, of impending disaster. This condition affects approximately 14.7-18.5% of depressed patients and is estimated to affect around 0.4% of community adult samples, with a higher prevalence in the elderly community at around 1.4-3.0%. People with psychotic depression are at a higher risk of attempting and completing suicide than those with non-psychotic depression.

      Diagnosis

      Psychotic depression is currently classified as a subtype of depression in both the ICD-11 and the DSM-5. The main difference between the two is that in the ICD-11, the depressive episode must be moderate of severe to qualify for a diagnosis of depressive episode with psychotic symptoms, whereas in the DSM-5, the diagnosis can be applied to any severity of depressive illness.

      Treatment

      The recommended treatment for psychotic depression is tricyclics as first-line treatment, with antipsychotic augmentation. Second-line treatment includes SSRI/SNRI. Augmentation of antidepressant with olanzapine or quetiapine is recommended. The optimum dose and duration of antipsychotic augmentation are unknown. If one treatment is to be stopped during the maintenance phase, then this should be the antipsychotic. ECT should be considered where a rapid response is required of where other treatments have failed. According to NICE (ng222), combination treatment with antidepressant medication and antipsychotic medication (such as olanzapine or quetiapine) should be considered for people with depression with psychotic symptoms. If a person with depression with psychotic symptoms does not wish to take antipsychotic medication in addition to an antidepressant, then treat with an antidepressant alone.

    • This question is part of the following fields:

      • General Adult Psychiatry
      131.6
      Seconds
  • Question 116 - If a child with attention deficit hyperactivity disorder develops tics due to taking...

    Correct

    • If a child with attention deficit hyperactivity disorder develops tics due to taking methylphenidate, what would be the appropriate course of action?

      Your Answer: Atomoxetine

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      3.8
      Seconds
  • Question 117 - Which of the following is not considered a risk factor for completed suicide...

    Correct

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

      Your Answer: Female gender

      Explanation:

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      8.1
      Seconds
  • Question 118 - You are asked to see a 70-year-old male who is an inpatient detained...

    Incorrect

    • You are asked to see a 70-year-old male who is an inpatient detained under section 3 of the Mental Health Act on a geriatric unit. Nursing staff are concerned as he fell earlier, and has been refusing all medication. He has a diagnosis of dementia, and agitation. His blood pressure is 90/60 mmHg. He has lost 2 kg in the past week, and on examination is unable to stand without assistance. You arrange several urgent investigations.
      Which of the following results would be most alarming?

      Your Answer: Glucose 3.0

      Correct Answer: Urea 20

      Explanation:

      1. Dehydration can lead to medical crisis and urgent medical assessment is necessary.
      2. Oral replacement is preferable, but parenteral fluids may be required if the patient is refusing to drink.
      3. A white cell count of >4 and neutrophils >1.5 is not normally a cause for concern.
      4. Chronic low potassium levels (down to 1.5) in purging are common, but acute changes are more dangerous.
      5. An albumin level of 36 is not normally a cause for concern.
      6. Glucose levels of 3.0 may be concerning, but immediate action is required if levels drop below 2.5.
      7. The Mental Health Act may be used to provide treatment for anorexia nervosa.

    • This question is part of the following fields:

      • General Adult Psychiatry
      16.1
      Seconds
  • Question 119 - What is the most frequently observed eye abnormality in individuals with Wernicke's encephalopathy?...

    Incorrect

    • What is the most frequently observed eye abnormality in individuals with Wernicke's encephalopathy?

      Your Answer: Conjugate gaze palsy

      Correct Answer: Nystagmus

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      1241.4
      Seconds
  • Question 120 - How can somatoform disorder be best defined? ...

    Incorrect

    • How can somatoform disorder be best defined?

      Your Answer: Psychalgia

      Correct Answer: Da Costa's syndrome

      Explanation:

      Psychalgia refers to pain that has a psychological origin.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      19.5
      Seconds
  • Question 121 - How many people need to be treated with the new drug to prevent...

    Correct

    • How many people need to be treated with the new drug to prevent one case of Alzheimer's disease in individuals with a positive family history, based on the results of a randomised controlled trial with 1,000 people in group A taking the drug and 1,400 people in group B taking a placebo, where the Alzheimer's rate was 2% in group A and 4% in group B?

      Your Answer: 50

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      9.2
      Seconds
  • Question 122 - Which type of bias is the second phase of the study intended to...

    Incorrect

    • Which type of bias is the second phase of the study intended to address if the second phase involved home visits to those people who did not reply to the mailed questionnaire on levels of physical activity in adults aged 50 and above?

      Your Answer: Loss to follow up bias

      Correct Answer: Participation bias

      Explanation:

      Types of Bias in Statistics

      Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.

      There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      6.6
      Seconds
  • Question 123 - What is a true statement about dementia caused by Parkinson's disease? ...

    Incorrect

    • What is a true statement about dementia caused by Parkinson's disease?

      Your Answer: It is pathologically distinct from dementia with Lewy bodies

      Correct Answer: Cognitive deficits such as alexia, dyspraxia, and anomia are less pronounced in dementia due to Parkinson's

      Explanation:

      Dementia with Parkinson’s Disease: Understanding Cognitive Symptoms

      Dementia with Parkinson’s disease is a syndrome that involves a decline in memory and other cognitive domains, leading to social and occupational dysfunction. Along with motor problems, non-motor symptoms such as cognitive, behavioral, and psychological issues can also arise. There is debate over whether Lewy body dementia and dementia due to Parkinson’s are different conditions. Drugs used to treat Parkinson’s can interfere with cognitive function, and people with this type of dementia tend to have marked problems with executive function. Cholinesterase inhibitors can improve cognitive performance, but they are not well tolerated and can cause side effects. Understanding the cognitive symptoms of dementia with Parkinson’s disease is crucial for effective clinical management.

    • This question is part of the following fields:

      • Old Age Psychiatry
      21
      Seconds
  • Question 124 - A teenager is referred after experiencing a traumatic event that has caused a...

    Incorrect

    • A teenager is referred after experiencing a traumatic event that has caused a decline in their mental well-being. What would be the most helpful in distinguishing between a diagnosis of post traumatic stress disorder and adjustment disorder?

      Your Answer: The symptoms have persisted for over three months

      Correct Answer: The patient reports flashbacks

      Explanation:

      If an individual experiences symptoms that meet the criteria for Post-Traumatic Stress Disorder but the event of situation is not considered serious, they should be diagnosed with adjustment disorder instead. Additionally, it is common for individuals who have experienced a highly traumatic event to develop adjustment disorder rather than Post-Traumatic Stress Disorder. The diagnosis should be based on meeting the full diagnostic criteria for either disorder, rather than solely on the type of stressor experienced.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      9.4
      Seconds
  • Question 125 - What is the accuracy of the NICE guidelines on bulimia? ...

    Correct

    • What is the accuracy of the NICE guidelines on bulimia?

      Your Answer: Medication should not be offered as the sole treatment for bulimia

      Explanation:

      Eating Disorders: NICE Guidelines

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

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

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

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

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

      Note: These guidelines are taken from NICE guidelines 2017.

    • This question is part of the following fields:

      • General Adult Psychiatry
      8
      Seconds
  • Question 126 - Which plant species, commonly known as St John's Wort, is used for treating...

    Correct

    • Which plant species, commonly known as St John's Wort, is used for treating depression?

      Your Answer: Hypericum perforatum

      Explanation:

      Herbal Remedies for Depression and Anxiety

      Depression can be treated with Hypericum perforatum (St John’s Wort), which has been found to be more effective than placebo and as effective as standard antidepressants. However, its use is not advised due to uncertainty about appropriate doses, variation in preparations, and potential interactions with other drugs. St John’s Wort can cause serotonin syndrome and decrease levels of drugs such as warfarin and ciclosporin. The effectiveness of the combined oral contraceptive pill may also be reduced.

      Anxiety can be reduced with Piper methysticum (kava), but it cannot be recommended for clinical use due to its association with hepatotoxicity.

    • This question is part of the following fields:

      • General Adult Psychiatry
      3.4
      Seconds
  • Question 127 - A 10 year old boy has been referred by his GP due to...

    Correct

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

      Your Answer: Atomoxetine

      Explanation:

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

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      8.1
      Seconds
  • Question 128 - A 45-year-old female with a history of diabetes mellitus complains of feeling down,...

    Incorrect

    • A 45-year-old female with a history of diabetes mellitus complains of feeling down, sleeping excessively, and overeating. She is diagnosed with atypical depression and prescribed an antidepressant. However, a few days after starting the medication, she experiences weakness and ultimately has a seizure. Her blood glucose level is found to be 2.6 mmol/L (4.0-5.5). What is the most probable cause of her symptoms?

      Your Answer: Venlafaxine

      Correct Answer: Tranylcypromine

      Explanation:

      Tranylcypromine belongs to the class of drugs known as monoamine oxidase inhibitors (MAOIs), which are primarily used to treat atypical depression. However, it is important to note that MAOIs have been linked to a decrease in blood sugar levels in patients with diabetes. Furthermore, when taken together with oral hypoglycemic agents, MAOIs may intensify of prolong the hypoglycemic response.

    • This question is part of the following fields:

      • General Adult Psychiatry
      11.6
      Seconds
  • Question 129 - Which substance withdrawal is linked to symptoms of hypersomnia, hyperphagia, and irritability? ...

    Correct

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

      Your Answer: Amphetamine

      Explanation:

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      7.6
      Seconds
  • Question 130 - What is the best course of action regarding medication for a woman with...

    Correct

    • What is the best course of action regarding medication for a woman with bipolar disorder who is 6 weeks pregnant and wishes to continue the pregnancy while being stable on valproate for several years?

      Your Answer: Stop the valproate and offer an antipsychotic for prophylaxis

      Explanation:

      Valproate is a potent teratogen and should ideally be discontinued during pregnancy. However, the decision to stop must be carefully weighed against the risk of relapse, which is high in some cases. If the history suggests mild to moderate illness, continuing valproate may not be supported. In such cases, NICE Guidelines recommend stopping valproate and starting an antipsychotic as prophylaxis. Pregnancy is a high-risk period for bipolar relapse, so stopping valproate without replacing it with an antipsychotic would be unwise. A shared decision-making approach should be used to determine the best course of action. (Macfarlane, 2018)

      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
      8.8
      Seconds
  • Question 131 - A 50 year old lady with breast cancer taking Tamoxifen visits her GP...

    Correct

    • A 50 year old lady with breast cancer taking Tamoxifen visits her GP complaining of depression. The GP decides to prescribe an antidepressant. What medication should the GP steer clear of due to its interaction with Tamoxifen?

      Your Answer: Fluoxetine

      Explanation:

      Tamoxifen and Antidepressant Interactions

      Tamoxifen is a medication used to treat breast cancer by reducing relapse rates and increasing overall survival. It works by antagonizing estrogen in the breast, with its anti-estrogen affinity depending on its primary metabolite, endoxifen. However, tamoxifen is metabolized to endoxifen through the liver enzyme CYP2D6, and any drug that inhibits this enzyme can reduce the conversion of tamoxifen to endoxifen.

      Women taking tamoxifen for breast cancer treatment of prevention may also take antidepressants for psychiatric disorders of hot flushes. Some antidepressants have been found to inhibit the metabolism of tamoxifen to its more active metabolites by the CYP2D6 enzyme, thereby decreasing its anticancer effect. Strong CYP2D6 inhibitors include paroxetine, fluoxetine, bupropion, and duloxetine, while moderate inhibitors include sertraline, escitalopram, and doxepin, and venlafaxine is a weak inhibitor.

      Therefore, it is important for healthcare providers to consider potential drug interactions when prescribing antidepressants to women taking tamoxifen for breast cancer treatment of prevention.

    • This question is part of the following fields:

      • General Adult Psychiatry
      10.3
      Seconds
  • Question 132 - How can it be determined if the study on the effectiveness of a...

    Incorrect

    • How can it be determined if the study on the effectiveness of a new oral treatment for schizophrenia patients in preventing hospital admissions has yielded statistically significant results?

      Your Answer: p-value < significance level

      Correct Answer:

      Explanation:

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      4.8
      Seconds
  • Question 133 - What is a true statement about paedophilic disorder as defined by the DSM-5?...

    Incorrect

    • What is a true statement about paedophilic disorder as defined by the DSM-5?

      Your Answer: It can be diagnosed in people who report urges towards prepubescent children but who have not acted on these and feel no distress by the urges

      Correct Answer: The individual must be at least 5 years older than the child of interest to qualify for a diagnosis

      Explanation:

      There is a correlation between adult males with paedophilia and a history of childhood sexual abuse, but it is uncertain whether this relationship indicates that childhood sexual abuse causes adult paedophilia.

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      11.8
      Seconds
  • Question 134 - You are planning to develop an early intervention service for adolescents with psychosis....

    Incorrect

    • You are planning to develop an early intervention service for adolescents with psychosis. Which of the following factors is most strongly associated with a long duration of untreated psychosis?

      Your Answer: Low socioeconomic status

      Correct Answer: Insidious onset

      Explanation:

      Duration of Untreated Psychosis and its Impact on Psychotic Illness

      The longer a person with a psychotic illness goes without treatment, the more severe the outcomes become. Research has shown that when the onset of the illness is gradual, the duration of untreated psychosis tends to be longer (Morgan, 2006). This highlights the importance of early intervention and prompt treatment for individuals experiencing symptoms of psychosis. Delayed treatment can lead to poorer outcomes and a more difficult recovery process. It is crucial for healthcare professionals to recognize the signs of psychosis and provide appropriate care as soon as possible.

    • This question is part of the following fields:

      • General Adult Psychiatry
      606.2
      Seconds
  • Question 135 - What is the most efficient medication for managing Parkinson's-related psychosis? ...

    Incorrect

    • What is the most efficient medication for managing Parkinson's-related psychosis?

      Your Answer: Risperidone

      Correct Answer: Clozapine

      Explanation:

      In Parkinson’s disease, only clozapine and quetiapine are appropriate antipsychotic medications, and if one is not well-tolerated, the other may be considered.

      Parkinson’s Disease: Presentation, Aetiology, Medical Treatment, and Psychiatric Aspects

      Parkinson’s disease is a degenerative disease of the brain that is characterised by motor symptoms such as rigidity, bradykinesia, and tremor. It has a long prodromal phase and early symptoms generally present asymmetrically. The tremor associated with Parkinson’s disease is classically described as ‘pill rolling’. The principle abnormality is the degeneration of dopaminergic neurons in the pars compacta of the substantia nigra, which leads to an accumulation of alpha-synuclein in these abnormal dopaminergic cells. The majority of cases of Parkinson’s disease are idiopathic, but single gene mutations occur in a minority of cases. Pesticide, herbicide, and heavy metal exposures are linked to an increased risk of Parkinson’s disease in some epidemiologic studies, whereas smoking and caffeine use are associated with decreased risks.

      Treatment for Parkinson’s disease predominantly focuses on symptomatic relief with drugs aiming to either restore the level of dopamine in the striatum of to act on striatal postsynaptic dopamine receptors. However, as dopamine is not the only neurotransmitter involved in Parkinson’s disease, many other drugs are also being used to target specific symptoms, such as depression of dementia. Psychiatric symptoms are common in Parkinson’s disease and range from mild to severe. Factors associated with severe symptoms include age, sleep disturbance, dementia, and disease severity. Hallucinations are common in Parkinson’s disease and tend to be visual but can be auditory of tactile. In the majority of patients, psychotic symptoms are thought to be secondary to dopaminergic medication rather than due to the Parkinson’s disease itself. Anticholinergics and dopamine agonists seem to be associated with a higher risk of inducing psychosis than levodopa of catechol-O-methyltransferase inhibitors. Medications used for psychotic symptoms may worsen movement problems. Risperidone and the typicals should be avoided completely. Low dose quetiapine is the best tolerated. Clozapine is the most effective antipsychotic drug for treating psychosis in Parkinson’s disease but its use in clinical practice is limited by the need for monitoring and the additional physical risks.

    • This question is part of the following fields:

      • Old Age Psychiatry
      3.1
      Seconds
  • Question 136 - Among the listed medications, which one has the strongest evidence for reducing persistent...

    Correct

    • Among the listed medications, which one has the strongest evidence for reducing persistent aggression and violence in individuals with schizophrenia?

      Your Answer: Clozapine

      Explanation:

      Recent research suggests that clozapine may be effective in reducing persistent aggression in individuals with schizophrenia, even independent of its antipsychotic properties. However, this evidence is largely based on uncontrolled trials. Additionally, there is some indication that mood stabilizers, specifically carbamazepine, may be helpful as an adjunct treatment for assaultive behavior in schizophrenia. On the other hand, there is currently no strong evidence to support the use of benzodiazepines of high-dose antipsychotics for chronic aggression in this population. These findings were discussed in a 2005 article by Davison on the management of violence in general psychiatry.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      10.1
      Seconds
  • Question 137 - A 70-year-old patient with cognitive impairment, who was discharged from section 2 of...

    Incorrect

    • A 70-year-old patient with cognitive impairment, who was discharged from section 2 of the Mental Health Act a month ago and was under Deprivation of Liberty Safeguards, has been discovered deceased in her care home with an empty bottle of opioids beside her bed. Why is it necessary to notify the coroner?

      Your Answer: Because the patient has recently been detained under the MHA

      Correct Answer: Because the death appears to be due to self-inflicted poisoning

      Explanation:

      Guidance for Registered Medical Practitioners on the Notification of Deaths Regulations 2019

      If there is reason to suspect that the deceased died from self-inflicted poisoning, the coroner should be informed. The Notification of Deaths Regulations 2019 provides national guidance for registered medical practitioners on reporting deaths. This guidance supersedes any local protocols. There are several causes of death that must be referred to the coroner, including death from poisoning, violence of trauma, self-harm, neglect, medical procedures, employment-related injury of disease, unnatural death, unknown cause of death, death in state detention, and unidentified individuals. This does not include patients recently detained under the Mental Health Act of subject to DOLS, unless one of the above reasons applies.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      11
      Seconds
  • Question 138 - What is the percentage of individuals with alcohol dependence who have attempted of...

    Incorrect

    • What is the percentage of individuals with alcohol dependence who have attempted of completed suicide at some point in their lifetime?

      Your Answer: 10%

      Correct Answer: 7%

      Explanation:

      Alcohol Dependence and Suicide Risk

      Alcohol dependence is a significant factor that increases the likelihood of suicidal behavior. According to Inskip’s (1998) research, individuals with alcohol dependence have a lifetime risk of suicide estimated at 7%, which is significantly higher than the general population’s risk of approximately 1%. This finding highlights the importance of addressing alcohol dependence as a risk factor for suicide and providing appropriate interventions and support to individuals struggling with alcohol addiction.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      10.1
      Seconds
  • Question 139 - Who is recognized as the creator of interpersonal theory? ...

    Incorrect

    • Who is recognized as the creator of interpersonal theory?

      Your Answer: Anthony Ryle

      Correct Answer: Harry Stack Sullivan

      Explanation:

      Fonagy and Bateman – Mentalisation-Based Treatment

      Mentalisation-Based Treatment (MBT) was developed by Peter Fonagy and Anthony Bateman in the 1990s. It is a psychodynamic therapy that focuses on improving the patient’s ability to mentalise, which is the capacity to understand one’s own and others’ mental states. MBT is primarily used to treat borderline personality disorder, but it has also been used to treat other mental health conditions.

      Fonagy and Bateman work on MBT was influenced by their research on attachment theory and the importance of early relationships in shaping mentalisation abilities. They believed that individuals with borderline personality disorder have difficulties with mentalisation due to early attachment disruptions, and that MBT could help them develop more stable and secure relationships.

      MBT is typically delivered in a group of individual format, and it involves a combination of psychoeducation, cognitive-behavioral techniques, and psychodynamic interventions. The therapist helps the patient to identify and reflect on their thoughts, feelings, and behaviors, and to understand how these are influenced by their past experiences and relationships. The therapist also helps the patient to develop more adaptive coping strategies and to improve their interpersonal skills.

      Overall, Fonagy and Bateman work on MBT has contributed to the development of psychodynamic therapies that are more focused on specific treatment goals and evidence-based practices.

    • This question is part of the following fields:

      • Psychotherapy
      3.6
      Seconds
  • Question 140 - The outpatient clinic receives a 10-year-old child who is experiencing attentional problems and...

    Correct

    • The outpatient clinic receives a 10-year-old child who is experiencing attentional problems and struggling academically. After assessment, the child is diagnosed with attention deficit hyperactivity disorder, and conduct disorder features are also observed. Substance misuse is not a concern. Based on NICE guidelines, which medication is recommended for this child?

      Your Answer: Methylphenidate

      Explanation:

      The presence of conduct disorder alone does not alter the primary treatment recommendation for ADHD. Atomoxetine, which is less effective than methylphenidate, would only be considered if there is a concern about the potential for misuse of diversion.

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      7.4
      Seconds
  • Question 141 - 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
      6.2
      Seconds
  • Question 142 - What is a true statement about the utilization of lithium? ...

    Correct

    • What is a true statement about the utilization of lithium?

      Your Answer: People over the age of 65 should have lithium levels checked every 3 months once stabilised

      Explanation:

      It is recommended to check lithium levels every 6 months if the person has been stabilized for over a year, of every 3 months if there are additional factors such as older age, drug interactions, impaired renal of thyroid function, raised calcium levels, poor symptom control, poor adherence, of previous plasma lithium levels of 0.8 mmol per litre of higher. Thyroid function should also be checked every 6 months. Lithium is typically taken at night to allow for a blood test at least 12 hours after the last dose, and once-daily prescribing is preferred.

      Lithium – Clinical Usage

      Lithium is primarily used as a prophylactic agent for bipolar disorder, where it reduces the severity and number of relapses. It is also effective as an augmentation agent in unipolar depression and for treating aggressive and self-mutilating behavior, steroid-induced psychosis, and to raise WCC in people using clozapine.

      Before prescribing lithium, renal, cardiac, and thyroid function should be checked, along with a Full Blood Count (FBC) and BMI. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Once daily administration is preferred, and various preparations are available. Abrupt discontinuation of lithium increases the risk of relapse, and if lithium is to be discontinued, the dose should be reduced gradually over a period of at least 4 weeks.

      Inadequate monitoring of patients taking lithium is common, and it is often an exam hot topic. Lithium salts have a narrow therapeutic/toxic ratio, and samples should ideally be taken 12 hours after the dose. The target range for prophylaxis is 0.6–0.75 mmol/L.

      Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI and neuro symptoms.

      The severity of toxicity can be assessed using the AMDISEN rating scale.

    • This question is part of the following fields:

      • General Adult Psychiatry
      1705.4
      Seconds
  • Question 143 - What is a commonly used tool for predicting the likelihood of someone committing...

    Correct

    • What is a commonly used tool for predicting the likelihood of someone committing a sexual offense again?

      Your Answer: RRASOR

      Explanation:

      The Beck Hopelessness Scale (BHS) is a recognized instrument utilized for forecasting suicidal tendencies.

      Methods of Risk Assessment

      Methods of risk assessment are important in determining the potential harm that an individual may pose to others. There are three main methods for assessing risk to others: unstructured clinical approach, actuarial risk assessment, and structured professional judgment. The unstructured clinical approach is based solely on professional experience and does not involve any specific framework. Actuarial risk assessment uses tools that are based on statistical models of weighted factors supported by research as being predictive for future risk. Structured professional judgment combines professional judgment with a consideration of static and dynamic risk factors. Following this, the risk is formulated, and a plan is devised. There are various tools available for each method, such as the Historical-Clinical-Risk Management-20 (HCR-20) for violence, the Risk of Sexual Violence Protocol (RSVP) for sexual risk, and the Hare Psychopathy Checklist (PCL-R) for violence. It is important to use a multidisciplinary approach and consider all relevant risk factors in the formulation.

    • This question is part of the following fields:

      • Forensic Psychiatry
      5.7
      Seconds
  • Question 144 - You are requested to provide a Court report on a 30-year-old individual with...

    Incorrect

    • You are requested to provide a Court report on a 30-year-old individual with a moderate intellectual disability who is accused of committing an act of vandalism with reckless behavior. Counsel wants you to assess whether the individual is 'mute of malice'.
      What does the term 'mute of malice' mean in this context?

      Your Answer: The defendant meant no harm through his actions

      Correct Answer: The defendant is wilfully choosing not to speak

      Explanation:

      The term ‘mute of malice’ is used to describe a defendant who is intentionally refusing to speak, rather than being physically or psychologically unable to do so. It is one of three special pleas in the UK, along with ‘previously acquitted’ and ‘previously convicted’. If a defendant is suspected of being mute of malice, a pre-trial hearing will be held to determine the matter, and a not guilty plea may be entered on their behalf if they are found to be so.

      The defence of Not Guilty by Reason of Insanity (NGRI), also known as the McNaughton Rules, relates to cases where the defendant suffers from a disease of the mind and is unable to understand the nature of their actions of that they are legally wrong. If the defendant did not intend to harm others, this may be taken into account when considering the specific charge, such as arson with intent to endanger life versus reckless endangerment.

    • This question is part of the following fields:

      • Forensic Psychiatry
      188.9
      Seconds
  • Question 145 - What is a common tool used to help determine the appropriate sample size...

    Correct

    • What is a common tool used to help determine the appropriate sample size for qualitative research?

      Your Answer: Saturation

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      5
      Seconds
  • Question 146 - What is a true statement about antisocial personality disorder? ...

    Incorrect

    • What is a true statement about antisocial personality disorder?

      Your Answer: A diagnosis requires a history of criminal behaviour

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

      Explanation:

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

      Personality Disorder (Antisocial / Dissocial)

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

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

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

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

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      1280.9
      Seconds
  • Question 147 - A 65-year-old patient on clozapine has a white blood cell count of 4...

    Correct

    • A 65-year-old patient on clozapine has a white blood cell count of 4 10^9/L. Which of the following does this correspond to?

      Your Answer: This is a normal blood result

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      11.3
      Seconds
  • Question 148 - How can primary process thinking be described? ...

    Correct

    • How can primary process thinking be described?

      Your Answer: Id

      Explanation:

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

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

    • This question is part of the following fields:

      • Psychotherapy
      4.1
      Seconds
  • Question 149 - You diagnose schizophrenia in a 40 year old man. He asks you what...

    Correct

    • You diagnose schizophrenia in a 40 year old man. He asks you what the likelihood is of his child developing the condition. What percentage should you provide as an estimate?

      Your 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
      6.9
      Seconds
  • Question 150 - You are requested to provide an expert psychiatric evaluation on a 38-year-old woman...

    Incorrect

    • You are requested to provide an expert psychiatric evaluation on a 38-year-old woman who is accused of assaulting her neighbor with a kitchen knife. She has a history of uncontrolled seizures due to temporal lobe epilepsy (TLE) and claims that she cannot recall the incident as she was having a seizure at the time. Her defense counsel has inquired whether she could plead 'diminished responsibility' due to her epilepsy.
      What would be your recommendation in this case?

      Your Answer: He can make a defence of diminished responsibility as he was suffering from an abnormality of mental functioning (TLE) which substantially impaired his mental ability to understand his conduct

      Correct Answer: He cannot make a defence of diminished responsibility as the charge is attempted murder

      Explanation:

      – Diminished responsibility can only be applied in murder cases in English law
      – It diminishes the defendant’s liability for their actions
      – Criteria for diminished responsibility include:
      – Abnormality of mental functioning caused by a recognised medical condition
      – Impairment of mental ability to understand the nature of their conduct, form a rational judgement, of exercise self-control
      – Advising that the defendant did not know the nature of their act refers to Not Guilty By Reason of Insanity
      – Advising that the defendant cannot follow proceedings in court refers to Fitness to Plead
      – Epilepsy has been used as a mental health defence in both Diminished Responsibility and Not Guilty by Reason of Insanity pleas in the past.

    • This question is part of the following fields:

      • Forensic Psychiatry
      11.5
      Seconds
  • Question 151 - What is the recommended management approach for Wernicke's encephalopathy that is accompanied by...

    Correct

    • What is the recommended management approach for Wernicke's encephalopathy that is accompanied by petechial hemorrhages?

      Your Answer: Intravenous vitamin B1

      Explanation:

      Standard practice should be followed when petechial hemorrhages are observed in an MRI of a patient with Wernicke’s, as they are a typical characteristic of the disease.

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      428.9
      Seconds
  • Question 152 - In scientific research, what variable type has traditionally been used to record the...

    Incorrect

    • In scientific research, what variable type has traditionally been used to record the age of study participants?

      Your Answer: Categorical

      Correct Answer: Binary

      Explanation:

      Gender has traditionally been recorded as either male of female, creating a binary of dichotomous variable. Other categorical variables, such as eye color and ethnicity, can be grouped into two or more categories. Continuous variables, such as temperature, height, weight, and age, can be placed anywhere on a scale and have mathematical properties. Ordinal variables allow for ranking, but do not allow for direct mathematical comparisons between values.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      5.9
      Seconds
  • Question 153 - Based on statistics from England and Wales, what is the percentage of males...

    Incorrect

    • Based on statistics from England and Wales, what is the percentage of males who claim to have experienced the most severe forms of rape of sexual assault by penetration within the last year?

      Your Answer: 2%

      Correct Answer: 0.10%

      Explanation:

      Sexual Offending in England and Wales: Key Findings

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

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

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      11.3
      Seconds
  • Question 154 - According to Klerman's bipolar subtypes, which of the following refers to hypomania of...

    Correct

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

      Your Answer: Bipolar IV

      Explanation:

      Bipolar Disorder: Historical Subtypes

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      4.3
      Seconds
  • Question 155 - What is the recommended therapeutic range for lithium as a prophylactic treatment for...

    Correct

    • What is the recommended therapeutic range for lithium as a prophylactic treatment for bipolar disorder in a young and healthy adult who has recovered from their initial manic episode?

      Your Answer: 0.6–0.75 mmol/L

      Explanation:

      Lithium – Clinical Usage

      Lithium is primarily used as a prophylactic agent for bipolar disorder, where it reduces the severity and number of relapses. It is also effective as an augmentation agent in unipolar depression and for treating aggressive and self-mutilating behavior, steroid-induced psychosis, and to raise WCC in people using clozapine.

      Before prescribing lithium, renal, cardiac, and thyroid function should be checked, along with a Full Blood Count (FBC) and BMI. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

      Once daily administration is preferred, and various preparations are available. Abrupt discontinuation of lithium increases the risk of relapse, and if lithium is to be discontinued, the dose should be reduced gradually over a period of at least 4 weeks.

      Inadequate monitoring of patients taking lithium is common, and it is often an exam hot topic. Lithium salts have a narrow therapeutic/toxic ratio, and samples should ideally be taken 12 hours after the dose. The target range for prophylaxis is 0.6–0.75 mmol/L.

      Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI and neuro symptoms.

      The severity of toxicity can be assessed using the AMDISEN rating scale.

    • This question is part of the following fields:

      • General Adult Psychiatry
      10.1
      Seconds
  • Question 156 - A 25-year-old male presents with chest pain, confusion, and agitation that started shortly...

    Correct

    • A 25-year-old male presents with chest pain, confusion, and agitation that started shortly after using a recreational substance. Upon examination, he has a fever of 38.3°C and a blood pressure of 188/102 mmHg. Which recreational drug is the most probable cause of his symptoms?

      Your Answer: Cocaine

      Explanation:

      The young male is exhibiting confusion and agitation, which is likely due to drug abuse, specifically cocaine. Cocaine can cause sweating, fever, and high blood pressure through its effects on the central nervous system and adrenergic receptors. Additionally, it may lead to the constriction of coronary and cerebral arteries, potentially resulting in heart attacks of strokes.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      6.9
      Seconds
  • Question 157 - What diagnostic tool is most effective in identifying dementia? ...

    Incorrect

    • What diagnostic tool is most effective in identifying dementia?

      Your Answer: SPECT

      Correct Answer: Clinical interview

      Explanation:

      The diagnosis of dementia is based on a clinical interview, as it is a clinical syndrome.

      Dementia: An Overview

      Dementia is a syndrome that results in a decline in memory and at least one other cognitive domain, such as language, visuospatial of executive functioning. This decline is significant enough to interfere with social and occupational function in an alert person. The diagnosis of dementia is based on evidence of neurocognitive impairment, which is demonstrated by standardized neuropsychological of cognitive testing. Behavioural changes may also be present, and the symptoms result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      Epidemiology

      The total population prevalence of dementia among over 65s is 7.1%, which equals 1.3% of the entire UK population. Alzheimer’s disease is the most common cause of dementia in the UK, followed by vascular and Lewy body dementia. These conditions may coexist. The proportions of dementia severity among people with late-onset dementia are as follows: 55.4% have mild dementia, 32.1% have moderate dementia, and 12.5% have severe dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
      6
      Seconds
  • Question 158 - What statement accurately describes the World Mental Health Survey Initiative? ...

    Correct

    • What statement accurately describes the World Mental Health Survey Initiative?

      Your Answer: It includes information on severity

      Explanation:

      It is important to note that England is not involved in the WMH Survey Initiative, which may limit the generalizability of the study’s findings to our own communities.

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      11.5
      Seconds
  • Question 159 - For what age group would early onset schizophrenia be a suitable diagnosis? ...

    Incorrect

    • For what age group would early onset schizophrenia be a suitable diagnosis?

      Your Answer: Oct-16

      Correct Answer: 13-18

      Explanation:

      Schizophrenia in children is rare compared to adults, with a prevalence estimate of 0.05% for those under 15 years old. There are two classifications based on age of onset: early onset schizophrenia (EOS) when symptoms appear between 13-18 years old, and very early onset schizophrenia (VEOS) when symptoms appear at of before 13 years old. EOS and VEOS have atypical features compared to adult-onset schizophrenia, including insidious onset, more severe neurodevelopmental abnormalities, terrifying visual hallucinations, constant inappropriate of blunted affects, higher rates of familial psychopathology, minor response to treatment, and poorer outcomes. Preliminary data suggests that VEOS and EOS may be due to greater familial vulnerability from genetic, psychosocial, and environmental factors. Poor outcomes are most reliably linked to a positive history of premorbid difficulties, greater symptom severity (especially negative symptoms) at baseline, and longer duration of untreated psychosis. Age at psychosis onset and sex are not consistent predictors of outcome.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      27.8
      Seconds
  • Question 160 - What is a true statement about St John's Wort? ...

    Incorrect

    • What is a true statement about St John's Wort?

      Your Answer: It is associated with more severe adverse effects than the SSRIs

      Correct Answer: It may cause early development of macular degeneration

      Explanation:

      St John’s Wort, like other antidepressants, can lead to hypomania. While it is generally better tolerated than SSRIs, it is not recommended due to uncertainty about its active ingredient. There are potential risks associated with its use, including early macular degeneration and a risk of bleeding. Common side effects include dry mouth, nausea, constipation, fatigue, dizziness, headache, and restlessness. These considerations are outlined in the Maudsley Guidelines 10th Edition.

      Herbal Remedies for Depression and Anxiety

      Depression can be treated with Hypericum perforatum (St John’s Wort), which has been found to be more effective than placebo and as effective as standard antidepressants. However, its use is not advised due to uncertainty about appropriate doses, variation in preparations, and potential interactions with other drugs. St John’s Wort can cause serotonin syndrome and decrease levels of drugs such as warfarin and ciclosporin. The effectiveness of the combined oral contraceptive pill may also be reduced.

      Anxiety can be reduced with Piper methysticum (kava), but it cannot be recommended for clinical use due to its association with hepatotoxicity.

    • This question is part of the following fields:

      • General Adult Psychiatry
      21.3
      Seconds
  • Question 161 - What percentage of individuals with an intellectual disability cannot have a cause identified?...

    Correct

    • What percentage of individuals with an intellectual disability cannot have a cause identified?

      Your Answer: 60%

      Explanation:

      Aetiology of Intellectual Disability

      Intellectual disability (ID), previously known as learning disability, affects between 1% and 3% of the global population. The severity of ID varies, with mild cases being the most common, affecting around 85% of those with the condition. Moderate, severe, and profound cases affect 10%, 4%, and 2% of the population, respectively. The cause of ID can be attributed to environmental and/of genetic factors, although up to 60% of cases have no identifiable cause. Genetic factors are responsible for 25-50% of cases, with the likelihood increasing with the severity of the condition. Down Syndrome is the most common genetic cause of ID, while Fragile X syndrome is the most common X-linked cause and the second most common genetic cause of learning difficulty. Foetal alcohol syndrome is the most common acquired form of ID.

    • This question is part of the following fields:

      • Learning Disability
      10.2
      Seconds
  • Question 162 - In an elderly patient, which medication is the most probable cause of delirium?...

    Incorrect

    • In an elderly patient, which medication is the most probable cause of delirium?

      Your Answer: Digoxin

      Correct Answer: Pethidine

      Explanation:

      Compared to other opioids, pethidine has a greater likelihood of causing delirium. This is possibly due to its tendency to build up in the body when kidney function is compromised, leading to the formation of a metabolite that possesses anticholinergic properties.

      Risk Factors for Delirium

      Delirium is a common condition that affects many elderly individuals. There are several risk factors that can increase the likelihood of developing delirium. These risk factors include age, cognitive impairment, severe medical illness, previous history of delirium of neurological disease, psychoactive drug use, polypharmacy, and anticholinergic drug use.

      Medications are the most common reversible cause of delirium and dementia in the elderly. Certain classes of drugs, such as opioids, benzodiazepines, and anticholinergics, are strongly associated with the development of drug-induced dementia. Long-acting benzodiazepines are more troublesome than shorter-acting ones. Opioids are associated with an approximately 2-fold increased risk of delirium in medical and surgical patients. Pethidine, a member of the opioid class, appears to have a higher risk of delirium compared with other opioids due to its accumulation in individuals with impaired renal function and conversion to a metabolite with anticholinergic properties.

      Overall, it is important to be aware of these risk factors and to carefully monitor medication use in elderly individuals to prevent the development of delirium.

    • This question is part of the following fields:

      • Old Age Psychiatry
      1647.7
      Seconds
  • Question 163 - What is the most crucial test of investigation to perform when a patient...

    Correct

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

      Your Answer: Troponin

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      9.3
      Seconds
  • Question 164 - What is the most prevalent type of Down's syndrome? ...

    Correct

    • What is the most prevalent type of Down's syndrome?

      Your Answer: Trisomy 21

      Explanation:

      Down Syndrome: Causes and Risk Factors

      Down syndrome is a genetic disorder caused by the presence of extra genetic material from chromosome 21. There are three different types of Down syndrome, each with its own cause and inheritance pattern. The most common form, full trisomy 21, is not inherited and accounts for 95% of cases. It occurs when there is a failure of chromosome 21 to separate properly during cell division, resulting in an extra copy of the chromosome. This can happen randomly, with the extra chromosome coming from the mother 88% of the time and from the father 12% of the time.

      The second type, translocation Down syndrome, is inherited and accounts for 2-3% of cases. It occurs when a piece of chromosome 21 breaks off and attaches to another chromosome, resulting in extra genetic material. This type of Down syndrome is caused by a balanced translocation, which means that the parent carrying the translocation has no signs of symptoms of the disorder.

      The third type, mosaic Down syndrome, is not inherited and also accounts for 2-3% of cases. It occurs as a random event during cell division early in fetal development, resulting in some cells having an extra copy of chromosome 21 while others do not.

      The risk of having a child with Down syndrome increases as a mother gets older. At age 35, the risk is 1 in 385; at age 40, the risk is 1 in 106; and at age 45, the risk is 1 in 30. It is important for women to be aware of these risk factors and to discuss them with their healthcare provider if they are planning to have a child.

    • This question is part of the following fields:

      • Learning Disability
      5.7
      Seconds
  • Question 165 - What is the most frequently reported symptom by caregivers in cases of Munchausen's...

    Incorrect

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

      Your Answer: Rash

      Correct Answer: Apnoea

      Explanation:

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      6.9
      Seconds
  • Question 166 - The Delphi method is used to evaluate what? ...

    Correct

    • The Delphi method is used to evaluate what?

      Your Answer: Expert consensus

      Explanation:

      The Delphi Method: A Widely Used Technique for Achieving Convergence of Opinion

      The Delphi method is a well-established technique for soliciting expert opinions on real-world knowledge within specific topic areas. The process involves multiple rounds of questionnaires, with each round building on the previous one to achieve convergence of opinion among the participants. However, there are potential issues with the Delphi method, such as the time-consuming nature of the process, low response rates, and the potential for investigators to influence the opinions of the participants. Despite these challenges, the Delphi method remains a valuable tool for generating consensus among experts in various fields.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      3.1
      Seconds
  • Question 167 - A researcher wants to compare the mean age of two groups of participants...

    Incorrect

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

      Your Answer: Chi square test

      Correct Answer: Unpaired t test

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      16.1
      Seconds
  • Question 168 - What is the truth about controlled drugs in the UK? ...

    Incorrect

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

      Your Answer: Schedule two drugs require a licence from the Home Office

      Correct Answer: Controlled drug prescriptions are required for drugs under schedules 2 and 3

      Explanation:

      Drug Misuse (Law and Scheduling)

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      38
      Seconds
  • Question 169 - The national Health Department is concerned about reducing mortality rates among elderly patients...

    Incorrect

    • The national Health Department is concerned about reducing mortality rates among elderly patients with heart disease. They have tasked a team of researchers with comparing the effectiveness and economic costs of treatment options A and B in terms of life years gained. The researchers have collected data on the number of life years gained by each treatment option and are seeking advice on the next steps for analysis. What type of analysis would you recommend they undertake?

      Your Answer: Cost utility analysis

      Correct Answer: Cost effectiveness analysis

      Explanation:

      Cost effectiveness analysis (CEA) is an economic evaluation method that compares the costs and outcomes of different courses of action. The outcomes of the interventions must be measurable using a single variable, such as life years gained, making it useful for comparing preventative treatments for fatal conditions.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      35.5
      Seconds
  • Question 170 - In order to avoid the risk of relapse, the dose of clozapine will...

    Incorrect

    • In order to avoid the risk of relapse, the dose of clozapine will not be reduced despite the patient's serum clozapine level of 0.6 mg/L. As a precautionary measure against seizures, what prophylactic treatment should be considered?

      Your Answer: Carbamazepine

      Correct Answer: Valproate

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.5
      Seconds
  • Question 171 - What is the illicit substance with the highest lifetime prevalence of use in...

    Correct

    • What is the illicit substance with the highest lifetime prevalence of use in Europe?

      Your Answer: Cannabis

      Explanation:

      Drug usage patterns in the UK are comparable to those observed throughout Europe, as reported by the EMCDDA. Cannabis remains the most frequently used drug in the UK, followed by amphetamines, hallucinogens, cocaine, and ecstasy.

      Illicit Drug Use Epidemiology

      The EMCDDA regularly gathers data on the misuse of illicit drugs. A survey conducted between 2004 and 2008 revealed the following results regarding the lifetime prevalence of drug use:

      – Cannabis: 22.5%
      – Cocaine: 4.1%
      – Amphetamine: 3.7%
      – Ecstasy: 3.3%
      – Opioids*: 0.5%

      *Note that opioids were only included if they were taken for illicit purposes, rather than for pain relief.

      The above figures provide insight into the extent of illicit drug use across Europe during the survey period. While cannabis was the most commonly used drug, followed by cocaine, amphetamine, and ecstasy, opioid use was relatively low. These findings can inform public health policies and interventions aimed at reducing drug-related harm.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      5.4
      Seconds
  • Question 172 - What is a true statement about exhibitionism? ...

    Correct

    • What is a true statement about exhibitionism?

      Your Answer: Exhibitionism is highly unusual in females

      Explanation:

      According to DSM-5, it is rare for females to exhibit exhibitionistic disorder. While there have been suggestions that childhood sexual and emotional abuse, as well as hypersexuality, may increase the risk of developing exhibitionism, the causal relationship and specificity to this disorder are uncertain.

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      2.8
      Seconds
  • Question 173 - Which drug interacts with a G-coupled receptor to exert its effects? ...

    Incorrect

    • Which drug interacts with a G-coupled receptor to exert its effects?

      Your Answer: Diazepam

      Correct Answer: Heroin

      Explanation:

      The mechanism of action of heroin involves attaching to opiate receptors, which are G-coupled. This attachment results in the suppression of cellular activity through stimulation.

      Mechanisms of action for illicit drugs can be classified based on their effects on ionotropic receptors of ion channels, G coupled receptors, of monoamine transporters. Cocaine and amphetamine both increase dopamine levels in the synaptic cleft, but through different mechanisms. Cocaine directly blocks the dopamine transporter, while amphetamine binds to the transporter and increases dopamine efflux through various mechanisms, including inhibition of vesicular monoamine transporter 2 and monoamine oxidase, and stimulation of the intracellular receptor TAAR1. These mechanisms result in increased dopamine levels in the synaptic cleft and reuptake inhibition.

    • This question is part of the following fields:

      • General Adult Psychiatry
      2.9
      Seconds
  • Question 174 - Which antidepressant medication, as per NICE Guidelines, necessitates hematological monitoring (FBC) for elderly...

    Correct

    • Which antidepressant medication, as per NICE Guidelines, necessitates hematological monitoring (FBC) for elderly individuals?

      Your Answer: Mianserin

      Explanation:

      Mianserin is a type of antidepressant that falls under the category of tetracyclic antidepressants. The British National Formulary (BNF) recommends that patients undergo a full blood count every four weeks during the first three months of treatment. Even after this initial period, patients should continue to be clinically monitored. If any signs of infection, such as fever, sore throat, of stomatitis, develop, treatment should be stopped and a full blood count should be obtained.

      In 1979, there were reports of blood dyscrasias associated with mianserin, including neutropenia/leukopenia and agranulocytosis, which led to fatalities. The elderly population was particularly affected, with an excess of cases and deaths reported in this group. The estimated rate of agranulocytosis was between 1:2000 and 1:4000 exposures. These findings were controversial, and the manufacturer even went to court to prevent the drug withdrawal in the UK.

      Due to the risk of blood dyscrasias, mianserin requires close haematological monitoring for at least the first three months of use, especially in the elderly population. This monitoring requirement limits the drug’s usefulness in this group, even though it lacks cardiotoxicity.

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      5.9
      Seconds
  • Question 175 - A study examines the benefits of adding an intensive package of dialectic behavioural...

    Correct

    • A study examines the benefits of adding an intensive package of dialectic behavioural therapy (DBT) to standard care following an episode of serious self-harm in adolescents. The following results are obtained:
      Percentage of adolescents having a further episode
      of serious self harm within 3 months
      Standard care 4%
      Standard care and intensive DBT 3%
      What is the number needed to treat to prevent one adolescent having a further episode of serious self harm within 3 months?

      Your Answer: 100

      Explanation:

      The number needed to treat (NNT) is equal to 100. This means that for every 100 patients treated, one patient will benefit from the treatment. The absolute risk reduction (ARR) is 0.01, which is the difference between the control event rate (CER) of 0.04 and the experimental event rate (EER) of 0.03.

      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
      37
      Seconds
  • Question 176 - By implementing a double-blinded randomised controlled trial to evaluate the efficacy of a...

    Correct

    • By implementing a double-blinded randomised controlled trial to evaluate the efficacy of a new medication for Lewy Body Dementia, what type of bias can be prevented by ensuring that both the patient and doctor are blinded?

      Your Answer: Expectation bias

      Explanation:

      Types of Bias in Statistics

      Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.

      There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      5.2
      Seconds
  • Question 177 - What is the recommended course of action for a pregnant woman with a...

    Correct

    • 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: 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
      7.2
      Seconds
  • Question 178 - Which drug interacts with a G-coupled receptor to exert its effects? ...

    Correct

    • Which drug interacts with a G-coupled receptor to exert its effects?

      Your Answer: Cannabis

      Explanation:

      Mechanisms of action for illicit drugs can be classified based on their effects on ionotropic receptors of ion channels, G coupled receptors, of monoamine transporters. Cocaine and amphetamine both increase dopamine levels in the synaptic cleft, but through different mechanisms. Cocaine directly blocks the dopamine transporter, while amphetamine binds to the transporter and increases dopamine efflux through various mechanisms, including inhibition of vesicular monoamine transporter 2 and monoamine oxidase, and stimulation of the intracellular receptor TAAR1. These mechanisms result in increased dopamine levels in the synaptic cleft and reuptake inhibition.

    • This question is part of the following fields:

      • General Adult Psychiatry
      5.7
      Seconds
  • Question 179 - A 28-year-old pregnant patient with a family history of bipolar disorder presents in...

    Incorrect

    • A 28-year-old pregnant patient with a family history of bipolar disorder presents in a manic state. What is the recommended initial medication for treatment?

      Your Answer: Sodium valproate

      Correct Answer: Haloperidol

      Explanation:

      When a pregnant woman experiences mania of psychosis without taking any psychotropic medication, the first-line treatment option should be an antipsychotic. If the patient does not respond to the maximum dose of the antipsychotic of if the mania is severe, lithium can be considered as an alternative. However, if the patient does not respond to lithium, ECT may be considered, although the question specifically asks about pharmacological treatment. It is not recommended to use valproate to treat mental health problems in women of childbearing age due to the risk of fetal abnormalities. Diazepam is unlikely to be effective, and if benzodiazepines are necessary during pregnancy, drugs with a shorter half-life should be preferred to avoid the risk of ‘floppy baby’ syndrome.

    • This question is part of the following fields:

      • General Adult Psychiatry
      8.7
      Seconds
  • Question 180 - What does the term diagnostic overshadowing refer to in the context of learning...

    Correct

    • What does the term diagnostic overshadowing refer to in the context of learning disabilities?

      Your Answer: The assumption that the presence of a learning disability explains the entire patient's behaviour

      Explanation:

      Diagnostic Shadowing: The Danger of Assuming One Condition Explains All

      Diagnostic shadowing refers to the risk of assuming that a single condition can account for all of a patient’s behavior of symptoms. This can lead to misdiagnosis and inappropriate treatment. For instance, a patient with a learning disability may be assumed to be aggressive solely due to their disability, when in fact they may have an underlying condition such as schizophrenia that has not been identified. Failing to recognize this underlying condition can result in ineffective treatment and a failure to address the root cause of the patient’s behavior. It is important for healthcare professionals to be aware of the potential for diagnostic shadowing and to consider all possible explanations for a patient’s symptoms. By doing so, they can provide more accurate diagnoses and better care for their patients.

    • This question is part of the following fields:

      • Learning Disability
      5.8
      Seconds
  • Question 181 - Globally, which demographic has the highest incidence of completed suicides? ...

    Incorrect

    • Globally, which demographic has the highest incidence of completed suicides?

      Your Answer: 50 to 69 years

      Correct Answer: 70 and over

      Explanation:

      The elderly have the highest suicide rates globally, with variations in different regions. Some areas show a steady increase in suicide rates with age, while others have a peak in young adults that decreases in middle age. Middle-aged men in high-income countries have higher suicide rates than those in low and middle-income countries. In the UK, the highest suicide rate is among people aged 40-44, with 15/100,000 per year. Suicide in the elderly is associated with mental illness, social isolation, cognitive decline, and physical pain. Additionally, the elderly are more likely to use lethal methods when attempting suicide.

    • This question is part of the following fields:

      • Old Age Psychiatry
      6.6
      Seconds
  • Question 182 - Which of the following conditions is not considered a type of frontotemporal lobar...

    Incorrect

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

      Your Answer: None of the above

      Correct Answer: Lewy body dementia

      Explanation:

      Frontotemporal Lobar Degeneration

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

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      5.3
      Seconds
  • Question 183 - Which of the following factors does not contribute to a higher likelihood of...

    Correct

    • Which of the following factors does not contribute to a higher likelihood of developing PTSD?

      Your Answer: Male gender

      Explanation:

      The likelihood of developing PTSD is greater for females. Additionally, experiencing significant distress and dissociation during the initial traumatic event are also linked to the development of PTSD.

      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
      14.8
      Seconds
  • Question 184 - What is the IQ range for individuals who have been diagnosed with severe...

    Correct

    • What is the IQ range for individuals who have been diagnosed with severe intellectual disability?

      Your Answer: 20-34

      Explanation:

      Classification of Intellectual Disability

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

    • This question is part of the following fields:

      • Learning Disability
      5.7
      Seconds
  • Question 185 - What is the estimated percentage of patients with schizophrenia who do not respond...

    Correct

    • What is the estimated percentage of patients with schizophrenia who do not respond to treatment?

      Your Answer: 30%

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      6.4
      Seconds
  • Question 186 - Calculate the median value from the following values:
    1, 3, 3, 3, 4, 5,...

    Correct

    • Calculate the median value from the following values:
      1, 3, 3, 3, 4, 5, 5, 6, 6, 6, 6

      Your Answer: 5

      Explanation:

      Measures of Central Tendency

      Measures of central tendency are used in descriptive statistics to summarize the middle of typical value of a data set. There are three common measures of central tendency: the mean, median, and mode.

      The median is the middle value in a data set that has been arranged in numerical order. It is not affected by outliers and is used for ordinal data. The mode is the most frequent value in a data set and is used for categorical data. The mean is calculated by adding all the values in a data set and dividing by the number of values. It is sensitive to outliers and is used for interval and ratio data.

      The appropriate measure of central tendency depends on the measurement scale of the data. For nominal and categorical data, the mode is used. For ordinal data, the median of mode is used. For interval data with a normal distribution, the mean is preferable, but the median of mode can also be used. For interval data with skewed distribution, the median is used. For ratio data, the mean is preferable, but the median of mode can also be used for skewed data.

      In addition to measures of central tendency, the range is also used to describe the spread of a data set. It is calculated by subtracting the smallest value from the largest value.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      4.9
      Seconds
  • Question 187 - What is the most accurate approximation of how many children have attention deficit...

    Correct

    • What is the most accurate approximation of how many children have attention deficit hyperactivity disorder?

      Your Answer: 5%

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      5.2
      Seconds
  • Question 188 - What is the term used to describe the inclination to attribute a shift...

    Correct

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

      Your Answer: Diagnostic overshadowing

      Explanation:

      Diagnostic Overshadowing in Learning Disability

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

    • This question is part of the following fields:

      • Learning Disability
      5.1
      Seconds
  • Question 189 - Which statement accurately reflects the relationship between learning disabilities and sexual abuse? ...

    Correct

    • Which statement accurately reflects the relationship between learning disabilities and sexual abuse?

      Your Answer: The perpetrator is known to the victim in the vast majority of cases

      Explanation:

      Learning Disability and Sexual Abuse

      People with learning disabilities are at a higher risk of being abused, particularly sexually. Research has shown that around 70% of victims are female, and almost all perpetrators are male. The perpetrators can be categorized as follows: 42% are other people with learning disabilities, 18% are family members, 14% are staff of volunteers, 17% are other known adults, and 10% are unknown. These findings highlight the need for increased protection and support for individuals with learning disabilities to prevent and address instances of sexual abuse.

    • This question is part of the following fields:

      • Learning Disability
      18.2
      Seconds
  • Question 190 - A 35-year-old woman has a 10 year history of treatment resistant bipolar disorder,...

    Correct

    • A 35-year-old woman has a 10 year history of treatment resistant bipolar disorder, currently stabilized on lithium. She lives independently but has noticed a gradual weight gain of 10 pounds over the past year and is worried about it.
      What is the next step in addressing her weight gain concerns?

      Your Answer: Advise dietary counselling and exercise

      Explanation:

      To optimize the effectiveness of weight control measures, it is recommended to provide dietary counseling and encourage exercise to patients on clozapine before weight gain occurs. Nonetheless, if the patient is stable on clozapine, these interventions should still be implemented as a first step.

    • This question is part of the following fields:

      • General Adult Psychiatry
      15.4
      Seconds
  • Question 191 - What is the recommended first-line treatment for severe OCD in children? ...

    Correct

    • What is the recommended first-line treatment for severe OCD in children?

      Your Answer: CBT (including ERP)

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      6.7
      Seconds
  • Question 192 - If a 12 year old with moderate depression has not responded to psychological...

    Correct

    • If a 12 year old with moderate depression has not responded to psychological therapy, what treatment is recommended?

      Your Answer: Fluoxetine

      Explanation:

      Depression in Children and Adolescents

      The first line of treatment for depression in children and adolescents is psychological therapy. If this approach is unsuccessful, fluoxetine is the preferred treatment. If fluoxetine is also ineffective, an alternative SSRI should be considered. However, there is limited data on which SSRI is most appropriate. These recommendations are based on the Maudsley Guidelines 10th Edition.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      8.5
      Seconds
  • Question 193 - A 42-year-old man is evaluated by an occupational health physician for prolonged absence...

    Correct

    • A 42-year-old man is evaluated by an occupational health physician for prolonged absence from work. He reports persistent lower back pain as the reason for his inability to work, but the physician notes discrepancies in his physical examination and suspects a non-organic etiology. Upon further questioning, the man confesses to intentionally exaggerating his symptoms to avoid his bullying boss. What is the most appropriate diagnosis in this scenario?

      Your Answer: Malingering

      Explanation:

      Both factitious disorder and malingering involve the deliberate manifestation of symptoms, but the latter is characterized by the presence of a motive for personal gain, while the former is not.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.4
      Seconds
  • Question 194 - A father is concerned that his 16-year-old daughter's marijuana consumption may lead to...

    Correct

    • A father is concerned that his 16-year-old daughter's marijuana consumption may lead to the development of schizophrenia. How would you explain to him the difference in the risk of schizophrenia between cannabis use and non-use?

      Your Answer: There is a 2-4 fold increase in the risk of schizophrenia attributable to cannabis

      Explanation:

      Schizophrenia and Cannabis Use

      The relationship between cannabis use and the risk of developing schizophrenia is a topic of ongoing debate. However, research suggests that cannabis use may increase the risk of later schizophrenia of schizophreniform disorder by two-fold (Arseneault, 2004). The risk of developing schizophrenia appears to be higher in individuals who start using cannabis at a younger age. For instance, regular cannabis smokers at the age of 15 are 4.5 times more likely to develop schizophrenia at the age of 26, compared to those who did not report regular use until age 18 (Murray, 2004).

      A systematic review published in the Lancet in 2007 found that the lifetime risk of developing psychosis increased by 40% in individuals who had ever used cannabis (Moore, 2007). Another meta-analysis reported that the age at onset of psychosis was 2.70 years younger in cannabis users than in non-users (Large, 2011). These findings suggest that cannabis use may have a significant impact on the development of schizophrenia and related disorders.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      10
      Seconds
  • Question 195 - What is the truth about the use of clozapine in combination with other...

    Correct

    • What is the truth about the use of clozapine in combination with other medications?

      Your Answer: Tobacco smoke tends to decrease clozapine levels

      Explanation:

      The levels of clozapine are decreased by smoking.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      5.9
      Seconds
  • Question 196 - What is the method used to establish accountability for criminal actions? ...

    Correct

    • What is the method used to establish accountability for criminal actions?

      Your Answer: McNaughten rules

      Explanation:

      The issue of consent in individuals under the age of 16 is evaluated through the Gillick test, while cases of medical negligence are assessed using the Bolam test.

      Criminal Responsibility and Age Limits

      To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

      Not Guilty by Reason of Insanity and Other Defenses

      A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.

    • This question is part of the following fields:

      • Forensic Psychiatry
      3.2
      Seconds
  • Question 197 - Which of the following is an atypical characteristic of paranoid personality disorder? ...

    Correct

    • Which of the following is an atypical characteristic of paranoid personality disorder?

      Your Answer: Unusual perceptual disturbances

      Explanation:

      Schizotypal personality disorder is characterized by atypical perceptual experiences.

      Paranoid Personality Disorder is a type of personality disorder where individuals have a deep-seated distrust and suspicion of others, often interpreting their actions as malevolent. This disorder is characterized by a pattern of negative interpretations of others’ words, actions, and intentions, leading to a reluctance to confide in others and holding grudges for long periods of time. The DSM-5 criteria for this disorder include at least four of the following symptoms: unfounded suspicions of exploitation, harm, of deception by others, preoccupation with doubts about the loyalty of trustworthiness of friends of associates, reluctance to confide in others due to fear of malicious use of information, reading negative meanings into benign remarks of events, persistent grudges, perceiving attacks on one’s character of reputation that are not apparent to others and reacting angrily of counterattacking, and recurrent suspicions of infidelity in a partner without justification. The ICD-11 does not have a specific category for paranoid personality disorder but covers many of its features under the negative affectivity qualifier under the element of mistrustfulness.

    • This question is part of the following fields:

      • General Adult Psychiatry
      10
      Seconds
  • Question 198 - You are consulted for guidance on a teenage patient with schizophrenia who has...

    Correct

    • You are consulted for guidance on a teenage patient with schizophrenia who has been brought to the emergency department by the police. The patient is believed to be on olanzapine 20 mg but there are concerns about non-adherence. Initially, the patient was calm but after the police left, he started to exhibit increasing agitation. The medical team has been using physical restraints to manage the patient, but this cannot be sustained for much longer. You are asked to suggest an intravenous medication for rapid sedation. What would be an appropriate choice?

      Your Answer: IV olanzapine

      Explanation:

      According to BAP, IV olanzapine is one of the options for rapid tranquilization.

      Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.

    • This question is part of the following fields:

      • Forensic Psychiatry
      16
      Seconds
  • Question 199 - The data from England and Wales indicates what percentage of females reported experiencing...

    Correct

    • The data from England and Wales indicates what percentage of females reported experiencing the most severe crimes of rape of sexual assault by penetration within the past year?

      Your Answer: 0.50%

      Explanation:

      Sexual Offending in England and Wales: Key Findings

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

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

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      7
      Seconds
  • Question 200 - What is the accurate description of the structure of interpersonal psychotherapy? ...

    Incorrect

    • What is the accurate description of the structure of interpersonal psychotherapy?

      Your Answer: It avoids the use of medical terms such as depression

      Correct Answer: It follows three phases

      Explanation:

      Interpersonal Therapy: A Structured Approach to Addressing Social Functioning Problems

      Interpersonal therapy (IPT) is a structured form of psychotherapy that is often used to treat depression. It is based on the belief that social functioning problems have a significant impact on psychological problems. IPT is a time-limited therapy that typically runs for 10-16 one hour sessions. The therapy is organized into three phases, with the first phase involving data collection and formulation. The remaining sessions explore the formulation in more detail.

      IPT focuses on four areas of social functioning problems: grief, role transitions, interpersonal deficits, and interpersonal disputes. The therapy aims to intervene at the level of social functioning, rather than focusing on personality. The therapy has been found to be effective in treating depression, particularly in patients with severe depression. However, it may be less effective in treating people with depression and comorbid personality disorders.

      The evidence base for IPT is most developed for eating disorders, and the intervention is recommended in NICE guidelines for eating disorders. Overall, IPT is a structured approach to addressing social functioning problems that can be effective in treating depression and other psychological problems.

    • This question is part of the following fields:

      • Psychotherapy
      9.7
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

General Adult Psychiatry (38/62) 61%
Substance Misuse/Addictions (14/23) 61%
Research Methods, Statistics, Critical Review And Evidence-Based Practice (19/39) 49%
Child And Adolescent Psychiatry (15/20) 75%
Old Age Psychiatry (2/12) 17%
Psychotherapy (4/12) 33%
Organisation And Delivery Of Psychiatric Services (2/6) 33%
Forensic Psychiatry (12/18) 67%
Learning Disability (8/8) 100%
Passmed