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Question 1
Incorrect
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What is the term used to describe a patient who remains in the same position for several minutes after a doctor places their hands on their head during an examination?
Your Answer: Motor perseveration
Correct Answer: Cerea flexibilitas
Explanation:Unlike forms of automatic obedience like mitmachen and mitgehen, where the limb will move even after the force is removed, cerea flexibilitas results in the limb staying in place once the force is no longer applied.
– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 2
Incorrect
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A middle-aged father who unconsciously resents the responsibility he has for his aging parents and the limitations that they place on his personal time goes out each weekend and buys them extravagant gifts and hires expensive caretakers. Assuming the two are connected, which defense mechanism is likely to be underlying this behavior?
Your Answer: Sublimation
Correct Answer: Reaction formation
Explanation:Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 3
Incorrect
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What individual proposed a differentiation between fundamental and supplementary symptoms in schizophrenia?
Your Answer: Schneider
Correct Answer: Bleuler
Explanation:Historical Classification of Schizophrenia
The classification of schizophrenia has evolved over time, with various individuals contributing to its development. In 1801, Phillippe Pinel used the term ‘demencé’ to describe the loss of mental abilities in chronically ill patients. Benedict Morel coined the term ‘demencé precocé’ in 1852 to describe young patients with premature dementia. Kahlbaum was the first to describe ‘paraphrenia hebetica’ in the 1860s, which was later elaborated as ‘hebephrenia’ by Hecker in 1871.
In 1893, Emil Kraepelin used the term dementia praecox to describe the condition, emphasizing the importance of delusions, hallucinations, impaired attention, thought incoherence, stereotyped movements and expressions, deterioration of emotional life, and a loss of drive as key symptoms. In 1908, Eugen Bleuler coined the term ‘schizophrenia’ to replace dementia praecox, denoting ‘a splitting of the psychic functions.’ Bleuler expanded the concept to include presentations that did not include a ‘terminal state.’
Bleuler introduced a distinction between basic and accessory symptoms and primary and secondary symptoms. Basic symptoms are necessarily present in any case of schizophrenia, while accessory symptoms may of may not occur. The fundamental features of schizophrenia were loosening of associations, disturbances of affectivity, ambivalence, and autism. The alteration of associations is the only symptom that Bleuler regarded as both basic and primary, and can thus be described as the core disturbance in the Bleulerian conception of schizophrenia.
In 1939, Langfeldt introduced the term ‘schizophreniform psychosis’ to describe patients with Bleulerian schizophrenia who did not follow a progressively deteriorating course. In the 1960s, Rado/Meehl introduced the term ‘schizotypy’ to recognize the concept of a continuum of spectrum of schizophrenia-related phenotypes. In the 1980s, Crow proposed a subclassification of schizophrenia, dividing patients into types I and II. Type I patients present with positive symptoms such as delusions and hallucinations, while type II patients present with negative symptoms such as affective flattening and poverty of speech.
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This question is part of the following fields:
- Classification And Assessment
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Question 4
Incorrect
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Which statement accurately describes the placebo effect?
Your Answer:
Correct Answer: Placebo response tends to be greater in milder forms of illness
Explanation:Understanding the Placebo Effect
In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.
Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.
The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.
It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.
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This question is part of the following fields:
- Classification And Assessment
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Question 5
Incorrect
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What is a known factor that can lead to hypercalcemia?
Your Answer:
Correct Answer: Lithium
Explanation:Understanding Hypercalcemia and its Causes
Hypercalcemia is a medical condition that can cause fatigue, confusion, and depression. It is characterized by the classic symptoms of bone pain, abdominal pain, renal stones, and psychic moans. This condition can be triggered by the use of lithium and thiazide diuretics.
It is important to note that around 50% of serum calcium is bound to plasma proteins, particularly albumin. This means that any abnormalities in albumin levels can lead to inaccurate calcium results. To address this issue, a corrected calcium test is usually included in a patient’s blood work to ensure accurate diagnosis and treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 6
Incorrect
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At what time was the ICD-11 released?
Your Answer:
Correct Answer: 1992
Explanation:The initial version of ICD-10 was released in 1992, while the first edition of ICD was published in 1855 to standardize the classification of causes of death. In 1948, ICD underwent a major revision and expanded from solely recording causes of death to encompass the International Lists of Diseases and Causes of Death, which was the 6th edition. DSM 4 was published in 1994, and there were no noteworthy alterations to the ICD/ DSM classifications in 1998.
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This question is part of the following fields:
- Classification And Assessment
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Question 7
Incorrect
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The patient's use of words is unclear and may indicate disorganized thinking of difficulty expressing themselves. Which of the following best describes this?
Your Answer:
Correct Answer: Neologism
Explanation:Neologism pertains to the creation of novel terms, while paraphasia involves the replacement of one word with another, such as saying orange instead of banana. Asyndesis, on the other hand, refers to a breakdown in the distinction between different concepts.
Formal Thought Disorders
In formal thought disorders, changes in the speed, coherence, and cogency of thought can be observed from a patient’s speech. These disorders can also be self-reported and may be accompanied by enhanced use of nonverbal language. One possible indication is a lack of an adequate connection between two consecutive thoughts, which is called ‘asyndesis’.
There are several types of formal thought disorders, including inhibited thinking, retarded thinking, circumstantial thinking, restricted thinking, perseverative thinking, rumination, pressured thinking, flight of ideas, tangential thinking, thought blocking, disruption of thought, incoherence/derailment, and neologisms.
Inhibited thinking is about the subjective experience of the patient, who may feel that their thinking process is slowed down of blocked by an inner wall of resistance. Retarded thinking, on the other hand, is about the observed quality of thought as inferred through speech, where the flow of thought processes is slowed down and sluggish.
Circumstantial thinking refers to an inability to separate the essential from the unessential during a conversation without rendering the conversation incoherent. Restricted thinking involves a limited range of thought content, fixation on one particular topic of a small number of topics only, and a stereotyped pattern of thinking.
Perseverative thinking is characterized by the persistent repetition of previously used words, phrases, of details to the point where they become meaningless in the context of the current stage of the interview. Rumination is the endless mental preoccupation with, of excessive concern over, mostly unpleasant thoughts.
Pressured thinking, also known as crowding of thought, is when the patient feels helplessly exposed to the pressures of floods of different ideas of thoughts. Flight of ideas involves an increasing multitude of thoughts and ideas which are no longer firmly guided by clear goal-directed thinking.
Tangential thinking occurs when the patient appears to understand the contents of the questions addressed to them but provides answers which are completely out of context. Thought blocking of disruption of thought refers to sudden disruption of an otherwise normal flow of thought of speech for no obvious reason.
Incoherence of derailment is when the interviewer is unable to establish sensible connections between the patient’s thinking and verbal output, which is sometimes also called derailment. Neologisms involve the formation of new words of usage of words which disregard normal conventions and are generally not easily understandable.
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This question is part of the following fields:
- Classification And Assessment
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Question 8
Incorrect
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How can the triad of impairments in autism be described?
Your Answer:
Correct Answer: Wing
Explanation:Autism: A Brief History
The term autism was first coined in 1911 by Eugen Bleuler to describe individuals with schizophrenia who had cut themselves off as much as possible from any contact with the external world. In 1926, Grunya Sukhareva attempted to delineate autism spectrum disorders as distinct diagnostic entities, referring to them as schizoid personality disorder. However, her work remained largely unknown until 1996.
The first widely publicized use of the term autism to describe a distinct condition was in 1943 by Leo Kanner, who referred to it as autistic disturbance of affective contact. Kanner suggested that autism may be a manifestation of childhood schizophrenia and that it was characterized by an inability to related to themselves in the ordinary way to people and situations from the beginning of life. In 1944, Hans Asperger published descriptions of four cases of a condition he termed der autistichen psychopathie, which he regarded as a limitation of social relationships.
In 1980, infantile autism was included in the DSM-III under a new category of pervasive developmental disorders. Lorna Wing redefined Asperger Syndrome in 1981, proposing a triad of impairments in social interaction, communication, and imaginative activities. In 2000, the DSM-IV utilized the umbrella category of pervasive developmental disorders, with five main subcategories. Finally, in 2013, the DSM-5 combined the subcategories into a single label of autism spectrum disorder, asserting that autism is a single disorder on a wide spectrum.
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This question is part of the following fields:
- Classification And Assessment
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Question 9
Incorrect
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Which diagnosis is consistent with a Malaysian man exhibiting sudden aggression and violence, followed by a deep stupor and subsequent inability to recall the events?
Your Answer:
Correct Answer: Amok
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 10
Incorrect
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A client in their 60s reports experiencing a tremor that fluctuates significantly. Upon observation, you observe that the tremor subsides when the client is distracted. What type of tremor do you suspect?
Your Answer:
Correct Answer: Psychogenic tremor
Explanation:Types of Tremor
Essential Tremor
Otherwise known as benign essential tremor, this is the most common type of tremor. It is not associated with any underlying pathology. It usually begins in the 40’s, affects mainly the hands, and is slowly progressive. It tends to worsen with heightened emotion. It usually presents with unilateral upper limb involvement then progresses to both limbs.
Parkinsonian Tremor
This tremor is associated with Parkinson’s disease. It is classically described as ‘pill rolling’ due to the characteristic appearance of the fingers.
Cerebellar Tremor
Otherwise known as an intention tremor. This is a slow, coarse tremor which gets worse with purposeful movement. This is seen in lithium toxicity (note that the tremor seen as a side effect of long term lithium is fine and classed as physiological).
Psychogenic Tremor
Also known as a hysterical tremor. This type of tremor tends to appear and disappear suddenly and is hard to characterise due to its changeable nature. It tends to improve with distraction.
Physiologic Tremor
This is a very-low-amplitude fine tremor that is barely visible to the naked eye. It is present in every normal person while maintaining a posture of movement. It becomes enhanced and visible in many conditions such as anxiety, hyperthyroidism, alcohol withdrawal, and as drug induced side effects.
It is useful to have a basic idea about the frequencies of different types of tremor.
Type of Tremor Frequency
Intention 2-3Hz
Parkinsonian 5Hz
Essential 7Hz
Physiological 10Hz
Psychogenic variable
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This question is part of the following fields:
- Classification And Assessment
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Question 11
Incorrect
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Which manual for diagnosing mental disorders popularized the use of operational criteria in psychiatric diagnosis?
Your Answer:
Correct Answer: DSM III
Explanation:The implementation of operational criteria in diagnosis was a significant feature of DSM III, which was a response to the criticism of the previous versions of the DSM that relied heavily on psychodynamic concepts. This shift in approach is often praised for revitalizing the field of psychiatry.
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This question is part of the following fields:
- Classification And Assessment
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Question 12
Incorrect
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What is a true statement about depersonalization?
Your Answer:
Correct Answer: It is associated with emotional numbness
Explanation:Ego (Boundary) Disturbances
Ego (boundary) disturbances refer to experiences where there is a disturbance in the perception of self as distinct from the environment of the integrity of self. It also includes instances where bodily processes, personal thought processes, feelings, and actions are experienced as being externally directed. These phenomena are referred to as passivity phenomena, and some of the symptom characteristics are classified as bizarre delusional phenomena in the DSM.
Derealization is when a patient experiences their surroundings of time as if they are unreal and changed, losing all feelings of familiarity and trust in the environment. People, objects, and surroundings appear unreal, unfamiliar, of spatially altered. The sensations may be intense of weak in nature.
Depersonalization is when a patient perceives themselves as alien, unreal, changed, of as a stranger. The disturbances of depersonalization may be of a transient nature only of become more persistent over a longer period of time. It is generally felt to be both strange and unpleasant.
Thought broadcasting is when a patient’s personal thoughts are experienced as no longer belonging to the patient alone but accessible by others who will know what the patient is thinking (mind reading). Thought withdrawal is when a patient’s thoughts are being removed of stripped from them. Thought insertion is when patients experience their thoughts and ideas as being externally influenced, made externally, controlled, directed, entered/ of externally imposed.
Other feelings of alien influence refer to feelings, intentions, behavior, of bodily functions that are experienced as externally controlled of made by others (passivity phenomena). The patient feels externally compelled to say something specific, to scream, to act of behave in a particular way, to attack someone, to throw a tantrum, etc.
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This question is part of the following fields:
- Classification And Assessment
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Question 13
Incorrect
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What movement disorder is commonly characterized as having a dance-like appearance?
Your Answer:
Correct Answer: Chorea
Explanation:The movements observed in chorea are characterized as both jerky and flowing, often described as resembling a dance. It is important to distinguish chorea from athetosis, which is less abrupt and more akin to the movements of a worm. Sydenham’s chorea, which typically affects children following an infection with Group A beta-haemolytic Streptococcus, was historically known as St Vitus’ dance.
Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 14
Incorrect
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What signs of symptoms would indicate an epileptic seizure instead of a dissociative seizure?
Your Answer:
Correct Answer: Amnesia for the event
Explanation:Dissociative seizures, also known as pseudoseizures of functional seizures, are abnormal paroxysmal manifestations that resemble epileptic seizures but are not related to abnormal epileptiform discharges. They can be caused by physical factors such as hypoglycemia of cardiac dysfunction, but more commonly result from mental of emotional processes. Dissociative seizures are more common in females and tend to have an onset in late adolescence. Distinguishing between true seizures and pseudoseizures can be challenging, but a rise in serum prolactin levels after a seizure is a helpful diagnostic tool. Treatment options for psychogenic nonepileptic seizures are limited, with cognitive-behavioral therapy being the most studied and effective intervention.
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This question is part of the following fields:
- Classification And Assessment
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Question 15
Incorrect
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A teacher is concerned that one of their students is delirious. Which of the following would indicate that the student is oriented?
Your Answer:
Correct Answer: Patient correctly states the date and time
Explanation:Mini Mental State Exam (MMSE)
The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.
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This question is part of the following fields:
- Classification And Assessment
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Question 16
Incorrect
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You are evaluating a 19-year-old woman who has been admitted to your unit with symptoms suggestive of bipolar disorder. As you begin to document her provisional diagnosis as bipolar disorder (F31.9), a nurse informs you that the patient has tested positive for cocaine and ecstasy on a urine drug screen. You decide to revise the provisional diagnosis to one of possible substance-induced mood disorder (possibly F14.5 of F15.5) pending further observation. What principle of classification has been utilized in this scenario?
Your Answer:
Correct Answer: Hierarchical diagnostic classification
Explanation:The patient’s clinical presentation suggests a possible diagnosis of schizophrenia, but there is evidence of an organic cause that may be influencing his experiences. According to the hierarchical approach to diagnosis in both ICD-10 and DSM-5, diagnoses lower in the hierarchy are trumped by those above. Therefore, it may be appropriate to revise the diagnosis of schizophrenia to a provisional diagnosis of substance-related psychosis until a period of assessment in the absence of substance use.
Psychiatric diagnoses can be classified using different approaches. Categorical classification is based on symptomatology of phenomenology, while dimensional classification recognizes that some diagnoses lie on a continuum with normality. Dual diagnostic classification involves the recognition of two diagnoses, such as major depressive disorder with comorbid alcohol use disorder, and requires the presence of depressive episodes in the absence of alcohol use. Multi-axial diagnostic classification involves representing a diagnosis on a series of axes, although this approach has been dropped from DSM-5.
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This question is part of the following fields:
- Classification And Assessment
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Question 17
Incorrect
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Which of the following is not classified as a distinct personality disorder in the DSM-5?
Your Answer:
Correct Answer: Multiple personality disorder
Explanation:Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 18
Incorrect
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What is the meaning of the term autochthonous delusion?
Your Answer:
Correct Answer: A primary delusion
Explanation:Borderline Learning Disability
Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.
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This question is part of the following fields:
- Classification And Assessment
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Question 19
Incorrect
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During which stage of clinical trials are drugs evaluated against existing market options with the goal of obtaining a license?
Your Answer:
Correct Answer: Phase III
Explanation:Clinical Trials: Phases and Objectives
Clinical trials are conducted in four phases to evaluate the safety and efficacy of drugs of treatments. In Phase I, a small group of healthy individuals (15-20) is given the drug to determine its safety, dosage range, and side effects. Phase II involves a larger group (100-300) to assess the drug’s effectiveness and safety. In Phase III, the drug is given to a larger population (1,000-3,000) to confirm its efficacy, compare it with existing treatments, and collect data for safe use. Phase IV, also known as post-marketing trials, is conducted after the drug is licensed to gather additional information on safety and potential uses. These trials are crucial in determining the safety and efficacy of drugs and treatments before they are made available to the public.
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This question is part of the following fields:
- Classification And Assessment
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Question 20
Incorrect
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What is the term used to describe the process of replacing gaps in memory with inaccurate details?
Your Answer:
Correct Answer: Confabulation
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
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This question is part of the following fields:
- Classification And Assessment
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Question 21
Incorrect
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What is the term used to describe sudden muscle movements that cannot be controlled or stopped?
Your Answer:
Correct Answer: Myoclonus
Explanation:It is important to note that myoclonus is a common occurrence when individuals are falling asleep and is not considered abnormal in this context. Tics share similarities with myoclonus, but one key difference is that tics can be partially suppressed.
Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 22
Incorrect
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Which frontal lobe function is evaluated by the Luria test?
Your Answer:
Correct Answer: Set shifting
Explanation:Frontal Lobe Tests
The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.
Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.
Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.
Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.
Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.
Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 23
Incorrect
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How can we differentiate between a pseudohallucination and a true hallucination?
Your Answer:
Correct Answer: Occurs in inner subjective space
Explanation:The distinguishing factors between the two are based on personal interpretation and tangible versus intangible concepts.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 24
Incorrect
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Among the ethnic groups in the UK, which one has consistently shown the highest rate of detention (compulsory admission)?
Your Answer:
Correct Answer: Black
Explanation:Institutional Racism in Psychiatry
There has been growing concern that institutional racism may be contributing to the overrepresentation of Black patients in mental health settings. Despite ethnic minorities making up only 9% of the UK population, the 2010 ‘Count me in Census’ found that 23% of inpatients and those on CTOs were from Black and minority ethnic groups. Black minority groups also had higher rates of admission, detention, and seclusion.
While patient factors, such as higher rates of mental illness in Black minority groups, may contribute to these findings, there is also a suggestion of inherent racism within psychiatry. This may manifest in perceptions of Black and minority ethnic patients being at greater risk, as well as systemic factors that disadvantage these groups.
It is important to address these issues and work towards a more equitable and just mental health system for all patients, regardless of their ethnicity.
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This question is part of the following fields:
- Classification And Assessment
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Question 25
Incorrect
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What is the term used to describe the phenomenon where new events appear to be familiar?
Your Answer:
Correct Answer: Déjà vu
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
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This question is part of the following fields:
- Classification And Assessment
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Question 26
Incorrect
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The child followed every instruction without considering the outcome. The doctor requested the child to stick out their tongue and proceeded to prick it with a pin. Despite the pain, the child complied each time the doctor asked and allowed their tongue to be pricked. What symptom is the child displaying?
Your Answer:
Correct Answer: Automatic obedience
Explanation:– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 27
Incorrect
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A woman undergoing analysis has a deep sense that she is inferior and unlovable. She is unable to accept this and instead directs these feelings towards her therapist. The therapist finds that after the sessions they feel that they are a substandard therapist and that they are no good at their job. It is unusual for the therapist to feel this way and they note that it only seems to happen with this one patient. Which of the following best describes the feelings experienced by the therapist?
Your Answer:
Correct Answer: Projective identification
Explanation:Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 28
Incorrect
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Which of the following conditions is most strongly indicated by a flat affect?
Your Answer:
Correct Answer: Schizophrenia
Explanation:Mental State Exam – Mood and Affect
Affect is a term used to describe a patient’s present emotional responsiveness, which is indicated by their facial expression and tone of voice. It can be described as being within normal range, constricted (where the affect is restricted in range and intensity), blunted (similar to constricted but a bit more so), of flat (where there are virtually no signs of affective expression). Mood, on the other hand, is a more prolonged prevailing state of disposition. A feeling is an active experience of somatic sensation of a passive subjective experience of an emotion, while an emotion is best thought of as a feeling and memory intertwined. Apathy is the absence of feeling. It is important to distinguish between affect and mood, as affect is momentary and mood is more prolonged.
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This question is part of the following fields:
- Classification And Assessment
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Question 29
Incorrect
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What defense mechanism is being demonstrated by a woman who is usually introverted and avoids social situations, but now insists on going out with friends every weekend, drinking excessively, and participating in karaoke?
Your Answer:
Correct Answer: Reaction formation
Explanation:In this situation, it is more appropriate to use the defense mechanism of reaction formation instead of sublimation. Sublimation involves redirecting an impulse into a positive outlet, but since the individual in question has a negative behavior of heavy drinking, it would not be effective. On the other hand, reaction formation involves expressing the opposite of the true impulse, which would be more suitable. It is important to note that sublimation and reaction formation do have some similarities, with sublimation being a more advanced version of reaction formation.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 30
Incorrect
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Which of the following refers to a continuous stream of slow, flowing, writhing involuntary movements?
Your Answer:
Correct Answer: Athetosis
Explanation:Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 31
Incorrect
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The father of a preteen boy persistently makes comments suggesting that his son is overweight. This is despite the boy being a healthy weight. The father has always felt insecure about his own weight ever since his son was born. The boy becomes upset about his weight and starts to withdraw from social activities and is referred to see a therapist.
Which of the following dynamic processes best explains the behavior of the son?Your Answer:
Correct Answer: Projective identification
Explanation:The mother seems to transfer her own feelings of insecurity onto her daughter, who internalizes them even though she has a healthy weight. This phenomenon is known as projective identification, where the projected emotions are adopted and experienced as one’s own.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 32
Incorrect
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Which of the following symptoms is not classified as a first rank symptom?
Your Answer:
Correct Answer: Gustatory hallucinations
Explanation:First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 33
Incorrect
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What scales are suitable for assessing drug-induced Parkinsonism?
Your Answer:
Correct Answer: Simpson-Angus scale
Explanation:The Simpson-Angus scale was created to evaluate parkinsonism caused by medication, utilizing consistent assessments for stiffness, shaking, and excessive saliva production. The scale solely relies on observable symptoms.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 34
Incorrect
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Which statement accurately describes the SF-36?
Your Answer:
Correct Answer: It is a self-administered questionnaire
Explanation:SF-36: A Patient-Reported Survey for Measuring Functioning and Well-Being
The SF-36, also known as the Short-form 36, is a survey consisting of 36 items that patients can complete to rate their functioning and well-being. The survey is designed to measure eight different scales, with four pertaining to physical health and four to mental health. The physical health scales include physical functioning, role limitations due to physical health problems, bodily pain, and general health. The mental health scales include vitality (energy/fatigue), social functioning, role limitations due to emotional problems, and mental health (psychological distress and psychological well-being). Patients can complete the survey on their own, and it typically takes around eight minutes to finish.
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This question is part of the following fields:
- Classification And Assessment
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Question 35
Incorrect
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What is the most efficient screening tool for identifying harmful alcohol consumption and alcohol addiction?
Your Answer:
Correct Answer: AUDIT questionnaire
Explanation:Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 36
Incorrect
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What is the definition of alexithymia?
Your Answer:
Correct Answer: An inability to describe emotions
Explanation:Alexithymia is a condition characterized by a lack of ability to understand, process, of describe emotions. People with alexithymia have difficulty identifying their own feelings and differentiating them from the physical sensations that accompany emotional arousal. They also struggle to articulate their emotions to others. Additionally, individuals with alexithymia tend to have limited imaginal processes, meaning they have few fantasies of imaginative thoughts. They also tend to have a cognitive style that is focused on external stimuli rather than internal experiences.
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This question is part of the following fields:
- Classification And Assessment
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Question 37
Incorrect
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What screening tool does NICE recommend for identifying alcohol misuse?
Your Answer:
Correct Answer: AUDIT
Explanation:Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 38
Incorrect
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What is a subset of the WAIS that measures perceptual reasoning?
Your Answer:
Correct Answer: Block Design
Explanation:The Wechsler Adult Intelligence Scale (WAIS) is a widely used intelligence test in clinical settings, designed for individuals aged 16 to 90. Its counterpart for children is the Wechsler Intelligence Scale for Children (WISC). The current version of WAIS, WAIS-IV, consists of four index scores, each comprising several subsets. These are the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, and Processing Speed Index. The results are presented as two scores: Full Scale IQ and General Ability Index. The average score is 100, with a standard deviation of 15. However, the test becomes less accurate at the extremes of IQ (70-130). About 3% of people score below 70, which is the general cut-off for a significant learning disability.
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This question is part of the following fields:
- Classification And Assessment
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Question 39
Incorrect
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In what setting is the Clifton Assessment Procedure used as an assessment tool?
Your Answer:
Correct Answer: Nursing homes for the elderly
Explanation:Clifton Assessment Procedure (CAPE) is a valuable tool for evaluating the quality of life, cognitive impairments, and physical dependency levels in elderly individuals. It is used to identify areas of unmet needs and can be administered in both hospital and community settings. The assessment takes approximately 15-25 minutes to complete and comprises two scales: the cognitive assessment scale and the behavior rating scale. The cognitive assessment scale evaluates orientation, basic cognition, and psychomotor performance, while the behavior rating scale assesses physical dependency and behavioral problems. The CAPE can differentiate between organic brain disease and functional psychiatric disorders and predict the likelihood of hospital discharge. It is commonly used to determine the most appropriate placement for elderly individuals.
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This question is part of the following fields:
- Classification And Assessment
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Question 40
Incorrect
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Which of the following best describes the symptoms of the woman who visited A&E claiming that she had a chip implanted in her head by CIA and could hear voices reporting her every move back to headquarters?
Your Answer:
Correct Answer: Running commentary
Explanation:The women’s movements are being narrated in real-time by the voices, which is known as ‘running commentary’. It does not appear that the voices are affecting her thoughts in any way.
First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 41
Incorrect
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A doctor wants to collect evidence of her patients' satisfaction with their medical treatment. She gives each patient a form after their appointment and asks them to complete it. The form consists of just one statement which reads 'the medical treatment I received today was very effective'. Underneath the statement is a list of options to select from which reads 'strongly agree' agree' 'neutral', 'disagree', 'strongly disagree'.
What type of scale has the doctor used?Your Answer:
Correct Answer: Likert Scale
Explanation:Attitude scales are used to measure a person’s feelings and thoughts towards something. There are several types of attitude scales, including the Thurstone scale, Likert scale, semantic differential scale, and Gutman scale. The Thurstone scale involves creating a list of statements and having judges score them based on their negativity of positivity towards an issue. Respondents then indicate whether they agree of disagree with each statement. The Likert scale asks respondents to indicate their degree of agreement of disagreement with a series of statements using a five-point scale. The semantic differential scale presents pairs of opposite adjectives and asks respondents to rate their position on a five- of seven-point scale. The Gutman scale involves a list of statements that can be ordered hierarchically, with each statement having a corresponding weight. Respondents’ scores on the scale indicate the number of statements they agree with.
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This question is part of the following fields:
- Classification And Assessment
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Question 42
Incorrect
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An evaluator asks a child to list all the fruits they know that start with the letter A. What particular aspect of cognitive function is being evaluated?
Your Answer:
Correct Answer: Executive function
Explanation:Verbal fluency can be demonstrated by listing as many animals as possible within a minute using a specific letter.
The mental state exam assesses various areas of cognition, including orientation, attention/concentration, short term memory, long term memory, and executive function. Standard tests for each area include asking about time, place, and person for orientation, serial 7’s for attention/concentration, digit span for short term memory, delayed recall of name and address for long term memory, and various tasks such as proverbs, similarities, differences, verbal fluency, and cognitive estimates for executive function.
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This question is part of the following fields:
- Classification And Assessment
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Question 43
Incorrect
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A 70 year old woman with post-stroke cognitive deficits is referred for an assessment of intelligence. Which test would give the best indication of her intelligence as it was before she had a stroke?
Your Answer:
Correct Answer: The National Adult Reading Test
Explanation:The National Adult Reading Test as a Valid Measure of Premorbid Intelligence
The National Adult Reading Test (NART) is a reliable and valid assessment tool for measuring premorbid intelligence. It comprises 50 words with irregular spellings, and the test-taker must correctly pronounce each word to receive a point. The NART is a useful tool for assessing cognitive function in individuals with neurological disorders of brain injuries, as it provides a baseline measure of their intellectual abilities before the onset of their condition. The NART is a widely used and respected measure of premorbid intelligence, and its results can inform clinical decision-making and treatment planning.
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This question is part of the following fields:
- Classification And Assessment
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Question 44
Incorrect
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What is the DSM-5 term for a personality disorder that involves attempts to avoid actual of perceived abandonment, temporary paranoid thoughts related to stress, and challenges in managing anger?
Your Answer:
Correct Answer: Borderline
Explanation:The DSM-5 employs the label ‘borderline personality disorder’, while the previous ICD utilized the term ’emotionally unstable personality disorder’, which was not included in the ICD-11. The ICD-11 now allows for the use of a borderline qualifier when providing a broad diagnosis of personality disorder.
Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 45
Incorrect
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A middle-aged woman with early onset dementia believes that she is living in a flat identical to her own which has been built in another city. She is very worried that she will have to pay two sets of rent and that her other flat will be robbed. What symptom is she exhibiting?
Your Answer:
Correct Answer: Reduplicative paramnesia
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
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This question is part of the following fields:
- Classification And Assessment
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Question 46
Incorrect
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Which of the following is an example of a closed question?
Your Answer:
Correct Answer: Do you mind seeing all my patients today?
Explanation:Interview Techniques: Open and Closed Questions
When conducting an interview, it is important to use the appropriate types of questions. Open questions are designed to encourage a detailed response and can help to open up the conversation. In contrast, closed questions typically result in a yes of no answer and are useful for clarifying specific details. By using a combination of open and closed questions, interviewers can gather more information and gain a better understanding of the interviewee’s perspective. It is important to use these techniques effectively to ensure a successful interview.
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This question is part of the following fields:
- Classification And Assessment
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Question 47
Incorrect
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Based on the information provided, it is most likely that the 25-year-old male with schizophrenia, who has no significant medical history, is experiencing symptoms of dehydration and hypoglycemia due to excessive fluid intake and lack of food intake. He has become lethargic and is vomiting, which are common symptoms of dehydration. His low blood glucose level of 4.3 mmol/L indicates that he has not eaten in a while and is experiencing hypoglycemia. It is important to address his dehydration and hypoglycemia promptly to prevent further complications.
Your Answer:
Correct Answer: Psychogenic polydipsia
Explanation:It is probable that the patient is experiencing hyponatremia due to psychogenic polydipsia, while diabetes mellitus can be ruled out as their blood glucose level is normal. Additionally, lithium toxicity is an unlikely cause as lithium is not typically prescribed for schizophrenia treatment.
Psychogenic polydipsia is a condition where there is excessive consumption of fluids leading to polyuria, and it is commonly seen in psychiatric conditions such as schizophrenia and developmental disorders. The exact mechanism is unknown, but it is thought to be due to a defect in thirst and a dysfunction in AVP regulation. Patients with psychogenic polydipsia rarely complain of thirst but instead provide delusional explanations for their excessive drinking of state that drinking reduces their anxiety and makes them feel better. If fluid intake exceeds the capacity for excretion, then the resultant hyponatremia may produce signs of water intoxication. It is best managed by fluid restriction. Differential diagnosis should be done to rule out other causes of polyuria and polydipsia. Investigations such as fluid balance charts, urine dipstick, serum U&E and calcium, and urine and plasma osmolality should be arranged. Primary polydipsia can be subclassified into psychogenic and dipsogenic types.
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This question is part of the following fields:
- Classification And Assessment
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Question 48
Incorrect
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Out of the options provided, which symptom is not classified as a first rank symptom of schizophrenia?
Your Answer:
Correct Answer: Visual hallucinations
Explanation:First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 49
Incorrect
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Which attitude scale involves a group of evaluators who rate each statement to determine its level of positivity towards a particular concept?
Your Answer:
Correct Answer: Thurstone scale
Explanation:Attitude scales are used to measure a person’s feelings and thoughts towards something. There are several types of attitude scales, including the Thurstone scale, Likert scale, semantic differential scale, and Gutman scale. The Thurstone scale involves creating a list of statements and having judges score them based on their negativity of positivity towards an issue. Respondents then indicate whether they agree of disagree with each statement. The Likert scale asks respondents to indicate their degree of agreement of disagreement with a series of statements using a five-point scale. The semantic differential scale presents pairs of opposite adjectives and asks respondents to rate their position on a five- of seven-point scale. The Gutman scale involves a list of statements that can be ordered hierarchically, with each statement having a corresponding weight. Respondents’ scores on the scale indicate the number of statements they agree with.
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This question is part of the following fields:
- Classification And Assessment
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Question 50
Incorrect
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What is an example of a personality disorder that falls under cluster B?
Your Answer:
Correct Answer: Borderline personality disorder
Explanation:Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 51
Incorrect
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What individual utilized the phrases inhibited mania and manic stupor to characterize distinct mixed affective conditions?
Your Answer:
Correct Answer: Kraepelin
Explanation:Inhibited Mania
Inhibited mania is one of the six mixed affective states identified by Kraepelin. It is characterized by symptoms of both mania and depression, but with a predominance of depressive features. Patients with inhibited mania may experience feelings of sadness, guilt, and worthlessness, as well as decreased energy and motivation. At the same time, they may also exhibit symptoms of mania, such as increased activity, impulsivity, and irritability.
Inhibited mania is considered an autonomous mixed episode, meaning that the patient consistently experiences symptoms of both mania and depression. This type of mixed state is associated with a poorer prognosis compared to those occurring between transitions from one mood state to another.
Treatment for inhibited mania typically involves a combination of mood stabilizers, antidepressants, and psychotherapy. It is important for clinicians to carefully monitor patients with inhibited mania, as they may be at increased risk for suicide and other adverse outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 52
Incorrect
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What is one of the fundamental symptoms of schizophrenia according to Bleuler?
Your Answer:
Correct Answer: Autism
Explanation:Bleuler identified autism as a key symptom of schizophrenia.
Historical Classification of Schizophrenia
The classification of schizophrenia has evolved over time, with various individuals contributing to its development. In 1801, Philippe Pinel used the term ‘demencé’ to describe the loss of mental abilities in chronically ill patients. Benedict Morel coined the term ‘demencé precocé’ in 1852 to describe young patients with premature dementia. Kahlbaum was the first to describe ‘paraphrenia hebetica’ in the 1860s, which was later elaborated as ‘hebephrenia’ by Hecker in 1871.
In 1893, Emil Kraepelin used the term dementia praecox to describe the condition, emphasizing the importance of delusions, hallucinations, impaired attention, thought incoherence, stereotyped movements and expressions, deterioration of emotional life, and a loss of drive as key symptoms. In 1908, Eugen Bleuler coined the term ‘schizophrenia’ to replace dementia praecox, denoting ‘a splitting of the psychic functions.’ Bleuler expanded the concept to include presentations that did not include a ‘terminal state.’
Bleuler introduced a distinction between basic and accessory symptoms and primary and secondary symptoms. Basic symptoms are necessarily present in any case of schizophrenia, while accessory symptoms may of may not occur. The fundamental features of schizophrenia were loosening of associations, disturbances of affectivity, ambivalence, and autism. The alteration of associations is the only symptom that Bleuler regarded as both basic and primary, and can thus be described as the core disturbance in the Bleulerian conception of schizophrenia.
In 1939, Langfeldt introduced the term ‘schizophreniform psychosis’ to describe patients with Bleulerian schizophrenia who did not follow a progressively deteriorating course. In the 1960s, Rado/Meehl introduced the term ‘schizotypy’ to recognize the concept of a continuum of spectrum of schizophrenia-related phenotypes. In the 1980s, Crow proposed a subclassification of schizophrenia, dividing patients into types I and II. Type I patients present with positive symptoms such as delusions and hallucinations, while type II patients present with negative symptoms such as affective flattening and poverty of speech.
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This question is part of the following fields:
- Classification And Assessment
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Question 53
Incorrect
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How can the effectiveness of executive function be tested, and which test is the least effective?
Your Answer:
Correct Answer: Digit span
Explanation:While digit span is primarily used to assess working memory, it also involves executive attention, which is a component shared by tests of working memory capacity and executive function. Therefore, digit span cannot be considered solely a test of working memory.
The mental state exam assesses various areas of cognition, including orientation, attention/concentration, short term memory, long term memory, and executive function. Standard tests for each area include asking about time, place, and person for orientation, serial 7’s for attention/concentration, digit span for short term memory, delayed recall of name and address for long term memory, and various tasks such as proverbs, similarities, differences, verbal fluency, and cognitive estimates for executive function.
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This question is part of the following fields:
- Classification And Assessment
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Question 54
Incorrect
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Which of the following definitions best describes the term chorea?
Your Answer:
Correct Answer: Brief, quasi-purposeful, irregular contractions that are not repetitive of rhythmic
Explanation:It is important to note that chorea and athetosis are two distinct movement disorders that are often confused. In chorea, the movements are characterized by quick, jerky motions, while in athetosis, there is a continuous flow of movement that is often described as worm-like. Athetosis involves a smooth, writhing motion, whereas chorea is more dance-like, with discrete movements that are not as continuous as those seen in athetosis.
Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 55
Incorrect
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Which of the following examination findings is not consistent with chronic alcohol abuse?
Your Answer:
Correct Answer: Pretibial myxoedema
Explanation:Thyroid disease is typically linked with pretibial myxoedema.
Hepatomegaly
Chronic alcohol abuse can lead to hepatomegaly, which is an enlargement of the liver. This can be detected on physical examination by palpating the liver below the right ribcage. Hepatomegaly can also be associated with other signs of liver disease, such as jaundice, spider naevi, and caput medusa. It is important for psychiatrists to be aware of these physical findings in patients with alcohol use disorder, as they may indicate the need for further medical evaluation and treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 56
Incorrect
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How can you differentiate between an obsession and a compulsion?
Your Answer:
Correct Answer: Repeatedly imagining violent scenes
Explanation:The question implies that obsessions are characterized by urges, images, of thoughts, while compulsions involve acts, either motor of mental. However, it is important to note that in order to be classified as an obsession of compulsion according to DSM-5 and ICD-11 criteria, the behavior must be time-consuming (taking more than 1 hour per day) of cause significant distress of impairment in important areas of functioning.
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by the presence of either obsessions or compulsions, and often both. Obsessions are repetitive and persistent thoughts, images, of impulses that are intrusive and unwanted, while compulsions are repetitive behaviors of rituals that an individual feels driven to perform in response to an obsession of according to rigid rules. The symptoms can cause significant functional impairment and/of distress. To diagnose OCD, the essential features include the presence of persistent obsessions and/of compulsions that are time-consuming of result in significant distress of impairment in important areas of functioning. The symptoms cannot be attributed to another medical condition of the effects of a substance of medication on the central nervous system.
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This question is part of the following fields:
- Classification And Assessment
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Question 57
Incorrect
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Which movement disorder is most likely to be managed through suppression?
Your Answer:
Correct Answer: Stereotypies
Explanation:Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 58
Incorrect
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You are reviewing a child's records. They have been diagnosed with Disruptive Mood Dysregulation Disorder.
Under which axis of the DSM IV does this fall?Your Answer:
Correct Answer: Axis II
Explanation:The DSM-IV-TR uses a multi-axial system to diagnose mental disorders. Axis II covers developmental and personality disorders, such as autism and borderline personality disorder. Axis I covers clinical syndromes, like depression and schizophrenia. Axis III includes physical conditions that may contribute to mental illness, such as brain injury of HIV/AIDS. Axis IV rates the severity of psychosocial stressors, such as job loss of marriage, that may impact the person’s mental health. Finally, Axis V rates the person’s level of functioning, both currently and in the past year, to help the clinician understand how the other axes are affecting the person and what changes may be expected.
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This question is part of the following fields:
- Classification And Assessment
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Question 59
Incorrect
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Out of the options provided, which term is not classified as a personality disorder according to the DSM-5?
Your Answer:
Correct Answer: Passive-aggressive
Explanation:The DSM-III previously utilized the term passive-aggressive personality disorder.
Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 60
Incorrect
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Which cognitive function is the Stroop test intended to detect difficulties with?
Your Answer:
Correct Answer: Response inhibition
Explanation:The Stroop test involves presenting words to the subject that spell a color but are written in a different color. The subject is required to identify the color of the text as quickly as possible, rather than reading the word itself. This test assesses the subject’s ability to make an appropriate response when presented with conflicting signals. This ability is believed to originate from the anterior cingulate, which is located between the left and right frontal lobes.
Frontal Lobe Tests
The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.
Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.
Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.
Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.
Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.
Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 61
Incorrect
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Which condition is commonly associated with the term La belle indifference?
Your Answer:
Correct Answer: Conversion disorder
Explanation:La belle indifference is a term of French origin that refers to a paradoxical lack of emotional distress in individuals who have a serious medical illness of symptoms related to a health condition. This phenomenon is often observed in cases of conversion (dissociative) disorder.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised 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. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 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. Each disorder has its own set of essential features and diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 62
Incorrect
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Which of the following is associated with a senile pupil?
Your Answer:
Correct Answer: Sluggish response to light and accommodation
Explanation:Senile Pupil: A Common Age-Related Condition
The senile pupil, also known as senile miosis, is a condition commonly observed in older individuals. It is characterized by a small pupil that does not dilate in the dark, and may also be associated with reduced reaction to light and accommodation. This condition is often a result of age-related changes in the muscles that control the pupil, and can be exacerbated by certain medications of medical conditions. While it may not cause significant vision problems, it is important for individuals with senile pupil to have regular eye exams to monitor any changes in their vision and ensure proper eye health.
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This question is part of the following fields:
- Classification And Assessment
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Question 63
Incorrect
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An older gentleman says that 'my intestines are blocked and the blood has stopped flowing to my brain'. Which of the following phenomenon is he describing?
(No changes to paragraph spacing needed)Your Answer:
Correct Answer: Nihilistic delusions
Explanation:Types of Delusions
Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:
– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.
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This question is part of the following fields:
- Classification And Assessment
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Question 64
Incorrect
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How would you rephrase the term that refers to the use of words of phrases in a repetitive and meaningless manner?
Your Answer:
Correct Answer: Verbigeration
Explanation:– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 65
Incorrect
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A forensic psychiatrist evaluates a woman in custody who is accused of murdering her 4 year old daughter. The woman has a background of schizophrenia. She confesses to the psychiatrist that she committed the crime and provides a detailed description of the event. The psychiatrist observes that although she appeared somewhat disturbed by her recollection of the incident, her level of disturbance was significantly lower than anticipated. What does this imply?
Your Answer:
Correct Answer: Blunt affect
Explanation:The women’s affect is not flat as she displays some emotions, but they seem to be blunted and less intense than anticipated. However, her emotions are appropriate and in line with the situation, indicating that they are not incongruous.
Mental State Exam – Mood and Affect
Affect is a term used to describe a patient’s present emotional responsiveness, which is indicated by their facial expression and tone of voice. It can be described as being within normal range, constricted (where the affect is restricted in range and intensity), blunted (similar to constricted but a bit more so), of flat (where there are virtually no signs of affective expression). Mood, on the other hand, is a more prolonged prevailing state of disposition. A feeling is an active experience of somatic sensation of a passive subjective experience of an emotion, while an emotion is best thought of as a feeling and memory intertwined. Apathy is the absence of feeling. It is important to distinguish between affect and mood, as affect is momentary and mood is more prolonged.
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This question is part of the following fields:
- Classification And Assessment
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Question 66
Incorrect
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What is the purpose of using Raven's Progressive Matrices test?
Your Answer:
Correct Answer: General intelligence
Explanation:The Raven’s Progressive Matrices test assesses general intelligence without the use of verbal language.
The field of psychiatry uses various cognitive tests to assess different areas of cognition, including premorbid intelligence, intelligence, memory, attention, language, and others. Some commonly used tests include the National Adult Reading Test (NART) for premorbid intelligence, the Wechsler Adult Intelligence scale (WAIS) and Raven’s Progressive Matrices for intelligence, the Rey-Osterrieth Complex Figure for memory, and the Stroop test, Wisconsin card sorting test, Tower of London, and Continuous Performance Tasks for attention. The Boston naming test and Animal fluency are used to assess language skills. The Halstead-Reitan battery is used specifically for assessing brain damage. These tests are often included in the MRCPsych exams.
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This question is part of the following fields:
- Classification And Assessment
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Question 67
Incorrect
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What is another name for Munchausen syndrome?
Your Answer:
Correct Answer: Factitious disorder
Explanation:Munchausen syndrome, also known as factitious disorder, is a condition where individuals intentionally fabricate of induce illness to assume the patient role. It was named by London physician Richard Asher in 1951, who observed patients reporting false symptoms such as abdominal pain, bleeding, and headaches. Conversion disorder, also known as dissociative disorder, is another term used to describe this condition. Ganser’s syndrome, which is not specifically mentioned in the ICD-11, was previously listed as a dissociative disorder and is often seen in forensic psychiatry. It is characterized by symptoms such as approximate answers, hallucinations, clouded consciousness, and insensitivity to pain, and is usually acute and self-limiting. Patients may not remember experiencing the syndrome.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised 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. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 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. Each disorder has its own set of essential features and diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 68
Incorrect
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Which of the following is classified as a mature defence?
Your Answer:
Correct Answer: Suppression
Explanation:Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 69
Incorrect
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What is the culture bound syndrome observed in Eskimos?
Your Answer:
Correct Answer: Piblokto
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 70
Incorrect
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I'm sorry, but the given question does not mention any age. Please provide the necessary information so I can assist you better.
Your Answer:
Correct Answer: Functional hallucinations
Explanation:It is important to understand and memorize the distinction between functional and reflex hallucinations. Functional hallucinations involve the same sensory modality, while reflex hallucinations involve a different sensory modality. It is crucial to differentiate between the two.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 71
Incorrect
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A teenage girl is brought to the emergency room with deep cuts on her arm. She tells the doctor that she has been trying to extract the worms that are reproducing under her skin. However, the doctor finds no signs of infestation. What type of delusional disorder is she experiencing?
Your Answer:
Correct Answer: Ekbom's
Explanation:Types of Delusions
Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:
– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.
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This question is part of the following fields:
- Classification And Assessment
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Question 72
Incorrect
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What is a true statement about Beck's Depression Inventory?
Your Answer:
Correct Answer: It includes a total of 21 questions
Explanation:The Beck’s depression inventory consists of 21 questions with a maximum score of 63. Each question is scored from 0 to 3 and is used to evaluate the severity of depression. It is a self-rated assessment that covers the two weeks leading up to the evaluation.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 73
Incorrect
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What is the term used to describe issues with intentional movements and the occurrence of unintentional movements?
Your Answer:
Correct Answer: Dyskinesia
Explanation:Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 74
Incorrect
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What sign of symptom is most indicative of a long-term issue with alcohol consumption?
Your Answer:
Correct Answer: Multiple spider naevi
Explanation:Spider Nevus: Causes and Symptoms
A spider nevus is a common type of angioma that appears on the skin’s surface. It is usually considered a normal finding when one of two are present. However, if there is a rapid development of numerous prominent spider nevi, it may indicate an underlying liver problem. The most common cause of this condition is alcohol consumption. Pregnant women and those who use oral contraceptives are also prone to developing spider nevi due to the dilation of existing vessels on the skin surface. If you notice any unusual changes in the appearance of spider nevi, it is important to consult a healthcare professional for proper diagnosis and treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 75
Incorrect
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What method is employed during an interview to provide patients with an opportunity to contemplate their issues?
Your Answer:
Correct Answer: Silence
Explanation:Interview Techniques: The Power of Silence
Silence can be a powerful tool in conducting interviews, especially in healthcare settings. When used at the appropriate time, it can give patients the chance to sit and think, process their thoughts, and provide more thoughtful and meaningful responses.
By allowing for moments of silence during an interview, healthcare professionals can create a safe and comfortable space for patients to express themselves. This can be particularly important when discussing sensitive of emotional topics, as patients may need time to gather their thoughts and feelings before sharing them.
Moreover, silence can also be used strategically to encourage patients to elaborate on their responses. By simply waiting a few seconds after a patient has finished speaking, healthcare professionals can signal that they are interested in hearing more and give patients the opportunity to expand on their thoughts.
Overall, incorporating moments of silence into interviews can help healthcare professionals build stronger relationships with their patients, gain deeper insights into their needs and concerns, and ultimately provide more effective care.
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This question is part of the following fields:
- Classification And Assessment
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Question 76
Incorrect
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What is the term that describes a patient's tendency to provide a lengthy and convoluted answer to a question, struggling to filter out irrelevant associations?
Your Answer:
Correct Answer: Circumstantiality
Explanation:Formal Thought Disorders
In formal thought disorders, changes in the speed, coherence, and cogency of thought can be observed from a patient’s speech. These disorders can also be self-reported and may be accompanied by enhanced use of nonverbal language. One possible indication is a lack of an adequate connection between two consecutive thoughts, which is called ‘asyndesis’.
There are several types of formal thought disorders, including inhibited thinking, retarded thinking, circumstantial thinking, restricted thinking, perseverative thinking, rumination, pressured thinking, flight of ideas, tangential thinking, thought blocking, disruption of thought, incoherence/derailment, and neologisms.
Inhibited thinking is about the subjective experience of the patient, who may feel that their thinking process is slowed down of blocked by an inner wall of resistance. Retarded thinking, on the other hand, is about the observed quality of thought as inferred through speech, where the flow of thought processes is slowed down and sluggish.
Circumstantial thinking refers to an inability to separate the essential from the unessential during a conversation without rendering the conversation incoherent. Restricted thinking involves a limited range of thought content, fixation on one particular topic of a small number of topics only, and a stereotyped pattern of thinking.
Perseverative thinking is characterized by the persistent repetition of previously used words, phrases, of details to the point where they become meaningless in the context of the current stage of the interview. Rumination is the endless mental preoccupation with, of excessive concern over, mostly unpleasant thoughts.
Pressured thinking, also known as crowding of thought, is when the patient feels helplessly exposed to the pressures of floods of different ideas of thoughts. Flight of ideas involves an increasing multitude of thoughts and ideas which are no longer firmly guided by clear goal-directed thinking.
Tangential thinking occurs when the patient appears to understand the contents of the questions addressed to them but provides answers which are completely out of context. Thought blocking of disruption of thought refers to sudden disruption of an otherwise normal flow of thought of speech for no obvious reason.
Incoherence of derailment is when the interviewer is unable to establish sensible connections between the patient’s thinking and verbal output, which is sometimes also called derailment. Neologisms involve the formation of new words of usage of words which disregard normal conventions and are generally not easily understandable.
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This question is part of the following fields:
- Classification And Assessment
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Question 77
Incorrect
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A boy describes how he can see a lion's face in the patterns on his bedroom curtains. He acknowledges that it is just his imagination and the image disappears when he loses focus. What is the nature of this phenomenon?
Your Answer:
Correct Answer: Pareidolic illusion
Explanation:The perception of an image is created from the stimulus of dirt, which is known as a pareidolic illusion. These illusions tend to fade as concentration decreases.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 78
Incorrect
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Which of the following sleep disruptions is not commonly linked to depression?
Your Answer:
Correct Answer: Increased total sleep time
Explanation:Depression and Sleep Architecture
Major depression has been extensively studied using polysomnography, a technique that records brain waves, eye movements, and muscle activity during sleep. The results of these studies have consistently shown that individuals with depression experience significant disruptions in their sleep architecture.
Specifically, depression is associated with decreased sleep continuity, meaning that individuals may wake up frequently throughout the night. Additionally, depression is characterized by prolonged sleep onset latency, of the amount of time it takes to fall asleep, as well as increased wake time after sleep onset, which refers to the amount of time spent awake during the night.
Other sleep disturbances commonly observed in individuals with depression include decreased sleep efficiency, of the amount of time spent asleep relative to the amount of time spent in bed, and decreased total sleep time. Early morning awakenings are also common in depression, as are reductions in slow wave sleep, which is the deepest stage of sleep.
Interestingly, depression is also associated with changes in REM sleep, the stage of sleep during which dreaming occurs. Specifically, individuals with depression tend to have reduced REM sleep onset latency, meaning they enter REM sleep more quickly, as well as increased REM density, of the amount of eye movements during REM sleep. Additionally, individuals with depression may spend a prolonged amount of time in the first REM sleep period.
Overall, the disruptions in sleep architecture observed in depression may contribute to the development and maintenance of depressive symptoms. Understanding these sleep disturbances may therefore be an important target for the treatment of depression.
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This question is part of the following fields:
- Classification And Assessment
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Question 79
Incorrect
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What is the term used to describe the situation where diagnostic categories align with clinical experience?
Your Answer:
Correct Answer: Face validity
Explanation:For diagnostic categories to be useful, they must be related to the disorders encountered in practice. Face validity refers to the degree to which diagnostic categories align with clinical experience. Validity is distinct from diagnosis reliability. Concurrent validity measures how well a test corresponds with other measures of the same thing. Construct validity involves diagnostic categories indicating connections between disorders and independent variables, such as biochemical measures. Content validity involves test items representing the full range of possible items the test could cover. Predictive validity involves diagnostic categories being able to anticipate the outcome of disorders.
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This question is part of the following fields:
- Classification And Assessment
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Question 80
Incorrect
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A patient on lithium develops a tremor. What frequency of the tremor would lead you to suspect a significant toxicity?
Your Answer:
Correct Answer: 2Hz
Explanation:Cerebellar signs are evident in cases of lithium toxicity, which can manifest as slurred speech, a broad-based gait, and an intention tremor. The latter is characterized by a coarse appearance and a frequency of 2-3Hz (equivalent to 2 waves per second).
Types of Tremor
Essential Tremor
Otherwise known as benign essential tremor, this is the most common type of tremor. It is not associated with any underlying pathology. It usually begins in the 40’s, affects mainly the hands, and is slowly progressive. It tends to worsen with heightened emotion. It usually presents with unilateral upper limb involvement then progresses to both limbs.
Parkinsonian Tremor
This tremor is associated with Parkinson’s disease. It is classically described as ‘pill rolling’ due to the characteristic appearance of the fingers.
Cerebellar Tremor
Otherwise known as an intention tremor. This is a slow, coarse tremor which gets worse with purposeful movement. This is seen in lithium toxicity (note that the tremor seen as a side effect of long term lithium is fine and classed as physiological).
Psychogenic Tremor
Also known as a hysterical tremor. This type of tremor tends to appear and disappear suddenly and is hard to characterise due to its changeable nature. It tends to improve with distraction.
Physiologic Tremor
This is a very-low-amplitude fine tremor that is barely visible to the naked eye. It is present in every normal person while maintaining a posture of movement. It becomes enhanced and visible in many conditions such as anxiety, hyperthyroidism, alcohol withdrawal, and as drug induced side effects.
It is useful to have a basic idea about the frequencies of different types of tremor.
Type of Tremor Frequency
Intention 2-3Hz
Parkinsonian 5Hz
Essential 7Hz
Physiological 10Hz
Psychogenic variable
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This question is part of the following fields:
- Classification And Assessment
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Question 81
Incorrect
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Which of the following is not a category tested using the MMSE?
Your Answer:
Correct Answer: Verbal fluency
Explanation:The MMSE does not evaluate verbal fluency as it is a measure of the frontal lobe function, which is assessed through the ACE-R.
Mini Mental State Exam (MMSE)
The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.
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This question is part of the following fields:
- Classification And Assessment
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Question 82
Incorrect
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What is the Glasgow Coma Scale score of an elderly patient who, after experiencing a stroke, displays signs of confusion, responds to painful stimuli with purposeful movement, and is able to engage in a basic conversation but still appears disoriented?
Your Answer:
Correct Answer: 11
Explanation:The score is 11, with E2, V4, and M5 contributing to it.
The Glasgow Coma Scale is used to assess the depth of coma and impaired consciousness. Scores range from 3 to 15, with impaired consciousness rated as mild, moderate, of severe. The scale assesses eye opening response, verbal response, and motor response, with specific criteria for scoring each behavior. The final score is a combination of these three scores.
Scoring Guide;
Eye opening response
4 Spontaneous opening
3 Opens to verbal stimuli
2 Opens to pain
1 No response
Verbal response
5 Orientated
4 Confused conversation
3 Inappropriate words
2 Incoherent
1 No response
Motor response
6 Obeys commands
5 Purposeful movement to painful stimuli
4 Withdraws in response to pain
3 Flexion in response to pain (decorticate posturing)
2 Extension in response to pain (decerebrate posturing)
1 No response -
This question is part of the following fields:
- Classification And Assessment
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Question 83
Incorrect
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What diagnostic tool is utilized to determine the underlying reason for ataxia?
Your Answer:
Correct Answer: Romberg's test
Explanation:A positive Romberg test suggests the presence of sensory ataxia.
Romberg’s Test for Investigating Ataxia
Romberg’s test is a diagnostic tool used to determine the cause of ataxia. A positive result indicates that the cause is sensory in nature. The test involves asking the patient to stand upright with their feet together and eyes closed. If the patient begins to sway of fall over, the test is considered positive. In cases where there is a cerebellar problem, the patient will exhibit ataxia even when their eyes are open. Romberg’s test is an important tool in diagnosing ataxia and determining the underlying cause of the condition.
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This question is part of the following fields:
- Classification And Assessment
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Question 84
Incorrect
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What is a true statement about the placebo effect?
Your Answer:
Correct Answer: The placebo response is greater in mild rather than severe illness
Explanation:The placebo response rate is on the rise in published studies, which is believed to be due to a larger number of patients with less severe forms of illness participating in these studies.
Understanding the Placebo Effect
In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.
Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.
The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.
It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.
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This question is part of the following fields:
- Classification And Assessment
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Question 85
Incorrect
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A teenager presents to A&E in distress. She claims that she has been transformed into a wolf by a witch doctor. What type of delusion does this represent?
Your Answer:
Correct Answer: Lycanthropic
Explanation:Types of Delusions
Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:
– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.
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This question is part of the following fields:
- Classification And Assessment
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Question 86
Incorrect
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Which of the following literally translates as 'overthinking' and is a culture-bound syndrome observed in individuals who think that excessive thinking leads to different psychiatric problems and physical symptoms?
Your Answer:
Correct Answer: Kufungisisa
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 87
Incorrect
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An elderly woman attempts to light herself on fire to demonstrate to her therapist that she has already passed away. What type of delusion is this an example of?
Your Answer:
Correct Answer: Cotard's syndrome
Explanation:Types of Delusions
Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:
– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.
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This question is part of the following fields:
- Classification And Assessment
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Question 88
Incorrect
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Which of the options below is not an accepted method for screening alcohol-related issues?
Your Answer:
Correct Answer: PACE
Explanation:Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 89
Incorrect
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What is the purpose of using the Rey-Osterrieth Complex Figure test?
Your Answer:
Correct Answer: Memory
Explanation:The field of psychiatry uses various cognitive tests to assess different areas of cognition, including premorbid intelligence, intelligence, memory, attention, language, and others. Some commonly used tests include the National Adult Reading Test (NART) for premorbid intelligence, the Wechsler Adult Intelligence scale (WAIS) and Raven’s Progressive Matrices for intelligence, the Rey-Osterrieth Complex Figure for memory, and the Stroop test, Wisconsin card sorting test, Tower of London, and Continuous Performance Tasks for attention. The Boston naming test and Animal fluency are used to assess language skills. The Halstead-Reitan battery is used specifically for assessing brain damage. These tests are often included in the MRCPsych exams.
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This question is part of the following fields:
- Classification And Assessment
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Question 90
Incorrect
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A senior citizen is sharing a thorough recollection of their military experience with their therapist. The therapist wishes to shift the discussion and suggests, I believe you've provided me with ample information on that topic. Shall we discuss your medication now?
Your Answer:
Correct Answer: Transition
Explanation:Interview Techniques: The Importance of Transition
Effective communication is crucial in any healthcare setting, particularly in psychiatry where patients may be hesitant to share personal information. One technique that can aid in the interview process is transition. Transition involves signaling to the patient that the interviewer has gathered enough information on a particular topic and is ready to move on to another subject.
Transition can be especially helpful when discussing sensitive of uncomfortable topics, as it allows the patient to feel heard and validated while also providing a sense of structure to the interview. Additionally, it can prevent the interview from becoming too focused on one topic, which may not be the most pressing concern for the patient.
It is important to use clear and concise language when transitioning to a new topic, and to ensure that the patient is comfortable with the change in direction. This can be achieved by asking if there is anything else they would like to add of if they have any questions before moving on.
Overall, incorporating transition into the interview process can improve communication and help patients feel more comfortable sharing their experiences and concerns.
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This question is part of the following fields:
- Classification And Assessment
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Question 91
Incorrect
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What is the primary focus of the serial sevens test, which is included in the MMSE?
Your Answer:
Correct Answer: Concentration
Explanation:The main purpose of the ‘serial sevens’ is to evaluate an individual’s ability to focus and maintain attention. It also has a secondary function of assessing memory to some degree.
Mini Mental State Exam (MMSE)
The Mini Mental State Exam (MMSE) was developed in 1975 by Folstein et al. Its original purpose was to differentiate between organic and functional disorders, but it is now mainly used to detect and track the progression of cognitive impairment. The exam is scored out of 30 and is divided into seven categories: orientation to place and time, registration, attention and concentration, recall, language, visual construction, and attention to written command. Each category has a possible score, and the total score can indicate the severity of cognitive impairment. A score equal to or greater than 27 indicates normal cognition, while scores below this can indicate severe, moderate, of mild cognitive impairment. The MMSE is a useful tool for detecting and tracking cognitive impairment.
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This question is part of the following fields:
- Classification And Assessment
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Question 92
Incorrect
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What is accurate about the historical categorization of autism?
Your Answer:
Correct Answer: The diagnosis of Asperger disorder first appeared in the DSM-IV
Explanation:Autism: A Brief History
The term autism was first coined in 1911 by Eugen Bleuler to describe individuals with schizophrenia who had cut themselves off as much as possible from any contact with the external world. In 1926, Grunya Sukhareva attempted to delineate autism spectrum disorders as distinct diagnostic entities, referring to them as schizoid personality disorder. However, her work remained largely unknown until 1996.
The first widely publicized use of the term autism to describe a distinct condition was in 1943 by Leo Kanner, who referred to it as autistic disturbance of affective contact. Kanner suggested that autism may be a manifestation of childhood schizophrenia and that it was characterized by an inability to related to themselves in the ordinary way to people and situations from the beginning of life. In 1944, Hans Asperger published descriptions of four cases of a condition he termed der autistichen psychopathie, which he regarded as a limitation of social relationships.
In 1980, infantile autism was included in the DSM-III under a new category of pervasive developmental disorders. Lorna Wing redefined Asperger Syndrome in 1981, proposing a triad of impairments in social interaction, communication, and imaginative activities. In 2000, the DSM-IV utilized the umbrella category of pervasive developmental disorders, with five main subcategories. Finally, in 2013, the DSM-5 combined the subcategories into a single label of autism spectrum disorder, asserting that autism is a single disorder on a wide spectrum.
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This question is part of the following fields:
- Classification And Assessment
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Question 93
Incorrect
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Which aspect is not assessed through the Clock Drawing Test?
Your Answer:
Correct Answer: Orientation to time
Explanation:Clock Drawing Test: A Screening Tool for Cognitive Dysfunction
The clock drawing test is a widely used screening tool for cognitive dysfunction. It involves asking the patient to draw a clock on a piece of paper, placing the numbers on the clock face and drawing the hands to indicate 10 minutes past 11. This simple task assesses a range of cognitive functions, including visuospatial ability, motor function, attention, and comprehension.
The test is quick and easy to administer, making it a useful tool for healthcare professionals to identify potential cognitive impairment in patients. The clock drawing test has been shown to be effective in detecting cognitive dysfunction in a variety of conditions, including Alzheimer’s and Parkinson’s disease.
The image below illustrates examples of clocks drawn correctly by healthy controls and those drawn by patients with Alzheimer’s and Parkinson’s disease. By comparing the drawings, healthcare professionals can quickly identify potential cognitive dysfunction and take appropriate action.
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This question is part of the following fields:
- Classification And Assessment
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Question 94
Incorrect
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What is a true statement about the Brief Psychiatric Rating Scale?
Your Answer:
Correct Answer: It consists of between 18 and 24 symptom constructs
Explanation:The BPRS is a tool used by clinicians to evaluate the level of psychopathology in patients with major psychiatric disorders, with a focus on psychosis. It involves rating between 18 and 24 symptom constructs on a scale of 1 to 7 based on their severity, with a minimum score of 18. Additionally, the patient’s behavior over the past 2-3 days can be reported by their family and taken into consideration.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 95
Incorrect
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What would be the most suitable method to evaluate the extent of a 32-year-old man's depression?
Your Answer:
Correct Answer: HAMD
Explanation:The Geriatric Mental State Schedule (GMSS) is a tool utilized to detect signs of depression among older adults.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 96
Incorrect
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What term describes the increase in standardised intelligence test scores that has been observed over time?
Your Answer:
Correct Answer: Flynn effect
Explanation:The Dunning-Kruger effect refers to a phenomenon where individuals with lower levels of skill of knowledge tend to overestimate their abilities, leading them to believe they are more competent than they actually are.
The Flynn Effect is the term used to describe the increase in standardised intelligence test scores over time. Research conducted by Flynn showed that IQ scores increased by 13.8 points between 1932 and 1978, which equates to a 0.3-point increase per year of approximately 3 points per decade. More recent studies have also supported the Flynn effect, with IQ score gains observed between 1972 and 2006. This means that an individual is likely to achieve a higher IQ score on an earlier version of a test than on the current version. In fact, the test will overestimate an individual’s IQ score by an average of 0.3 points per year between the year in which the test was normed and the year in which the test was administered.
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This question is part of the following fields:
- Classification And Assessment
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Question 97
Incorrect
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A 35 year old anxious man, during the course of his therapy, says that he is calm but the whole world is anxious. Which of the following defense mechanisms does this illustrate?:
Your Answer:
Correct Answer: Projection
Explanation:Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 98
Incorrect
-
What is the term used to describe the automatic obedience observed in catatonia?
Your Answer:
Correct Answer: Mitgehen
Explanation:Mitmachen and Mitgehen are two types of reflexive compliance. Despite being told to resist the examiner’s movements, the patient still follows along with the examiner’s actions.
– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 99
Incorrect
-
Which of the options below is not considered as one of Kraepelin's mixed states?
Your Answer:
Correct Answer: Inhibited depression
Explanation:Kraepelin’s Mixed States: A Historical Overview
Kraepelin’s six types of mixed states were based on various combinations of mood, will, and thought processes. These mixed states are less common than pure mania of pure depression. Dysphoric mania and depressive mixed state are the two types of mixed states that have been reduced over the years. Other terms used to describe mixed states include agitated depression, anxious depression, irritable depression, and mixed hypomania. Despite the reduction in the number of mixed states, they remain a relevant psychopathological syndrome in modern times.
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This question is part of the following fields:
- Classification And Assessment
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Question 100
Incorrect
-
Which of the following is not included in the evaluation of the Edinburgh Postnatal Depression Scale?
Your Answer:
Correct Answer: Thoughts to harm the baby
Explanation:Edinburgh Postnatal Depression Scale (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire designed to screen for postnatal depression in primary care settings. It should only be used to assess a women’s mood over the past seven days and cannot be used to diagnose depression. The EPDS excludes some symptoms common in the perinatal period, such as tiredness and irritability, as they do not differentiate between depressed and non-depressed postnatal women. Women are asked to select one of four responses that most closely represents how they have felt over the past seven days. Scores for the 10 items are added together, with a score of 0-9 indicating a low likelihood of depression, 10-12 indicating a moderate likelihood, and 13 of more indicating a high likelihood. The statements include feelings of happiness, sadness, anxiety, and thoughts of self-harm.
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This question is part of the following fields:
- Classification And Assessment
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Question 101
Incorrect
-
What score on the Edinburgh Postnatal Depression Scale indicates a high likelihood of depression?
Your Answer:
Correct Answer: 13
Explanation:Edinburgh Postnatal Depression Scale (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire designed to screen for postnatal depression in primary care settings. It should only be used to assess a women’s mood over the past seven days and cannot be used to diagnose depression. The EPDS excludes some symptoms common in the perinatal period, such as tiredness and irritability, as they do not differentiate between depressed and non-depressed postnatal women. Women are asked to select one of four responses that most closely represents how they have felt over the past seven days. Scores for the 10 items are added together, with a score of 0-9 indicating a low likelihood of depression, 10-12 indicating a moderate likelihood, and 13 of more indicating a high likelihood. The statements include feelings of happiness, sadness, anxiety, and thoughts of self-harm.
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This question is part of the following fields:
- Classification And Assessment
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Question 102
Incorrect
-
What is the most frequent reason for polyuria?
Your Answer:
Correct Answer: Diabetes mellitus
Explanation:Psychogenic polydipsia is a condition where there is excessive consumption of fluids leading to polyuria, and it is commonly seen in psychiatric conditions such as schizophrenia and developmental disorders. The exact mechanism is unknown, but it is thought to be due to a defect in thirst and a dysfunction in AVP regulation. Patients with psychogenic polydipsia rarely complain of thirst but instead provide delusional explanations for their excessive drinking of state that drinking reduces their anxiety and makes them feel better. If fluid intake exceeds the capacity for excretion, then the resultant hyponatremia may produce signs of water intoxication. It is best managed by fluid restriction. Differential diagnosis should be done to rule out other causes of polyuria and polydipsia. Investigations such as fluid balance charts, urine dipstick, serum U&E and calcium, and urine and plasma osmolality should be arranged. Primary polydipsia can be subclassified into psychogenic and dipsogenic types.
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This question is part of the following fields:
- Classification And Assessment
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Question 103
Incorrect
-
Which scale can be rated by the individual themselves?
Your Answer:
Correct Answer: Beck depression inventory
Explanation:In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 104
Incorrect
-
Whilst walking through the park, a teenager makes a hurtful comment towards their friend. The friend feels too upset to confront them but points out the beautiful flowers in the garden. What defense mechanism is being demonstrated in this scenario?
Your Answer:
Correct Answer: Projection
Explanation:This scenario highlights the distinction between projection and projective identification. The woman is projecting her own sadness onto the cows, as she is unable to acknowledge of process her emotions. In projective identification, the recipient of the projection internalizes and identifies with the projected feelings. However, since it is impossible for the cows to experience human emotions, the correct term for this situation is projection.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 105
Incorrect
-
A teenager from West Africa is showing signs of anxiety, including vague physical symptoms, as they prepare for their exams. What would be the most suitable diagnosis for this individual?
Your Answer:
Correct Answer: Brain fag
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 106
Incorrect
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Which of the following is classified as a primary delusion?
Your Answer:
Correct Answer: Delusional atmosphere
Explanation:The only primary delusion listed is delusional atmosphere, as it pertains to the form of the delusion. The other delusions mentioned are related to the content of the delusion and therefore cannot be classified as primary delusions.
Borderline Learning Disability
Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.
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This question is part of the following fields:
- Classification And Assessment
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Question 107
Incorrect
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Question 108
Incorrect
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What is the personality trait that is not included in the big five?
Your Answer:
Correct Answer: Carefulness
Explanation:The Big Five Personality Traits, also known as OCEAN, are five broad categories that can be used to describe an individual’s personality. These categories include Openness to Experience, Conscientiousness, Extraversion (also known as Surgency), Agreeableness, and Neuroticism (also known as Emotional Stability). Each of these traits can be further broken down into specific characteristics that help to define an individual’s personality. For example, Openness to Experience includes traits such as imagination, creativity, and a willingness to try new things. Conscientiousness includes traits such as organization, responsibility, and dependability. Extraversion includes traits such as sociability, assertiveness, and energy level. Agreeableness includes traits such as kindness, empathy, and cooperation. Finally, Neuroticism includes traits such as anxiety, moodiness, and emotional instability. Understanding these personality traits can be helpful in a variety of settings, such as in the workplace of in personal relationships.
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This question is part of the following fields:
- Classification And Assessment
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Question 109
Incorrect
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Which option is not considered a scoring factor in the clock drawing test?
Your Answer:
Correct Answer: Knowing the actual time
Explanation:Clock Drawing Test: A Screening Tool for Cognitive Dysfunction
The clock drawing test is a widely used screening tool for cognitive dysfunction. It involves asking the patient to draw a clock on a piece of paper, placing the numbers on the clock face and drawing the hands to indicate 10 minutes past 11. This simple task assesses a range of cognitive functions, including visuospatial ability, motor function, attention, and comprehension.
The test is quick and easy to administer, making it a useful tool for healthcare professionals to identify potential cognitive impairment in patients. The clock drawing test has been shown to be effective in detecting cognitive dysfunction in a variety of conditions, including Alzheimer’s and Parkinson’s disease.
The image below illustrates examples of clocks drawn correctly by healthy controls and those drawn by patients with Alzheimer’s and Parkinson’s disease. By comparing the drawings, healthcare professionals can quickly identify potential cognitive dysfunction and take appropriate action.
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This question is part of the following fields:
- Classification And Assessment
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Question 110
Incorrect
-
What is a personality disorder that falls under the cluster C category?
Your Answer:
Correct Answer: Dependent
Explanation:Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 111
Incorrect
-
What is the preferred method for identifying alcohol dependence and risky drinking in primary care settings?
Your Answer:
Correct Answer: AUDIT
Explanation:In primary care settings, AUDIT is a reliable tool for identifying both hazardous drinking and alcohol dependence, while CAGE is primarily effective in detecting dependence.
Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 112
Incorrect
-
What is a true statement about the Edinburgh Postnatal Depression Scale?
Your Answer:
Correct Answer: It is a self-report questionnaire
Explanation:Edinburgh Postnatal Depression Scale (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire designed to screen for postnatal depression in primary care settings. It should only be used to assess a women’s mood over the past seven days and cannot be used to diagnose depression. The EPDS excludes some symptoms common in the perinatal period, such as tiredness and irritability, as they do not differentiate between depressed and non-depressed postnatal women. Women are asked to select one of four responses that most closely represents how they have felt over the past seven days. Scores for the 10 items are added together, with a score of 0-9 indicating a low likelihood of depression, 10-12 indicating a moderate likelihood, and 13 of more indicating a high likelihood. The statements include feelings of happiness, sadness, anxiety, and thoughts of self-harm.
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This question is part of the following fields:
- Classification And Assessment
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Question 113
Incorrect
-
What is a true statement about movement disorders?
Your Answer:
Correct Answer: Dystonia is not typically observed during sleep
Explanation:Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 114
Incorrect
-
An adult patient while receiving treatment in a hospital ward thinks that they are in their own house that has magically turned into the hospital. What type of condition does this scenario illustrate?
Your Answer:
Correct Answer: Reduplicative paramnesia
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
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This question is part of the following fields:
- Classification And Assessment
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Question 115
Incorrect
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What category of behavior does saluting fall under?
Your Answer:
Correct Answer: Mannerisms
Explanation:– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 116
Incorrect
-
What factors are considered in the management of psychogenic polydipsia?
Your Answer:
Correct Answer: Fluid restriction
Explanation:Psychogenic polydipsia is a condition where there is excessive consumption of fluids leading to polyuria, and it is commonly seen in psychiatric conditions such as schizophrenia and developmental disorders. The exact mechanism is unknown, but it is thought to be due to a defect in thirst and a dysfunction in AVP regulation. Patients with psychogenic polydipsia rarely complain of thirst but instead provide delusional explanations for their excessive drinking of state that drinking reduces their anxiety and makes them feel better. If fluid intake exceeds the capacity for excretion, then the resultant hyponatremia may produce signs of water intoxication. It is best managed by fluid restriction. Differential diagnosis should be done to rule out other causes of polyuria and polydipsia. Investigations such as fluid balance charts, urine dipstick, serum U&E and calcium, and urine and plasma osmolality should be arranged. Primary polydipsia can be subclassified into psychogenic and dipsogenic types.
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This question is part of the following fields:
- Classification And Assessment
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Question 117
Incorrect
-
What is a personality disorder category in ICD-10?
Your Answer:
Correct Answer: Anankastic personality disorder
Explanation:ICD-10’s Anankastic personality disorder is the same as DSM V obsessive-compulsive personality disorder, while inadequate and passive aggressive personality disorders are not recognized in either classification system. Additionally, DSM V includes narcissistic personality disorder as a distinct category of personality disorder.
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This question is part of the following fields:
- Classification And Assessment
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Question 118
Incorrect
-
Which category of movement disorders do tics fall under?
Your Answer:
Correct Answer: Hyperkinesia
Explanation:Hyperkinesia is a defining feature of tics.
Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 119
Incorrect
-
Which of the following is not a known trigger for migraines?
Your Answer:
Correct Answer: Spicy foods
Explanation:Migraine
Migraine is a common condition that affects 5-10% of the population, with a higher prevalence in women than men (2-3:1). It typically starts in childhood of adolescence and has a strong familial association, with 2/3 of cases reporting a family history of migraine.
The most prominent symptom of migraine is headache, which is usually unilateral but can occur on both sides. Other symptoms include anorexia, nausea and vomiting, photophobia, and intolerance of noise.
In about 1/3 of cases, migraines are preceded by a visual aura (known as classic migraine). The most common form of visual aura is the ‘fortification spectra’ (semicircle of zigzag lights), but other disturbances such as micropsia, macropsia, zoom vision, mosaic vision, scotomas, and even hallucinations can occur.
Basilar migraines are a subtype of migraine where headache and aura are accompanied by difficulty speaking, vertigo, ringing in ears, of other brainstem-related symptoms, but not motor weakness.
Migraine can be triggered by various factors, including alcohol, cheese, chocolate, skipping meals, missing sleep, and oral contraceptives. Stress is also a common precipitant of migraine.
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This question is part of the following fields:
- Classification And Assessment
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Question 120
Incorrect
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What is the accurate formula for calculating BMI?
Your Answer:
Correct Answer: Mass (kg)/ height² (m)
Explanation:Assessment and Management of Obesity
Obesity is a condition that can increase the risk of various health problems, including type 2 diabetes, coronary heart disease, some types of cancer, and stroke. The body mass index (BMI) is a commonly used tool to assess obesity, calculated by dividing a person’s weight in kilograms by their height in meters squared. For adults over 20 years old, BMI falls into one of the following categories: underweight, normal of healthy weight, pre-obesity/overweight, obesity class I, obesity class II, and obesity class III.
Waist circumference can also be used in combination with BMI to guide interventions. Diet and exercise are the main interventions up to a BMI of 35, unless there are comorbidities such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidemia, and sleep apnea. Physical activity recommendations suggest that adults should accumulate at least 150 minutes of moderate intensity activity of 75 minutes of vigorous intensity activity per week. Dietary recommendations suggest diets that have a 600 kcal/day deficit.
Pharmacological options such as Orlistat of Liraglutide may be considered for those with a BMI of 30 kg/m2 of more, of 28 if associated risk factors. Surgical options such as bariatric surgery may be considered for those with a BMI of 40 kg/m2 of more, of between 35 kg/m2 and 40 kg/m2 with other significant diseases that could be improved with weight loss.
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This question is part of the following fields:
- Classification And Assessment
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Question 121
Incorrect
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What is a true statement about primary polydipsia?
Your Answer:
Correct Answer: Polyuria throughout the night is uncommonly reported by patients with primary polydipsia
Explanation:Patients with polydipsia tend to have a slower onset of symptoms and are less likely to report waking up at night to drink of urinate, in comparison to patients with conditions like diabetes insipidus (Fenske, 2012). Fenske’s (2012) clinical review discusses the current and future approaches to diagnosing diabetes insipidus.
Psychogenic polydipsia is a condition where there is excessive consumption of fluids leading to polyuria, and it is commonly seen in psychiatric conditions such as schizophrenia and developmental disorders. The exact mechanism is unknown, but it is thought to be due to a defect in thirst and a dysfunction in AVP regulation. Patients with psychogenic polydipsia rarely complain of thirst but instead provide delusional explanations for their excessive drinking of state that drinking reduces their anxiety and makes them feel better. If fluid intake exceeds the capacity for excretion, then the resultant hyponatremia may produce signs of water intoxication. It is best managed by fluid restriction. Differential diagnosis should be done to rule out other causes of polyuria and polydipsia. Investigations such as fluid balance charts, urine dipstick, serum U&E and calcium, and urine and plasma osmolality should be arranged. Primary polydipsia can be subclassified into psychogenic and dipsogenic types.
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This question is part of the following fields:
- Classification And Assessment
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Question 122
Incorrect
-
What is the definition of verbigeration?
Your Answer:
Correct Answer: Meaningless, repetition of words of phrases
Explanation:It is important to differentiate between verbigeration and vorbeirden. Verbigeration involves the senseless repetition of words of phrases, while vorbeirden occurs when a patient comprehends a question but provides an obviously incorrect answer. This phenomenon is commonly observed in Ganser’s syndrome, a type of dissociative psychosis that often affects incarcerated individuals awaiting trial.
– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 123
Incorrect
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What is a characteristic of the alcohol dependency syndrome according to the guidelines in ICD-10?
Your Answer:
Correct Answer: Salience
Explanation:The alcohol dependence syndrome, as defined in ICD-10, includes salience (of primacy) as a key feature. This refers to a state where obtaining of consuming alcohol becomes more important than previously significant aspects of a person’s life, such as family, relationships, of employment. Increased tolerance is also a part of this syndrome. However, narrowing of repertoire and relief drinking are not included in the ICD-10 definition. It is important to note that binge drinking is not considered a feature of the alcohol dependence syndrome.
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This question is part of the following fields:
- Classification And Assessment
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Question 124
Incorrect
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What sign is exhibited by a patient with catatonia who moves their arm in the direction of minimal force applied by a psychiatrist and returns it to its original position after the force is removed?
Your Answer:
Correct Answer: Mitgehen
Explanation:The terms mitmachen and mitgehen are often used interchangeably in the literature, leading to confusion. However, it is important to note that mitgehen is a more severe manifestation of mitmachen, as it involves the examiner being able to move the patient’s body with minimal pressure, as seen in the anglepoise lamp sign.
– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 125
Incorrect
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Choose the initial treatment option for focal epilepsy from the given choices:
Your Answer:
Correct Answer: Lamotrigine
Explanation:Epilepsy: An Overview
Epilepsy is a condition that is diagnosed when a person experiences at least two unprovoked seizures that occur more than 24 hours apart. In the UK, the prevalence of epilepsy is 5-10 cases per 1000. Seizure types are categorized as focal onset of generalized onset. Focal seizures only involve a localized part of the brain, while generalized seizures involve the whole of both hemispheres. Temporal lobe epilepsy is the most common type of focal epilepsy, accounting for 60-70% of cases.
In 60% of people with epilepsy, there is no identifiable cause. Approximately 70% of people with epilepsy achieve remission, meaning they have no seizures for 5 years on of off treatment. of those with convulsive seizures, 2/3 have focal epilepsies and secondary generalized seizures, while the other 1/3 have generalized tonic-clonic seizures.
The National Institute for Health and Care Excellence (NICE) recommends treatment with antiepileptic drugs (AEDs) after a second epileptic seizure. For newly diagnosed focal seizures, carbamazepine of lamotrigine are recommended as first-line treatment. Levetiracetam, oxcarbazepine, of sodium valproate may be offered if carbamazepine and lamotrigine are unsuitable of not tolerated. For newly diagnosed generalized tonic-clonic seizures, sodium valproate is recommended as first-line treatment, with lamotrigine as an alternative if sodium valproate is unsuitable. For absence seizures, ethosuximide of sodium valproate are recommended as first-line treatment. For myoclonic seizures, sodium valproate is recommended as first-line treatment, and for tonic of atonic seizures, sodium valproate is also recommended as first-line treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 126
Incorrect
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What is the term used to describe the experience of a male patient withdrawing from alcohol who sees small people walking on top of his bed sheets?
Your Answer:
Correct Answer: Lilliputian hallucinations
Explanation:Lilliputian hallucinations are commonly observed in conditions caused by organic factors, such as withdrawal and intoxication.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 127
Incorrect
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What is a true statement about the Glasgow Coma Scale?
Your Answer:
Correct Answer: A score of 2 out of 4 is given to patient who opens their eyes to pain
Explanation:The assessment of intersecting pentagons is included in the mini mental state exam, while the Glasgow Coma Scale (GCS) is primarily utilized to evaluate impaired consciousness resulting from factors like trauma and substance abuse.
The Glasgow Coma Scale is used to assess the depth of coma and impaired consciousness. Scores range from 3 to 15, with impaired consciousness rated as mild, moderate, of severe. The scale assesses eye opening response, verbal response, and motor response, with specific criteria for scoring each behavior. The final score is a combination of these three scores.
Scoring Guide;
Eye opening response
4 Spontaneous opening
3 Opens to verbal stimuli
2 Opens to pain
1 No response
Verbal response
5 Orientated
4 Confused conversation
3 Inappropriate words
2 Incoherent
1 No response
Motor response
6 Obeys commands
5 Purposeful movement to painful stimuli
4 Withdraws in response to pain
3 Flexion in response to pain (decorticate posturing)
2 Extension in response to pain (decerebrate posturing)
1 No response -
This question is part of the following fields:
- Classification And Assessment
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Question 128
Incorrect
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In which sensory modality does formication occur?
Your Answer:
Correct Answer: Tactile
Explanation:The feeling of insects crawling on the skin, also known as tactile hallucination, is referred to as formication. This symptom has been extensively studied and can be caused by various factors.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 129
Incorrect
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An elderly man complains that his urine appears milky white, on further questioning you ascertain that he believes he is passing semen in his urine. Which condition is he most likely to be suffering with?
Your Answer:
Correct Answer: Dhat
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 130
Incorrect
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What is the experience that the lady in A&E is going through when she covers her head with cloth and claims that people can hear her thoughts?
Your Answer:
Correct Answer: Thought broadcast
Explanation:First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 131
Incorrect
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After the death of his grandfather, a young man decides to take over his grandfather's business. This surprises the grandmother as the grandson always expressed his dislike for his grandfather and never showed any interest in the business. The grandmother inquires about his decision and senses that the grandson is at ease with his negative feelings towards his grandfather and does not seem to feel any remorse. What defense mechanism is likely underlying the grandson's behavior?
Your Answer:
Correct Answer: Sublimation
Explanation:Undoing and sublimation are two psychological concepts that are often mistaken for each other. While both involve a person’s attempt to deal with negative thoughts of emotions, there is a key difference between the two.
In undoing, a person tries to undo of neutralize their own unacceptable thoughts, emotions, of behaviors. This is often driven by feelings of guilt or remorse over something they have done of felt. The goal is to make amends and alleviate the negative feelings associated with their actions.
On the other hand, sublimation involves turning negative emotions into positive ones. However, unlike undoing, the person does not necessarily feel guilty of remorseful about their emotions. Instead, they may see their emotions as justified and seek to channel them into more positive outlets.
Therefore, while both undoing and sublimation involve coping with negative emotions, the key difference lies in the underlying motivation and feelings associated with the process.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 132
Incorrect
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Which of the options below is inconsistent with a diagnosis of delusional disorder?
Your Answer:
Correct Answer: Delusions of control
Explanation:Rapid Risk Assessment for Sex Offence Recidivism (RRASOR)
The Rapid Risk Assessment for Sex Offence Recidivism (RRASOR) is a well-known actuarial tool that is used to predict the likelihood of sex offence recidivism. It comprises of four items that have been proven to have predictive accuracy for sex offence recidivism. These items include the number of past sex offence convictions of charges, the age of the offender being less than 25, the offender being unrelated to the victim, and the gender of the victim.
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This question is part of the following fields:
- Classification And Assessment
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Question 133
Incorrect
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Which of the following is not an example of paramnesia?
Your Answer:
Correct Answer: Retrograde amnesia
Explanation:The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.
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This question is part of the following fields:
- Classification And Assessment
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Question 134
Incorrect
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What tools of methods are utilized to aid in identifying personality disorders?
Your Answer:
Correct Answer: IPDE
Explanation:The tools mentioned are used for screening and diagnosing personality disorders. The SAPAS is an interview method that focuses on 8 areas and takes 2 minutes to complete. The FFMRF is self-reported and consists of 30 items rated 1-5 for each item. The IPDE is a semistructured clinical interview compatible with the ICD and DSM and includes both a patient questionnaire and an interview. The PDQ-R is self-reported and consists of 100 true/false questions based on DSM-IV criteria. The IPDS is an interview method that consists of 11 criteria and takes less than 5 minutes. The IIP-PD is self-reported and contains 127 items rated 0-4.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 135
Incorrect
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Which statement accurately describes the Addenbrooke's cognitive exam?
Your Answer:
Correct Answer: It is a useful tool for detecting dementia
Explanation:The Addenbrooke’s Cognitive Exam: A Brief Screening Tool for Dementia
The Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool developed to detect dementia and differentiate Alzheimer’s dementia from frontotemporal dementia. It was created to address the limitations of the MMSE, which lacked sensitivity for frontal-executive dysfunction and visuospatial defects. The ACE is a brief test that takes 15-20 minutes to administer and is divided into five domains: attention and orientation, memory, verbal fluency, language, and visuospatial abilities. The total score is based on a maximum score of 100, with higher scores indicating better cognitive functioning.
The ACE has been shown to be a valid tool for detecting dementia, with two cut-off points often used depending on the required sensitivity and specificity. A score of less than 88 has 100% sensitivity for detecting dementia, while a score of less than 82 has 93% sensitivity and 100% specificity. It has also been useful in differentiating dementia from pseudo dementia and detecting cognitive impairment in atypical Parkinson syndromes. However, while the test has shown 100% sensitivity and specificity in studies, its performance may vary in clinical practice.
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This question is part of the following fields:
- Classification And Assessment
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Question 136
Incorrect
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What is the most indicative sign of hypomania in the mental state examination?
Your Answer:
Correct Answer: Garish makeup
Explanation:The YMRS includes a rating for appearance, which can provide insight into a person’s mental state. The scale ranges from 0 (appropriate dress and grooming) to 4 (completely unkempt, decorated, of wearing bizarre garb). This item can help clinicians assess the severity of a person’s manic symptoms and tailor treatment accordingly.
Mental State Exam: Appearance
The appearance of a patient can provide valuable clues to an underlying disorder. It is important to note that the following examples are not always present, but they can be helpful for educational purposes.
Individuals experiencing hypomania or mania may tend to wear bright and colorful clothing and may apply unusual of garish makeup. On the other hand, unfashionable and mismatched clothing may indicate schizoid personality traits of autistic spectrum disorders.
An excessively tidy appearance may suggest an obsessional personality. It is important to consider these cues in conjunction with other aspects of the mental state exam to arrive at an accurate diagnosis. Proper observation and interpretation of a patient’s appearance can aid in the development of an effective treatment plan.
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This question is part of the following fields:
- Classification And Assessment
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Question 137
Incorrect
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What is the most probable reason for a patient with delirium to seem unresponsive to attempts at communication?
Your Answer:
Correct Answer: Hypoacusis
Explanation:Sensory Distortions of Sound
Hyperacusis is a condition where an individual experiences an increased sensitivity to noise. This condition is commonly observed in people with anxiety and depressive disorders, as well as during a hangover of migraine. On the other hand, hypoacusis is a condition where an individual experiences a reduced sensitivity to sound. This condition is commonly observed in people with delirium and depression, where it is often accompanied by hyperacusis.
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This question is part of the following fields:
- Classification And Assessment
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Question 138
Incorrect
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The Wisconsin Card sorting test is used to assess which of the following?
Your Answer:
Correct Answer: Frontal lobe
Explanation:Frontal Lobe Tests
The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.
Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.
Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.
Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.
Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.
Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 139
Incorrect
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Which of the following characteristics is not associated with catatonia?
Your Answer:
Correct Answer: Akathisia
Explanation:– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 140
Incorrect
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What is the most indicative sign of depression in the mental state examination?
Your Answer:
Correct Answer: Disheveled hair
Explanation:Mental State Exam: Appearance
The appearance of a patient can provide valuable clues to an underlying disorder. It is important to note that the following examples are not always present, but they can be helpful for educational purposes.
Individuals experiencing hypomania or mania may tend to wear bright and colorful clothing and may apply unusual of garish makeup. On the other hand, unfashionable and mismatched clothing may indicate schizoid personality traits of autistic spectrum disorders.
An excessively tidy appearance may suggest an obsessional personality. It is important to consider these cues in conjunction with other aspects of the mental state exam to arrive at an accurate diagnosis. Proper observation and interpretation of a patient’s appearance can aid in the development of an effective treatment plan.
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This question is part of the following fields:
- Classification And Assessment
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Question 141
Incorrect
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What is a true statement about the Brief Psychiatric Rating Scale?
Your Answer:
Correct Answer: Uncooperativeness is rated as part of the scale
Explanation:The Brief Psychiatric Rating Scale assesses the level of cooperation with the interview, utilizing a combination of self-report and clinical observation. Due to its reliance on these methods, it cannot be conducted via telephone.
Brief Psychiatric Rating Scale: An Instrument for Evaluating Psychopathology in Psychiatric Patients
The Brief Psychiatric Rating Scale (BPRS) is a widely used tool for assessing psychopathology in psychiatric patients. It was developed in the 1960s by Overall and Gorham, using factor analysis, to evaluate the severity of schizophrenic states and provide clinicians with a quick way to assess patient change. Initially, the BPRS consisted of 16 items, but two more items were added to create the standard 18-item version. Later, an expanded 24-item version was introduced to measure additional aspects of schizophrenia, such as bizarre behavior, self-neglect, suicidality, elevated mood, motor hyperactivity, and distractibility.
The BPRS is rated by a clinician, who assesses each item on a 7-point scale of severity. Higher scores indicate greater severity of symptoms. The assessment relies on a combination of self-report and observation. Several variables are rated based on observation, while the rest are assessed through a short interview. The total score severity, using the 18-item version, has been estimated as mildly ill (31), moderately ill (41), and markedly ill (53). The administration of the BPRS can take 10-40 minutes, and versions have been validated for use in both children and older adults. As it is clinician-administered, the BPRS does not require patients to be able to read of write.
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This question is part of the following fields:
- Classification And Assessment
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Question 142
Incorrect
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A client with schizophrenia tells you that a neuropsychologist informed him he was deficient on the Hayling Test. He inquires about the meaning of this. What cognitive function would you propose is affected?
Your Answer:
Correct Answer: Response inhibition
Explanation:Assessing Executive Function with the Hayling and Brixton Tests
The Hayling and Brixton tests are two assessments designed to evaluate executive function. The Hayling Sentence Completion Test consists of two sets of 15 sentences, with the last word missing. In the first section, participants complete the sentences, providing a measure of response initiation speed. The second part, the Hayling, requires participants to complete a sentence with a nonsense ending word, suppressing a sensible one. This provides measures of response suppression ability and thinking time. Performance on such tests has been linked to frontal lobe dysfunction and dysexecutive symptoms in everyday life.
The Brixton Test is a rule detection and rule following task. Impairments on such tasks are commonly demonstrated in individuals with dysexecutive problems. Overall, these tests provide valuable insights into executive function and can help identify areas of weakness that may require intervention.
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This question is part of the following fields:
- Classification And Assessment
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Question 143
Incorrect
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How can non-motor seizure types be classified in a general sense?
Your Answer:
Correct Answer: Absence
Explanation:Epilepsy: An Overview
Epilepsy is a condition that is diagnosed when a person experiences at least two unprovoked seizures that occur more than 24 hours apart. In the UK, the prevalence of epilepsy is 5-10 cases per 1000. Seizure types are categorized as focal onset of generalized onset. Focal seizures only involve a localized part of the brain, while generalized seizures involve the whole of both hemispheres. Temporal lobe epilepsy is the most common type of focal epilepsy, accounting for 60-70% of cases.
In 60% of people with epilepsy, there is no identifiable cause. Approximately 70% of people with epilepsy achieve remission, meaning they have no seizures for 5 years on of off treatment. of those with convulsive seizures, 2/3 have focal epilepsies and secondary generalized seizures, while the other 1/3 have generalized tonic-clonic seizures.
The National Institute for Health and Care Excellence (NICE) recommends treatment with antiepileptic drugs (AEDs) after a second epileptic seizure. For newly diagnosed focal seizures, carbamazepine of lamotrigine are recommended as first-line treatment. Levetiracetam, oxcarbazepine, of sodium valproate may be offered if carbamazepine and lamotrigine are unsuitable of not tolerated. For newly diagnosed generalized tonic-clonic seizures, sodium valproate is recommended as first-line treatment, with lamotrigine as an alternative if sodium valproate is unsuitable. For absence seizures, ethosuximide of sodium valproate are recommended as first-line treatment. For myoclonic seizures, sodium valproate is recommended as first-line treatment, and for tonic of atonic seizures, sodium valproate is also recommended as first-line treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 144
Incorrect
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In which areas are the Hayling and Brixton tests utilized to identify deficiencies?
Your Answer:
Correct Answer: Executive function
Explanation:Assessing Executive Function with the Hayling and Brixton Tests
The Hayling and Brixton tests are two assessments designed to evaluate executive function. The Hayling Sentence Completion Test consists of two sets of 15 sentences, with the last word missing. In the first section, participants complete the sentences, providing a measure of response initiation speed. The second part, the Hayling, requires participants to complete a sentence with a nonsense ending word, suppressing a sensible one. This provides measures of response suppression ability and thinking time. Performance on such tests has been linked to frontal lobe dysfunction and dysexecutive symptoms in everyday life.
The Brixton Test is a rule detection and rule following task. Impairments on such tasks are commonly demonstrated in individuals with dysexecutive problems. Overall, these tests provide valuable insights into executive function and can help identify areas of weakness that may require intervention.
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This question is part of the following fields:
- Classification And Assessment
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Question 145
Incorrect
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Which BMI classification is accurate?
Your Answer:
Correct Answer: BMI 32 = obesity class I
Explanation:Assessment and Management of Obesity
Obesity is a condition that can increase the risk of various health problems, including type 2 diabetes, coronary heart disease, some types of cancer, and stroke. The body mass index (BMI) is a commonly used tool to assess obesity, calculated by dividing a person’s weight in kilograms by their height in meters squared. For adults over 20 years old, BMI falls into one of the following categories: underweight, normal of healthy weight, pre-obesity/overweight, obesity class I, obesity class II, and obesity class III.
Waist circumference can also be used in combination with BMI to guide interventions. Diet and exercise are the main interventions up to a BMI of 35, unless there are comorbidities such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidemia, and sleep apnea. Physical activity recommendations suggest that adults should accumulate at least 150 minutes of moderate intensity activity of 75 minutes of vigorous intensity activity per week. Dietary recommendations suggest diets that have a 600 kcal/day deficit.
Pharmacological options such as Orlistat of Liraglutide may be considered for those with a BMI of 30 kg/m2 of more, of 28 if associated risk factors. Surgical options such as bariatric surgery may be considered for those with a BMI of 40 kg/m2 of more, of between 35 kg/m2 and 40 kg/m2 with other significant diseases that could be improved with weight loss.
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This question is part of the following fields:
- Classification And Assessment
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Question 146
Incorrect
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What test can be used to detect constructional apraxia?
Your Answer:
Correct Answer: Clock drawing test
Explanation:Individuals with constructional apraxia are unable to replicate drawings of arrange objects to create patterns of designs.
Clock Drawing Test: A Screening Tool for Cognitive Dysfunction
The clock drawing test is a widely used screening tool for cognitive dysfunction. It involves asking the patient to draw a clock on a piece of paper, placing the numbers on the clock face and drawing the hands to indicate 10 minutes past 11. This simple task assesses a range of cognitive functions, including visuospatial ability, motor function, attention, and comprehension.
The test is quick and easy to administer, making it a useful tool for healthcare professionals to identify potential cognitive impairment in patients. The clock drawing test has been shown to be effective in detecting cognitive dysfunction in a variety of conditions, including Alzheimer’s and Parkinson’s disease.
The image below illustrates examples of clocks drawn correctly by healthy controls and those drawn by patients with Alzheimer’s and Parkinson’s disease. By comparing the drawings, healthcare professionals can quickly identify potential cognitive dysfunction and take appropriate action.
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This question is part of the following fields:
- Classification And Assessment
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Question 147
Incorrect
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A 12 year old male is referred by his GP following concerns by his school regarding his academic ability. He is unable to read of write. Which of the following would be the most appropriate measure of his intellectual functioning?
Your Answer:
Correct Answer: WISC
Explanation:The Wechsler Adult Intelligence Scale (WAIS) is a widely used intelligence test in clinical settings, designed for individuals aged 16 to 90. Its counterpart for children is the Wechsler Intelligence Scale for Children (WISC). The current version of WAIS, WAIS-IV, consists of four index scores, each comprising several subsets. These are the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, and Processing Speed Index. The results are presented as two scores: Full Scale IQ and General Ability Index. The average score is 100, with a standard deviation of 15. However, the test becomes less accurate at the extremes of IQ (70-130). About 3% of people score below 70, which is the general cut-off for a significant learning disability.
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This question is part of the following fields:
- Classification And Assessment
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Question 148
Incorrect
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Upon examination of a 24-year-old man admitted to A&E with vomiting blood and exhibiting a pill rolling tremor and a brown ring around the iris, one would anticipate the presence of certain blood results.
Your Answer:
Correct Answer: Low plasma ceruloplasmin
Explanation:The presence of a distinct brown ring encircling the iris is a clear indication of a Kayser-Fleischer ring, which is a telltale sign of Wilson’s disease. Vomiting of blood is a common symptom of esophageal varices, a complication that arises from liver failure, which is a common occurrence in individuals with Wilson’s disease.
Understanding Wilson’s Disease: Causes, Symptoms, and Management
Wilson’s disease, also known as hepatolenticular degeneration, is a genetic disorder that affects copper storage in the body. This condition is caused by a defect in the ATP7B gene, which leads to the accumulation of copper in the liver and brain. The onset of symptoms usually occurs between the ages of 10 and 25, with liver disease being the most common presentation in children and neurological symptoms in young adults.
The excessive deposition of copper in the tissues can cause a range of symptoms, including hepatitis, cirrhosis, basal ganglia degeneration, speech and behavioral problems, asterixis, chorea, dementia, Kayser-Fleischer rings, sunflower cataract, renal tubular acidosis, haemolysis, and blue nails. Diagnosis is based on reduced serum ceruloplasmin, reduced serum copper, and increased 24-hour urinary copper excretion.
The traditional first-line treatment for Wilson’s disease is penicillamine, which chelates copper. Trientine hydrochloride is an alternative chelating agent that may become first-line treatment in the future. Tetrathiomolybdate is a newer agent that is currently under investigation.
In summary, Wilson’s disease is a genetic disorder that affects copper storage in the body, leading to a range of symptoms that can affect the liver, brain, and eyes. Early diagnosis and treatment are essential to prevent complications and improve outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 149
Incorrect
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What scale necessitates the clinician to possess prior familiarity with the patient's ailment?
Your Answer:
Correct Answer: Clinical global impression
Explanation:In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 150
Incorrect
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A 60 year old man with depression is admitted to hospital for an assessment. During the physically examination you notice he has bilaterally small pupils. On further examination you note that they fail to dilate when the lights are turned off and react in a sluggish manner to accommodation. Which of the following do you suspect?
Your Answer:
Correct Answer: Senile miosis
Explanation:Senile Pupil: A Common Age-Related Condition
The senile pupil, also known as senile miosis, is a condition commonly observed in older individuals. It is characterized by a small pupil that does not dilate in the dark, and may also be associated with reduced reaction to light and accommodation. This condition is often a result of age-related changes in the muscles that control the pupil, and can be exacerbated by certain medications of medical conditions. While it may not cause significant vision problems, it is important for individuals with senile pupil to have regular eye exams to monitor any changes in their vision and ensure proper eye health.
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This question is part of the following fields:
- Classification And Assessment
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Question 151
Incorrect
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What is the name of the culture-bound syndrome commonly observed in Latinos that is marked by aggressive behavior, crying, and shouting?
Your Answer:
Correct Answer: Ataque de nervios
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 152
Incorrect
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How would you describe the delusional world of a woman who seems to lack any grasp of reality?
Your Answer:
Correct Answer: Autistic
Explanation:Delusional Structure
Delusions can be categorized based on their logical consistency and organization. Logical delusions are consistent with logical thinking, while paralogical delusions are not. Delusions can also be organized, integrated into a formed concept, of unorganized. Highly organized, logical delusions are referred to as systematized.
The relationship between delusional beliefs and reality can also be described in different ways. Polarized delusions mix fact and delusion together, while juxtaposed delusions exist side by side with facts but do not interact. Autistic delusions completely disregard actual reality, and the patient lives in a delusional world.
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This question is part of the following fields:
- Classification And Assessment
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Question 153
Incorrect
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Which of the following is an example of an extracampine hallucination?
Your Answer:
Correct Answer: A patient hears their brother shouting at them from another country
Explanation:Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 154
Incorrect
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What characteristic is commonly observed in individuals originating from West Africa?
Your Answer:
Correct Answer: Brain fag
Explanation:Culture bound illnesses are psychiatric conditions that are specific to one particular culture. There are many different types of culture bound illnesses, including Amok, Shenjing shuairuo, Ataque de nervios, Bilis, colera, Bouffee delirante, Brain fag, Dhat, Falling-out, blacking out, Ghost sickness, Hwa-byung, wool-hwa-byung, Koro, Latah, Locura, Mal de ojo, Nervios, Rootwork, Pibloktoq, Qi-gong psychotic reaction, Sangue dormido, Shen-k’uei, shenkui, Shin-byung, Taijin kyofusho, Spell, Susto, Zar, and Wendigo.
Some of the most commonly discussed culture bound illnesses include Amok, which is confined to males in the Philippines and Malaysia who experience blind, murderous violence after a real of imagined insult. Ataque de nervios is a condition that occurs in those of Latino descent and is characterized by intense emotional upset, shouting uncontrollably, aggression, dissociation, seizure-like episodes, and suicidal gestures. Brain fag is a form of psychological distress first identified in Nigerian students in the 1960s but reported more generally in the African diaspora. It consists of a variety of cognitive and sensory disturbances that occur during periods of intense intellectual activity. Koro is a condition that affects Chinese patients who believe that their penis is withdrawing inside their abdomen, resulting in panic and the belief that they will die. Taijin kyofusho is a Japanese culture bound illness characterized by anxiety about and avoidance of interpersonal situations due to the thought, feeling, of conviction that one’s appearance and actions in social interactions are inadequate of offensive to others. Finally, Wendigo is a culture bound illness that occurs in Native American tribes during severe winters and scarcity of food, characterized by a distaste for food that leads to anxiety and the belief that one is turning into a cannibalistic ice spirit.
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This question is part of the following fields:
- Classification And Assessment
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Question 155
Incorrect
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One of Kraepelin's mixed affective states was which of the following?
Your Answer:
Correct Answer: Depression with flight of ideas
Explanation:Inhibited Mania
Inhibited mania is one of the six mixed affective states identified by Kraepelin. It is characterized by symptoms of both mania and depression, but with a predominance of depressive features. Patients with inhibited mania may experience feelings of sadness, guilt, and worthlessness, as well as decreased energy and motivation. At the same time, they may also exhibit symptoms of mania, such as increased activity, impulsivity, and irritability.
Inhibited mania is considered an autonomous mixed episode, meaning that the patient consistently experiences symptoms of both mania and depression. This type of mixed state is associated with a poorer prognosis compared to those occurring between transitions from one mood state to another.
Treatment for inhibited mania typically involves a combination of mood stabilizers, antidepressants, and psychotherapy. It is important for clinicians to carefully monitor patients with inhibited mania, as they may be at increased risk for suicide and other adverse outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 156
Incorrect
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Which of the following dimensions were included in Eysenck's classification scheme from 1970?
Your Answer:
Correct Answer: Psychoticism
Explanation:Eysenck’s classification system consisted of three dimensions: Psychoticism, Neuroticism, and Introversion-extraversion. Despite its theoretical appeal, it has not been widely utilized, possibly due to challenges in its practical application in clinical settings.
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This question is part of the following fields:
- Classification And Assessment
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Question 157
Incorrect
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Which of the following best describes a patient with schizophrenia who reports feeling like their thoughts are compressed and racing?
Your Answer:
Correct Answer: Crowding
Explanation:Formal Thought Disorders
In formal thought disorders, changes in the speed, coherence, and cogency of thought can be observed from a patient’s speech. These disorders can also be self-reported and may be accompanied by enhanced use of nonverbal language. One possible indication is a lack of an adequate connection between two consecutive thoughts, which is called ‘asyndesis’.
There are several types of formal thought disorders, including inhibited thinking, retarded thinking, circumstantial thinking, restricted thinking, perseverative thinking, rumination, pressured thinking, flight of ideas, tangential thinking, thought blocking, disruption of thought, incoherence/derailment, and neologisms.
Inhibited thinking is about the subjective experience of the patient, who may feel that their thinking process is slowed down of blocked by an inner wall of resistance. Retarded thinking, on the other hand, is about the observed quality of thought as inferred through speech, where the flow of thought processes is slowed down and sluggish.
Circumstantial thinking refers to an inability to separate the essential from the unessential during a conversation without rendering the conversation incoherent. Restricted thinking involves a limited range of thought content, fixation on one particular topic of a small number of topics only, and a stereotyped pattern of thinking.
Perseverative thinking is characterized by the persistent repetition of previously used words, phrases, of details to the point where they become meaningless in the context of the current stage of the interview. Rumination is the endless mental preoccupation with, of excessive concern over, mostly unpleasant thoughts.
Pressured thinking, also known as crowding of thought, is when the patient feels helplessly exposed to the pressures of floods of different ideas of thoughts. Flight of ideas involves an increasing multitude of thoughts and ideas which are no longer firmly guided by clear goal-directed thinking.
Tangential thinking occurs when the patient appears to understand the contents of the questions addressed to them but provides answers which are completely out of context. Thought blocking of disruption of thought refers to sudden disruption of an otherwise normal flow of thought of speech for no obvious reason.
Incoherence of derailment is when the interviewer is unable to establish sensible connections between the patient’s thinking and verbal output, which is sometimes also called derailment. Neologisms involve the formation of new words of usage of words which disregard normal conventions and are generally not easily understandable.
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This question is part of the following fields:
- Classification And Assessment
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Question 158
Incorrect
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Which assessment tools can individuals rate themselves?
Your Answer:
Correct Answer: EPDS (Edinburgh postnatal major depression scale)
Explanation:In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 159
Incorrect
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Which condition related to catatonia involves the patient being placed in uncomfortable positions that are sustained for a significant amount of time?
Your Answer:
Correct Answer: Waxy flexibility
Explanation:Waxy flexibility involves the examiner imposing postures on the patient, while posturing involves spontaneous postures. On the other hand, mitgehen is a type of automatic obedience where the examiner can easily move the patient’s body with a gentle touch, but unlike waxy flexibility, the body part quickly returns to its original position.
– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 160
Incorrect
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A teenage boy visits the emergency department with a complaint of his leg feeling like it's being twisted. Upon examination, his leg appears normal. However, his eyes are bloodshot and his fingers are stained with tar. What type of experience does he report?
Your Answer:
Correct Answer: Paraschemazia
Explanation:Paraschemazia: A Distorted Perception of the Body
Paraschemazia is a condition where individuals experience a sensation that parts of their body are twisted of separated from the rest of their body. This feeling can be associated with the use of hallucinogenic drugs, an epileptic aura, of migraines. The perception of the body being distorted of separated can be distressing for individuals experiencing this condition. It is important for healthcare professionals to be aware of this symptom and its potential causes to provide appropriate treatment and support.
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This question is part of the following fields:
- Classification And Assessment
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Question 161
Incorrect
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What is a true statement about first rank symptoms?
Your Answer:
Correct Answer: They have been reported in personality disorders
Explanation:Although first rank symptoms are commonly associated with schizophrenia, they are not considered diagnostic of pathognomonic of the disorder, as they can also be present in other conditions. It is important to note that these symptoms were not originally designed for diagnostic purposes, but rather as a screening tool.
First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 162
Incorrect
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What kind of sensory experience is the man having when he hears a drum sound while trying to fall asleep?
Your Answer:
Correct Answer: Hypnagogic
Explanation:As individuals drift off to sleep, they may encounter hypnagogic hallucinations, which are characterized by sensory phenomena. These can vary from faint sensations to intense hallucinations. It is important to note that these occurrences are a natural part of the sleep cycle.
Altered Perceptual Experiences
Disorders of perception can be categorized into sensory distortions and sensory deceptions. Sensory distortions involve changes in the intensity, spatial form, of quality of a perception. Examples include hyperaesthesia, hyperacusis, and micropsia. Sensory deceptions, on the other hand, involve new perceptions that are not based on any external stimulus. These include illusions and hallucinations.
Illusions are altered perceptions of a stimulus, while hallucinations are perceptions in the absence of a stimulus. Completion illusions, affect illusions, and pareidolic illusions are examples of illusions. Auditory, visual, gustatory, olfactory, and tactile hallucinations are different types of hallucinations. Pseudohallucinations are involuntary and vivid sensory experiences that are interpreted in a non-morbid way. They are different from true hallucinations in that the individual is able to recognize that the experience is an internally generated event.
Understanding the different types of altered perceptual experiences is important in the diagnosis and treatment of various mental health conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 163
Incorrect
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Which of the following best represents a strong indication of being dependent on alcohol?
Your Answer:
Correct Answer: Raised MCV
Explanation:Alcohol Dependence Blood Profile
Alcohol dependence can have a significant impact on an individual’s blood profile. Several markers tend to be elevated in individuals with alcohol dependence, including GGT, AST, MCV, and ALT. Among these markers, GGT is considered the most reliable indicator of recent alcohol use. This means that elevated levels of GGT in the blood can suggest that an individual has consumed alcohol recently.
It is important to note that these blood markers may not be elevated in all individuals with alcohol dependence, and other factors can also contribute to changes in blood profile. However, monitoring these markers can be useful in assessing an individual’s alcohol use and identifying potential health risks associated with alcohol dependence. Healthcare professionals can use this information to develop appropriate treatment plans and support individuals in managing their alcohol use.
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This question is part of the following fields:
- Classification And Assessment
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Question 164
Incorrect
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What does axis 3 of ICD-10 refer to?
Your Answer:
Correct Answer: Current psychosocial problems
Explanation:The multi-axial version of ICD-10 expands the evaluation of the patient’s condition by utilizing three axes:
Axis 1 specifies the mental disorder, encompassing personality disorder and mental handicap
Axis 2 specifies the level of impairment, and
Axis 3 specifies existing psychosocial difficulties. -
This question is part of the following fields:
- Classification And Assessment
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Question 165
Incorrect
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A 28 year old man with anxiety is referred to clinic by his GP. On examination you find an elevated blood pressure and notice his lower legs appear mottled. His pulse is 140 bpm. Testing of his urine would most likely demonstrate raised levels of which of the following metabolites?:
Your Answer:
Correct Answer: Vanillylmandelic acid
Explanation:Based on the patient’s characteristics, it is possible that he has a pheochromocytoma.
Pheochromocytoma: Symptoms and Diagnosis
A pheochromocytoma is a tumor that secretes catecholamines and is usually found in the adrenal glands. Symptoms of this condition include hypertension, tachycardia, diaphoresis, livedo reticularis (mottled skin), postural hypotension, tachypnea, cold and clammy skin, severe headache, angina, palpitations, nausea, and vomiting.
To diagnose pheochromocytoma, doctors measure the levels of catecholamine products in the blood of urine. The metanephrines vanillylmandelic acid (VMA) and homovanillic acid (HVA) are the principal urinary metabolic products of epinephrine and norepinephrine. Healthy individuals excrete only small amounts of these substances.
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This question is part of the following fields:
- Classification And Assessment
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Question 166
Incorrect
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What is the truth about the sudden and unexpected death of an individual with epilepsy?
Your Answer:
Correct Answer: It is more common in adults than in children
Explanation:SUDEP, of sudden unexpected death in epilepsy, is a condition where patients with epilepsy die suddenly and unexpectedly without any apparent cause. It is estimated to be responsible for 20-30% of deaths in epilepsy patients. The condition is more common in adults than in children, affecting 1 in 1,000 adults with epilepsy per year. The main risk factor for SUDEP is having active generalised tonic clonic seizures (GTCS), and better control of these seizures through improved compliance can reduce the risk of SUDEP. Other risk factors include nocturnal seizures, lamotrigine, never having been treated with an antiepileptic drug, intellectual disability, and male sex. However, the evidence for these factors is considered low. Autopsy findings in SUDEP cases do not reveal any specific cause of death, but obstruction of the airways and cardiorespiratory events such as arrhythmia are thought to be possible mechanisms.
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This question is part of the following fields:
- Classification And Assessment
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Question 167
Incorrect
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What is the definition of delusional perception?
Your Answer:
Correct Answer: A normal perception followed by a delusional interpretation
Explanation:Borderline Learning Disability
Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.
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This question is part of the following fields:
- Classification And Assessment
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Question 168
Incorrect
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A 25-year-old woman is admitted to a psychiatric hospital due to her history of self-harm. She has been diagnosed with borderline personality disorder.
You want to develop a treatment plan for the patient and assess her risk. The treatment team suggests using a risk assessment tool to evaluate her suicidal risk.
Which of the following would be the most useful?:Your Answer:
Correct Answer: SARN (structured assessment of risk and need)
Explanation:The Minnesota multiphasic personality inventory (MMPI) is a tool used to diagnose personality dysfunction, but it is not designed to assess an individual’s risk of offending. On the other hand, the historical, clinical and risk management 20 (HCR 20), violence risk appraisal guide (VRAG), and violence risk scale (VRS) are instruments used to evaluate an individual’s risk of violent offending.
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This question is part of the following fields:
- Classification And Assessment
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Question 169
Incorrect
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What aspect of frontal lobe function is assessed by the Tower of London test?
Your Answer:
Correct Answer: Problem solving
Explanation:Frontal Lobe Tests
The frontal lobe is responsible for a variety of cognitive functions, including initiation, abstraction, problem-solving, decision-making, response inhibition, and set shifting. Different tests can be used to assess these functions.
Verbal and categorical fluency tests can be used to assess initiation. These tests require individuals to generate as many words of items as possible within a specific category of starting letter.
Proverbs, similarities, and cognitive estimates are examples of tests that can be used to assess abstraction. These tests require individuals to identify similarities between objects of concepts, make judgments based on incomplete information, of estimate quantities.
Tower of London, Cambridge stockings, and gambling tasks are examples of tests that can be used to assess problem-solving and decision-making. These tests require individuals to plan and execute a sequence of actions to achieve a goal of make decisions based on uncertain outcomes.
Alternating sequences, go-no-go test, Luria motor test, trail making test, Wisconsin card sorting test, and Stroop test are examples of tests that can be used to assess response inhibition and set shifting. These tests require individuals to inhibit prepotent responses, switch between tasks of mental sets, of ignore irrelevant information.
Overall, these tests can provide valuable information about an individual’s frontal lobe functioning and can be used to diagnose and treat various neurological and psychiatric conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 170
Incorrect
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What is a true statement about placebos?
Your Answer:
Correct Answer: Placebo induced analgesia can be blocked by naloxone
Explanation:Placebos that are inert can still cause negative effects.
Understanding the Placebo Effect
In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.
Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.
The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.
It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.
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This question is part of the following fields:
- Classification And Assessment
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Question 171
Incorrect
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Which of the following is not an example of delusional misidentification?
Your Answer:
Correct Answer: Cotard's syndrome
Explanation:Cotard’s syndrome is a condition where an individual has a false belief that they are deceased of do not exist.
Delusional Misidentification Syndrome
Delusional misidentification syndrome refers to a group of disorders where individuals believe that the identity of a person, object, of place has been altered of changed. There are several subtypes of this syndrome, including Capgras syndrome, Fregoli syndrome, intermetamorphosis, subjective doubles, reduplicative paramnesia, mirrored self, delusional companions, and clonal pluralisation of the self. Each subtype is characterised by a specific delusion, such as believing that a loved one has been replaced by an exact double of that a place has been duplicated. These delusions can have a significant impact on an individual’s daily life and require appropriate treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 172
Incorrect
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Which of the following is not a known trigger for migraines?
Your Answer:
Correct Answer: Vinegar
Explanation:Migraine
Migraine is a common condition that affects 5-10% of the population, with a higher prevalence in women than men (2-3:1). It typically starts in childhood of adolescence and has a strong familial association, with 2/3 of cases reporting a family history of migraine.
The most prominent symptom of migraine is headache, which is usually unilateral but can occur on both sides. Other symptoms include anorexia, nausea and vomiting, photophobia, and intolerance of noise.
In about 1/3 of cases, migraines are preceded by a visual aura (known as classic migraine). The most common form of visual aura is the ‘fortification spectra’ (semicircle of zigzag lights), but other disturbances such as micropsia, macropsia, zoom vision, mosaic vision, scotomas, and even hallucinations can occur.
Basilar migraines are a subtype of migraine where headache and aura are accompanied by difficulty speaking, vertigo, ringing in ears, of other brainstem-related symptoms, but not motor weakness.
Migraine can be triggered by various factors, including alcohol, cheese, chocolate, skipping meals, missing sleep, and oral contraceptives. Stress is also a common precipitant of migraine.
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This question is part of the following fields:
- Classification And Assessment
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Question 173
Incorrect
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How can the alcohol screening tool that only contains one question be described?
Your Answer:
Correct Answer: SASQ
Explanation:The SASQ is a screening questionnaire that consists of a single question asking about the last time an individual had more than a certain number of alcoholic drinks in one day (8 for men and 6 for women). If the response indicates that this occurred within the past 3 months, it suggests that the individual may be engaging in harmful of hazardous drinking.
Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.
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This question is part of the following fields:
- Classification And Assessment
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Question 174
Incorrect
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How do the ICD and DSM classification systems differ from each other?
Your Answer:
Correct Answer: The ICD has more simple and less technical language
Explanation:The ICD is designed to be accessible to a broader range of individuals than the DSM, including those with limited professional training. Therefore, the terminology used is generally less specialized.
DSM versus ICD: A Comparison of Mental Disorder Classifications
The DSM and ICD are two widely used classifications of mental disorders. While the ICD was initiated in Paris in 1900, the DSM-I was published in the USA in 1952 as a military classification of mental disorders. The ICD is intended for use by all health practitioners, while the DSM is primarily used by psychiatrists. The ICD is the official world classification, while the DSM is the official classification in the USA.
One major difference between the two classifications is their focus. The ICD has a major focus on clinical utility, with a planned reduction of the number of diagnoses in the upcoming ICD-11. On the other hand, the DSM tends to increase the number of diagnoses with each succeeding revision. Additionally, the ICD provides diagnostic descriptions and guidance but does not employ operational criteria, while the DSM depends on operational criteria.
It is important to note that the ICD has to be flexible and simple in the use of language to enable all practitioners, including those with very little formal qualifications in low- and middle-income countries, to be acceptable. Overall, understanding the differences between the DSM and ICD can help mental health practitioners choose the most appropriate classification for their needs.
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This question is part of the following fields:
- Classification And Assessment
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Question 175
Incorrect
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What is the standard test used to measure digit span?
Your Answer:
Correct Answer: Short-term memory
Explanation:The mental state exam assesses various areas of cognition, including orientation, attention/concentration, short term memory, long term memory, and executive function. Standard tests for each area include asking about time, place, and person for orientation, serial 7’s for attention/concentration, digit span for short term memory, delayed recall of name and address for long term memory, and various tasks such as proverbs, similarities, differences, verbal fluency, and cognitive estimates for executive function.
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This question is part of the following fields:
- Classification And Assessment
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Question 176
Incorrect
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How can one differentiate between a dissociative seizure and an epileptic seizure?
Your Answer:
Correct Answer: A gradual onset
Explanation:Distinguishing between dissociative seizures and other types of seizures can be aided by observing the gradual onset often seen in dissociative seizures. It is important to note that seizure activity during sleep is not the same as seizure activity at night, as the latter may be indicative of dissociative seizures.
Dissociative seizures, also known as pseudoseizures of functional seizures, are abnormal paroxysmal manifestations that resemble epileptic seizures but are not related to abnormal epileptiform discharges. They can be caused by physical factors such as hypoglycemia of cardiac dysfunction, but more commonly result from mental of emotional processes. Dissociative seizures are more common in females and tend to have an onset in late adolescence. Distinguishing between true seizures and pseudoseizures can be challenging, but a rise in serum prolactin levels after a seizure is a helpful diagnostic tool. Treatment options for psychogenic nonepileptic seizures are limited, with cognitive-behavioral therapy being the most studied and effective intervention.
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This question is part of the following fields:
- Classification And Assessment
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Question 177
Incorrect
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How can the immaturity of a defense mechanism be identified?
Your Answer:
Correct Answer: Projection
Explanation:Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 178
Incorrect
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Which scales require evaluation by a healthcare professional?
Your Answer:
Correct Answer: Hamilton anxiety rating scale
Explanation:In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 179
Incorrect
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What statement accurately describes the ECG?
Your Answer:
Correct Answer: T waves are flat and prolonged in hypokalemia
Explanation:ECG Changes Associated with Chlorpromazine
Chlorpromazine is a psychotropic medication that has been associated with various ECG changes. One of the most notable changes is repolarization changes, which can be seen as ST segment and T wave changes. Additionally, chlorpromazine has been linked to heart blocks, which can be detected by a prolonged PR interval.
Another significant ECG finding associated with chlorpromazine is QTc prolongation. This is a potentially dangerous condition that can lead to torsades de pointes, a type of ventricular tachycardia that can be life-threatening. Other medications that have been linked to QTc prolongation include a wide range of antipsychotics and antidepressants.
It is important to note that not all patients who take chlorpromazine will experience ECG changes. However, healthcare providers should be aware of the potential risks and monitor patients closely for any signs of cardiac abnormalities. If ECG changes are detected, the medication may need to be adjusted of discontinued to prevent further complications.
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This question is part of the following fields:
- Classification And Assessment
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Question 180
Incorrect
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What statement accurately describes the LUNSERS?
Your Answer:
Correct Answer: It includes 'red herring' items
Explanation:The LUNSERS is a self-administered rating scale consisting of 51 items used to detect side effects caused by antipsychotic medication. It comprises 41 established side effects of neuroleptics and 10 additional items that are not known to be side effects of such medication, such as hair loss and chilblains, to validate the results. The scale’s validity and reliability were assessed in a sample of 50 male and female patients with an average age of 46 years and 16 years of antipsychotic use, as well as a group of 50 healthy controls, with promising outcomes. Furthermore, the LUNSERS’ validity was compared to that of the UKU, which is the gold standard and takes approximately 60 minutes to complete.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 181
Incorrect
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Which of the following is the best example of a leading question?
Your Answer:
Correct Answer: So, when you took the overdose you didn't want to die, did you?
Explanation:Techniques for Conducting Effective Interviews: Avoiding Leading Questions
One technique to avoid when conducting interviews is the use of leading questions. These are questions that suggest a particular answer of response, and can result in inaccurate of biased information. Instead, interviewers should strive to ask open-ended questions that allow the respondent to provide their own thoughts and opinions. By avoiding leading questions, interviewers can gather more reliable and unbiased information from their subjects. Additionally, interviewers should be mindful of their tone and body language, as these can also influence the responses they receive. Overall, effective interviewing requires careful preparation and a focus on creating a comfortable and open environment for the respondent.
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This question is part of the following fields:
- Classification And Assessment
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Question 182
Incorrect
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Which statement accurately describes the placebo effect?
Your Answer:
Correct Answer: The effects of placebos tend to be short lived
Explanation:Understanding the Placebo Effect
In general, a placebo is an inert substance that has no pharmacological activity but looks, smells, and tastes like the active drug it is compared to. The placebo effect is the observable improvement seen when a patient takes a placebo, which results from patient-related factors such as expectations rather than the placebo itself. Negative effects due to patient-related factors are termed the nocebo effect.
Active placebos are treatments with chemical activity that mimic the side effects of the drug being tested in a clinical trial. They are used to prevent unblinding of the drug versus the placebo control group. Placebos need not always be pharmacological and can be procedural, such as sham electroconvulsive therapy.
The placebo effect is influenced by factors such as the perceived strength of the treatment, the status of the treating professional, and the branding of the compound. The placebo response is greater in mild illness, and the response rate is increasing over time. Placebo response is usually short-lived, and repeated use can lead to a diminished effect, known as placebo sag.
It is difficult to separate placebo effects from spontaneous remission, and patients who enter clinical trials generally do so when acutely unwell, making it challenging to show treatment effects. Breaking the blind may influence the outcome, and the expectancy effect may explain why active placebos are more effective than inert placebos. Overall, understanding the placebo effect is crucial in clinical trials and personalized medicine.
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This question is part of the following fields:
- Classification And Assessment
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Question 183
Incorrect
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A child undergoes a lower limb amputation. She comes to clinic, talks about her favorite toys and resists your attempts to discuss her operation. When you ask her how her leg is feeling, she replies by saying that she has no pain and that there is nothing wrong with her leg. She says that she used a wheelchair to get to clinic as she wanted to try it out.
Which defense mechanism is being used?Your Answer:
Correct Answer: Denial
Explanation:The man’s denial was evident as he refused to acknowledge the external reality that his legs had been amputated. On the other hand, if he tried to change the subject and only reluctantly accepted the truth when pressed, it would suggest that he was suppressing his emotions and thoughts about the amputation.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 184
Incorrect
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For male patients with learning disabilities who have newly diagnosed generalised tonic-clonic epilepsy, NICE recommends which of the following as the first-line treatment?
Your Answer:
Correct Answer: Sodium valproate
Explanation:If the question had been about a female patient with learning difficulties, the pharmacological management of epilepsy may need to be adjusted based on factors such as hormonal changes and potential interactions with birth control medication.
Epilepsy: An Overview
Epilepsy is a condition that is diagnosed when a person experiences at least two unprovoked seizures that occur more than 24 hours apart. In the UK, the prevalence of epilepsy is 5-10 cases per 1000. Seizure types are categorized as focal onset of generalized onset. Focal seizures only involve a localized part of the brain, while generalized seizures involve the whole of both hemispheres. Temporal lobe epilepsy is the most common type of focal epilepsy, accounting for 60-70% of cases.
In 60% of people with epilepsy, there is no identifiable cause. Approximately 70% of people with epilepsy achieve remission, meaning they have no seizures for 5 years on of off treatment. of those with convulsive seizures, 2/3 have focal epilepsies and secondary generalized seizures, while the other 1/3 have generalized tonic-clonic seizures.
The National Institute for Health and Care Excellence (NICE) recommends treatment with antiepileptic drugs (AEDs) after a second epileptic seizure. For newly diagnosed focal seizures, carbamazepine of lamotrigine are recommended as first-line treatment. Levetiracetam, oxcarbazepine, of sodium valproate may be offered if carbamazepine and lamotrigine are unsuitable of not tolerated. For newly diagnosed generalized tonic-clonic seizures, sodium valproate is recommended as first-line treatment, with lamotrigine as an alternative if sodium valproate is unsuitable. For absence seizures, ethosuximide of sodium valproate are recommended as first-line treatment. For myoclonic seizures, sodium valproate is recommended as first-line treatment, and for tonic of atonic seizures, sodium valproate is also recommended as first-line treatment.
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This question is part of the following fields:
- Classification And Assessment
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Question 185
Incorrect
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A woman who experiences frequent headaches tells her doctor that whenever she has a migraine, when her husband speaks to her it feels like he is yelling directly into her ear. What symptom is she displaying?
Your Answer:
Correct Answer: Hyperacusis
Explanation:Gedankenlautwerden pertains to thoughts that can be heard.
Sensory Distortions of Sound
Hyperacusis is a condition where an individual experiences an increased sensitivity to noise. This condition is commonly observed in people with anxiety and depressive disorders, as well as during a hangover of migraine. On the other hand, hypoacusis is a condition where an individual experiences a reduced sensitivity to sound. This condition is commonly observed in people with delirium and depression, where it is often accompanied by hyperacusis.
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This question is part of the following fields:
- Classification And Assessment
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Question 186
Incorrect
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What is the alternative name for Briquet's syndrome in the field of psychiatry?
Your Answer:
Correct Answer: Bodily distress disorder
Explanation:In 1859, Pierre Briquet, a French physician and psychologist, released his Treatise on Hysteria, which established the foundation for the contemporary diagnosis of somatization disorder (also known as Briquet syndrome). The ICD-11 now refers to this as bodily distress disorder.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised 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. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 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. Each disorder has its own set of essential features and diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 187
Incorrect
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What is accurate about the diagnosis and categorization of personality disorders?
Your Answer:
Correct Answer: Narcissistic personality disorder is recognised as a separate and distinct personality disorder within the DSM-5
Explanation:The DSM-5 includes a distinct classification for narcissistic personality disorder.
Personality Disorder Classification
A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.
Course
Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.
Classification
The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.
UK Epidemiology
The prevalence of personality disorders in Great Britain, according to the British National Survey of Psychiatric Morbidity, is 4.4%, with cluster C being the most common at 2.6%, followed by cluster A at 1.6% and cluster B at 1.2%. The most prevalent specific personality disorder is obsessive-compulsive (anankastic) at 1.9%.
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This question is part of the following fields:
- Classification And Assessment
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Question 188
Incorrect
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Which of the following is an example of a compound question?
Your Answer:
Correct Answer: Do you limit what you eat and exercise to keep thin?
Explanation:Understanding Compound Questions in Interview Techniques
When conducting interviews, it is important to be aware of compound questions. These are questions that combine multiple inquiries into what appears to be a single question. Compound questions can be confusing for the interviewee and may lead to inaccurate of incomplete responses.
To avoid compound questions, it is important to break down inquiries into separate, clear questions. This allows the interviewee to fully understand what is being asked and provide a thoughtful response. Additionally, it is important to avoid using conjunctions such as and of of when asking questions, as this can create compound questions.
By using clear and concise language and avoiding compound questions, interviewers can ensure that they are receiving accurate and complete responses from their interviewees. This can lead to a more successful and informative interview process.
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This question is part of the following fields:
- Classification And Assessment
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Question 189
Incorrect
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What was specifically designed to detect the effects of antidepressants on the body?
Your Answer:
Correct Answer: MADRS
Explanation:In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 190
Incorrect
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How can the doctor-patient relationship be structured to prioritize a collaborative decision-making process?
Your Answer:
Correct Answer: Interpretive
Explanation:Models of Doctor-Patient Relationship
There are four distinct models of doctor-patient relationship that have been identified. The first is the paternalistic of autocratic model, which assumes that the doctor knows best and makes all decisions regarding treatment. The patient is expected to simply comply with the doctor’s orders. The second model is the informative model, where the doctor provides information to the patient and leaves the decision-making process entirely up to them. The third model is the interpretive model, where the doctor takes the time to understand the patient’s circumstances and helps them make a decision based on their unique situation. This model involves shared decision-making and active participation from the patient. Finally, the deliberative model involves the doctor acting as a friend to the patient and attempting to steer them in a particular course of action that they believe is in the patient’s best interest. However, ultimately, the choice is left up to the patient. Understanding these different models can help doctors and patients work together more effectively to achieve the best possible outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 191
Incorrect
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What case prompted the creation of the Fraser Guidelines?
Your Answer:
Correct Answer: Gillick
Explanation:Gillick Competency and Fraser Guidelines
Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice of treatment to under 16-year-olds without parental consent. But since then, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.
In 1982, Mrs Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice of treatment to under 16-year-olds without parental consent.
The case went to the High Court where Mr Justice Woolf dismissed Mrs Gillick’s claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgement delivered by Mr Justice Woolf.
The Fraser Guidelines were laid down by Lord Fraser in the House of Lords’ case and state that it is lawful for doctors to provide contraceptive advice and treatment without parental consent providing that they are satisfied that:
– The young person will understand the professional’s advice
– The young person cannot be persuaded to inform their parents
– The young person is likely to begin, of to continue having, sexual intercourse with of without contraceptive treatment
– Unless the young person receives contraceptive treatment, their physical of mental health, of both, are likely to suffer
– The young person’s best interests require them to receive contraceptive advice of treatment with of without parental consent. -
This question is part of the following fields:
- Classification And Assessment
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Question 192
Incorrect
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What scales are used to assess the intensity of manic symptoms?
Your Answer:
Correct Answer: YMRS
Explanation:In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 193
Incorrect
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For which condition is the Addenbrooke's exam (ACE-III) most beneficial in evaluating?
Your Answer:
Correct Answer: Dementia
Explanation:The Addenbrooke’s Cognitive Exam: A Brief Screening Tool for Dementia
The Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool developed to detect dementia and differentiate Alzheimer’s dementia from frontotemporal dementia. It was created to address the limitations of the MMSE, which lacked sensitivity for frontal-executive dysfunction and visuospatial defects. The ACE is a brief test that takes 15-20 minutes to administer and is divided into five domains: attention and orientation, memory, verbal fluency, language, and visuospatial abilities. The total score is based on a maximum score of 100, with higher scores indicating better cognitive functioning.
The ACE has been shown to be a valid tool for detecting dementia, with two cut-off points often used depending on the required sensitivity and specificity. A score of less than 88 has 100% sensitivity for detecting dementia, while a score of less than 82 has 93% sensitivity and 100% specificity. It has also been useful in differentiating dementia from pseudo dementia and detecting cognitive impairment in atypical Parkinson syndromes. However, while the test has shown 100% sensitivity and specificity in studies, its performance may vary in clinical practice.
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This question is part of the following fields:
- Classification And Assessment
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Question 194
Incorrect
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The developmental stages were organized into how many levels by Vaillant's classification?
Your Answer:
Correct Answer: Four
Explanation:Vaillant categorized defenses into four levels of maturity, starting from the most severe psychotic level, followed by immature, neurotic, and finally, mature defenses.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 195
Incorrect
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What is the characteristic feature that is specific to Wilson's disease?
Your Answer:
Correct Answer: Kayser-Fleischer Ring
Explanation:While other conditions may also present with the same symptoms, a Kayser-Fleischer Ring, characterized by a golden-brown corneal ring due to copper deposits at the Descemet’s membrane, is considered a definitive indicator of Wilson’s disease.
Understanding Wilson’s Disease: Causes, Symptoms, and Management
Wilson’s disease, also known as hepatolenticular degeneration, is a genetic disorder that affects copper storage in the body. This condition is caused by a defect in the ATP7B gene, which leads to the accumulation of copper in the liver and brain. The onset of symptoms usually occurs between the ages of 10 and 25, with liver disease being the most common presentation in children and neurological symptoms in young adults.
The excessive deposition of copper in the tissues can cause a range of symptoms, including hepatitis, cirrhosis, basal ganglia degeneration, speech and behavioral problems, asterixis, chorea, dementia, Kayser-Fleischer rings, sunflower cataract, renal tubular acidosis, haemolysis, and blue nails. Diagnosis is based on reduced serum ceruloplasmin, reduced serum copper, and increased 24-hour urinary copper excretion.
The traditional first-line treatment for Wilson’s disease is penicillamine, which chelates copper. Trientine hydrochloride is an alternative chelating agent that may become first-line treatment in the future. Tetrathiomolybdate is a newer agent that is currently under investigation.
In summary, Wilson’s disease is a genetic disorder that affects copper storage in the body, leading to a range of symptoms that can affect the liver, brain, and eyes. Early diagnosis and treatment are essential to prevent complications and improve outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 196
Incorrect
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Which of the following is an example of a secondary delusion?
Your Answer:
Correct Answer: A person with depression develops the idea that they are responsible for the death of their spouse
Explanation:The delusional psychopathology is a secondary factor that can lead to delusions, while the other examples are considered primary delusions. It’s important to note that delusional mood is distinct from the mood disorder associated with depression, as it refers to a subtle sense of paranoia of unusual feeling that may precede the development of delusional beliefs.
Borderline Learning Disability
Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.
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This question is part of the following fields:
- Classification And Assessment
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Question 197
Incorrect
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Among the given defence mechanisms, which one falls under the category of neurotic?
Your Answer:
Correct Answer: Reaction formation
Explanation:Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 198
Incorrect
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A pediatrician who sees a child with asthma prescribes them the treatment which they believe is best based on their knowledge of the likely effectiveness of the medication. They fail to take into account the individual circumstances of the child. Which approach to doctor-patient relationships does the pediatrician adopt?
Your Answer:
Correct Answer: Paternalistic
Explanation:Models of Doctor-Patient Relationship
There are four distinct models of doctor-patient relationship that have been identified. The first is the paternalistic of autocratic model, which assumes that the doctor knows best and makes all decisions regarding treatment. The patient is expected to simply comply with the doctor’s orders. The second model is the informative model, where the doctor provides information to the patient and leaves the decision-making process entirely up to them. The third model is the interpretive model, where the doctor takes the time to understand the patient’s circumstances and helps them make a decision based on their unique situation. This model involves shared decision-making and active participation from the patient. Finally, the deliberative model involves the doctor acting as a friend to the patient and attempting to steer them in a particular course of action that they believe is in the patient’s best interest. However, ultimately, the choice is left up to the patient. Understanding these different models can help doctors and patients work together more effectively to achieve the best possible outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 199
Incorrect
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What is the scale used to determine the presence of psychiatric disorders in a population?
Your Answer:
Correct Answer: GHQ
Explanation:The college is evaluating your comprehension of the term ‘caseness’ through this question. The GHQ is an established instrument used to detect individuals who meet the criteria for ‘caseness’.
Defining ‘Caseness’ in Psychological Rating Scales
When utilizing a psychological rating scale for screening purposes, it is crucial to establish a clear definition of ‘caseness.’ This refers to the threshold at which a respondent of participant is identified as a case, typically represented by a numerical cutoff value. Without a defined caseness, the results of the screening may be ambiguous of inconsistent. Therefore, it is essential to establish a clear operational definition of caseness to ensure accurate and reliable screening outcomes.
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This question is part of the following fields:
- Classification And Assessment
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Question 200
Incorrect
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What is commonly used as a measure of intelligence prior to the onset of illness of injury?
Your Answer:
Correct Answer: National adult reading test
Explanation:The NART is a widely accepted assessment tool utilized for approximating an individual’s intelligence level prior to the onset of any cognitive impairment.
The field of psychiatry uses various cognitive tests to assess different areas of cognition, including premorbid intelligence, intelligence, memory, attention, language, and others. Some commonly used tests include the National Adult Reading Test (NART) for premorbid intelligence, the Wechsler Adult Intelligence scale (WAIS) and Raven’s Progressive Matrices for intelligence, the Rey-Osterrieth Complex Figure for memory, and the Stroop test, Wisconsin card sorting test, Tower of London, and Continuous Performance Tasks for attention. The Boston naming test and Animal fluency are used to assess language skills. The Halstead-Reitan battery is used specifically for assessing brain damage. These tests are often included in the MRCPsych exams.
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This question is part of the following fields:
- Classification And Assessment
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