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  • Question 1 - What is a true statement about dissociative disorders? ...

    Incorrect

    • What is a true statement about dissociative disorders?

      Your Answer: Dissociative disorders are also referred to as somatoform disorders

      Correct Answer: The onset is usually acute

      Explanation:

      Dissociative disorders involve an involuntary disturbance of interruption in the usual integration of various aspects such as identity, sensations, perceptions, emotions, thoughts, memories, bodily movements, of behavior. This disruption can be complete of partial and may vary in intensity over time. The condition usually develops suddenly.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 2 - What is a true statement about frontotemporal lobar degeneration? ...

    Incorrect

    • What is a true statement about frontotemporal lobar degeneration?

      Your Answer:

      Correct Answer: In semantic dementia, speech is characteristically fluent

      Explanation:

      Frontotemporal Lobar Degeneration

      Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.

      The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).

      As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.

      In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 3 - What intervention was implemented in the POTS study? ...

    Incorrect

    • What intervention was implemented in the POTS study?

      Your Answer:

      Correct Answer: Sertraline

      Explanation:

      The study known as POTS examined the effects of SSRIs (specifically sertraline) and CBT on children with OCD.

      POTS Study: Combination of CBT and Sertraline Best for Treating Pediatric OCD

      The Pediatric OCD Treatment Study (POTS I) was the first randomized trial in pediatric OCD to compare the efficacy of sertraline, OCD-specific cognitive behavioral treatment (CBT), their combination, and a placebo control condition in treating children and adolescents with clinically significant OCD. The study took place in the United States and involved 112 participants who were randomly assigned to receive CBT alone, sertraline alone, combined CBT and sertraline, of a placebo for 12 weeks.

      The study found that all three active treatments (CBT alone, sertraline alone, and combined treatment) were significantly more effective than the placebo. The combined treatment was found to be the most effective, with a remission rate of 53.6%, followed by CBT alone (39.3%) and sertraline alone (21.4%). The study also found that combined treatment was less susceptible to setting-specific variations than CBT and sertraline alone.

      The study concluded that children and adolescents with OCD should begin treatment with the combination of CBT plus a selective serotonin reuptake inhibitor of CBT alone. The three active treatments were found to be acceptable and well-tolerated, with no evidence of treatment-emergent harm to self of others.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 4 - Globally, which demographic has the highest incidence of completed suicides? ...

    Incorrect

    • Globally, which demographic has the highest incidence of completed suicides?

      Your Answer:

      Correct Answer: 70 and over

      Explanation:

      The elderly have the highest suicide rates globally, with variations in different regions. Some areas show a steady increase in suicide rates with age, while others have a peak in young adults that decreases in middle age. Middle-aged men in high-income countries have higher suicide rates than those in low and middle-income countries. In the UK, the highest suicide rate is among people aged 40-44, with 15/100,000 per year. Suicide in the elderly is associated with mental illness, social isolation, cognitive decline, and physical pain. Additionally, the elderly are more likely to use lethal methods when attempting suicide.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 5 - Which symptom is not considered a sign of PTSD in individuals with learning...

    Incorrect

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

      Your Answer:

      Correct Answer: Auditory hallucinations

      Explanation:

      Post Traumatic Stress Disorder in People with Learning Difficulties

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

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

    • This question is part of the following fields:

      • Learning Disability
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  • Question 6 - What is the term used to describe the act of a woman killing...

    Incorrect

    • What is the term used to describe the act of a woman killing her husband?

      Your Answer:

      Correct Answer: Mariticide

      Explanation:

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 7 - What is a characteristic of a personality disorder that includes anankastic? ...

    Incorrect

    • What is a characteristic of a personality disorder that includes anankastic?

      Your Answer:

      Correct Answer: Unreasonable insistence by the patient that others submit to exactly his of her way of doing things

      Explanation:

      Personality Disorder (Obsessive Compulsive)

      Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control, which can hinder flexibility and efficiency. This pattern typically emerges in early adulthood and can be present in various contexts. The estimated prevalence ranges from 2.1% to 7.9%, with males being diagnosed twice as often as females.

      The DSM-5 diagnosis requires the presence of four of more of the following criteria: preoccupation with details, rules, lists, order, organization, of agenda to the point that the key part of the activity is lost; perfectionism that hampers completing tasks; extreme dedication to work and efficiency to the elimination of spare time activities; meticulous, scrupulous, and rigid about etiquettes of morality, ethics, of values; inability to dispose of worn-out of insignificant things even when they have no sentimental meaning; unwillingness to delegate tasks of work with others except if they surrender to exactly their way of doing things; miserly spending style towards self and others; and rigidity and stubbornness.

      The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder, which can be further specified as “mild,” “moderate,” of “severe.” The anankastic trait domain is characterized by a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behavior and controlling situations to ensure conformity to these standards. Common manifestations of anankastic include perfectionism and emotional and behavioral constraint.

      Differential diagnosis includes OCD, hoarding disorder, narcissistic personality disorder, antisocial personality disorder, and schizoid personality disorder. OCD is distinguished by the presence of true obsessions and compulsions, while hoarding disorder should be considered when hoarding is extreme. Narcissistic personality disorder individuals are more likely to believe that they have achieved perfection, while those with obsessive-compulsive personality disorder are usually self-critical. Antisocial personality disorder individuals lack generosity but will indulge themselves, while those with obsessive-compulsive personality disorder adopt a miserly spending style toward both self and others. Schizoid personality disorder is characterized by a fundamental lack of capacity for intimacy, while in obsessive-compulsive personality disorder, this stems from discomfort with emotions and excessive devotion to work.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 8 - Which study design is susceptible to making the erroneous assumption that relationships observed...

    Incorrect

    • Which study design is susceptible to making the erroneous assumption that relationships observed among groups also hold true for individuals?

      Your Answer:

      Correct Answer: Ecological study

      Explanation:

      An ecological fallacy is a potential error that can occur when generalizing relationships observed among groups to individuals. This is a concern when conducting analyses of ecological studies.

      Types of Primary Research Studies and Their Advantages and Disadvantages

      Primary research studies can be categorized into six types based on the research question they aim to address. The best type of study for each question type is listed in the table below. There are two main types of study design: experimental and observational. Experimental studies involve an intervention, while observational studies do not. The advantages and disadvantages of each study type are summarized in the table below.

      Type of Question Best Type of Study

      Therapy Randomized controlled trial (RCT), cohort, case control, case series
      Diagnosis Cohort studies with comparison to gold standard test
      Prognosis Cohort studies, case control, case series
      Etiology/Harm RCT, cohort studies, case control, case series
      Prevention RCT, cohort studies, case control, case series
      Cost Economic analysis

      Study Type Advantages Disadvantages

      Randomized Controlled Trial – Unbiased distribution of confounders – Blinding more likely – Randomization facilitates statistical analysis – Expensive – Time-consuming – Volunteer bias – Ethically problematic at times
      Cohort Study – Ethically safe – Subjects can be matched – Can establish timing and directionality of events – Eligibility criteria and outcome assessments can be standardized – Administratively easier and cheaper than RCT – Controls may be difficult to identify – Exposure may be linked to a hidden confounder – Blinding is difficult – Randomization not present – For rare disease, large sample sizes of long follow-up necessary
      Case-Control Study – Quick and cheap – Only feasible method for very rare disorders of those with long lag between exposure and outcome – Fewer subjects needed than cross-sectional studies – Reliance on recall of records to determine exposure status – Confounders – Selection of control groups is difficult – Potential bias: recall, selection
      Cross-Sectional Survey – Cheap and simple – Ethically safe – Establishes association at most, not causality – Recall bias susceptibility – Confounders may be unequally distributed – Neyman bias – Group sizes may be unequal
      Ecological Study – Cheap and simple – Ethically safe – Ecological fallacy (when relationships which exist for groups are assumed to also be true for individuals)

      In conclusion, the choice of study type depends on the research question being addressed. Each study type has its own advantages and disadvantages, and researchers should carefully consider these when designing their studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 9 - What is the main focus of behavioural activation therapy? ...

    Incorrect

    • What is the main focus of behavioural activation therapy?

      Your Answer:

      Correct Answer: Depression

      Explanation:

      Understanding Behavioural Activation Therapy for Depression

      Behavioural activation therapy is a formal treatment for depression that emphasizes activity scheduling to encourage patients to approach activities they are avoiding. Unlike traditional cognitive therapy, it involves less cognitive therapy and is easier to train staff in its use. The therapy was introduced by Martell in 2001 and has two primary focuses: the use of avoided activities as a guide for activity scheduling and functional analysis of cognitive processes that involve avoidance.

      Behavioural activation theory suggests that when people become depressed, many of their activities function as avoidance and escape from aversive thoughts, feelings, of external situations. As a result, someone with depression engages less frequently in pleasant of satisfying activities and obtains less positive reinforcement than someone without depression. To address this, the patient is encouraged to identify activities and problems that they avoid and to establish valued directions to be followed. These are set out on planned timetables (activity schedules).

      In behavioural activation therapy, therapists do not engage in the content of the patient’s thinking. Instead, they use functional analysis to focus on the context and process of the individual’s response. The most common cognitive responses are rumination, fusion, and self-attack. A typical session has a structured agenda to review homework and progress towards goals, discuss feedback on the previous session, and focus on one of two specific issues. The number of sessions required to treat depression is typically between 12 and 24.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 10 - What statement accurately describes the STAR*D trial? ...

    Incorrect

    • What statement accurately describes the STAR*D trial?

      Your Answer:

      Correct Answer: It was a pragmatic trial

      Explanation:

      STAR*D Study

      The STAR*D trial, conducted in the USA, aimed to evaluate the effectiveness of treatments for major depressive disorder in real-world patients. The study involved four levels of treatment, with patients starting at level 1 and progressing to the next level if they did not respond. The outcome measure used was remission, and the study entry criteria were broadly defined to ensure results could be generalized to a wide range of patients.

      A total of 4,041 patients were enrolled in the first level of treatment, making STAR*D the largest prospective clinical trial of depression ever conducted. In level 1, one-third of participants achieved remission, and a further 10-15% responded but not to the point of remission. If treatment with an initial SSRI fails, then one in four patients who choose to switch to another medication will enter remission, regardless of whether the second medication is an SSRI of a medication of a different class. If patients choose to add a medication instead, one in three will get better.

      Overall, the STAR*D study provides valuable insights into the effectiveness of different treatments for major depressive disorder and highlights the importance of considering alternative treatments if initial treatment fails.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 11 - What vitamin is also known as niacin? ...

    Incorrect

    • What vitamin is also known as niacin?

      Your Answer:

      Correct Answer: Vitamin B3

      Explanation:

      Pantothenic acid is also known as Vitamin B5.

      Pellagra: A Vitamin B3 Deficiency Disease

      Pellagra is a disease caused by a lack of vitamin B3 (niacin) in the body. The name pellagra comes from the Italian words pelle agra, which means rough of sour skin. This disease is common in developing countries where corn is a major food source, of during prolonged disasters like famine of war. In developed countries, pellagra is rare because many foods are fortified with niacin. However, alcoholism is a common cause of pellagra in developed countries. Alcohol dependence can worsen pellagra by causing malnutrition, gastrointestinal problems, and B vitamin deficiencies. It can also inhibit the conversion of tryptophan to niacin and promote the accumulation of 5-ALA and porphyrins.

      Pellagra affects a wide range of organs and tissues in the body, so its symptoms can vary. The classic symptoms of pellagra are known as the three Ds: diarrhea, dermatitis, and dementia. Niacin deficiency can cause dementia, depression, mania, and psychosis, which is called pellagra psychosis. The most noticeable symptom of pellagra is dermatitis, which is a hyperpigmented rash that appears on sun-exposed areas of the skin. This rash is usually symmetrical and bilateral, and it is often described as Casal’s necklace when it appears on the neck.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 12 - What is a true statement about Bion's theory of group dynamics? ...

    Incorrect

    • What is a true statement about Bion's theory of group dynamics?

      Your Answer:

      Correct Answer: Basic assumption groups reflect a subconscious process that operates within the group

      Explanation:

      The underlying process of basic assumption groups operates at a subconscious level within the group, serving to shield the group as a whole from distressing anxiety rather than focusing on individual members. In contrast, work groups prioritize productivity and shared responsibility for achieving goals, distinguishing them from basic assumption groups. Work groups are primarily focused on accomplishing the task at hand.

      Bion, a psychoanalyst, was fascinated by group dynamics and believed that groups had a collective unconscious that functioned similarly to that of an individual. He argued that this unconsciousness protected the group from the pain of reality. Bion identified two types of groups: the ‘working group’ that functioned well and achieved its goals, and the ‘basic assumption group’ that acted out primitive fantasies and prevented progress. Bion then described different types of basic assumption groups, including ‘dependency,’ where the group turns to a leader to alleviate anxiety, ‘fight-flight,’ where the group perceives an enemy and either attacks of avoids them, and ‘pairing,’ where the group believes that the solution lies in the pairing of two members. These dynamics can be observed in various settings, such as when strangers come together for the first time of when doctors in different specialties criticize one another.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 13 - A man in his 50s with breast cancer has developed moderate depression. He...

    Incorrect

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

      Your Answer:

      Correct Answer: Fluoxetine

      Explanation:

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

      Tamoxifen and Antidepressant Interactions

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 14 - A 35-year-old woman with a 2-year history of bipolar disorder has experienced two...

    Incorrect

    • A 35-year-old woman with a 2-year history of bipolar disorder has experienced two severe episodes in the past few months. Her family, who believe she can manage her condition without medication, present you with a list of alternative treatments they found online. They inquire about any additional interventions that can help prevent future relapses. What evidence-based recommendations would you offer to reduce relapse rates in bipolar disorder?

      Your Answer:

      Correct Answer: Family therapy

      Explanation:

      Schizophrenia treatment involving individual psychotherapy is not effective, while family therapy can reduce relapse rates by 50%, especially in adolescents with the illness who come from families with high expressed emotion. Additionally, social skills training and supported employment can improve social outcomes, but do not have an impact on relapse rates.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 15 - A 72 year old man with a progressive history of breathlessness is brought...

    Incorrect

    • A 72 year old man with a progressive history of breathlessness is brought to the emergency department by his daughter. She reports that his breathing has recently worsened. Upon diagnosis of chronic obstructive pulmonary disease, he is prescribed several new medications. However, two weeks later, he returns to the emergency department with his daughter reporting that he has stopped sleeping, has become agitated, and will not stop talking. What is the most probable cause of his new presentation?

      Your Answer:

      Correct Answer: Budesonide

      Explanation:

      Budesonide is a type of steroid that is often administered through an inhaler to manage asthma symptoms. However, it has been noted that the use of inhaled steroids can trigger episodes of hypomania and mania. This information was reported in a study by E Brown et al. titled The psychiatric side effects of corticosteroids, which was published in the Annals of Allergy, Asthma & Immunology in 1999.

      Drug-Induced Mania: Evidence and Precipitating Drugs

      There is strong evidence that mania can be triggered by certain drugs, according to Peet (1995). These drugs include levodopa, corticosteroids, anabolic-androgenic steroids, and certain classes of antidepressants such as tricyclic and monoamine oxidase inhibitors.

      Additionally, Peet (2012) suggests that there is weaker evidence that mania can be induced by dopaminergic anti-Parkinsonian drugs, thyroxine, iproniazid and isoniazid, sympathomimetic drugs, chloroquine, baclofen, alprazolam, captopril, amphetamine, and phencyclidine.

      It is important for healthcare professionals to be aware of the potential for drug-induced mania and to monitor patients closely for any signs of symptoms. Patients should also be informed of the risks associated with these medications and advised to report any unusual changes in mood of behavior.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 16 - What changes would be anticipated when transitioning a middle-aged man with long-term schizophrenia...

    Incorrect

    • What changes would be anticipated when transitioning a middle-aged man with long-term schizophrenia from a conventional antipsychotic to a newer atypical antipsychotic medication?

      Your Answer:

      Correct Answer: A reduction in extrapyramidal side effects

      Explanation:

      Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 17 - How do the odds of excessive drinking differ between patients with liver cirrhosis...

    Incorrect

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

      Your Answer:

      Correct Answer: 16

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 18 - What is a true statement about individuals with rapid cycling bipolar disorder? ...

    Incorrect

    • What is a true statement about individuals with rapid cycling bipolar disorder?

      Your Answer:

      Correct Answer: It lasts less than 2 years in approximately 50% of patients

      Explanation:

      If rapid cycling bipolar disorder occurs, propranolol should be discontinued as it is believed to be a contributing factor.

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 19 - What is a true statement about strategic family therapy? ...

    Incorrect

    • What is a true statement about strategic family therapy?

      Your Answer:

      Correct Answer: The main problem is assumed to be one of communication rather than structure

      Explanation:

      Strategic family therapy prioritizes communication over structure.

      Family Therapy Models

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

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

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

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 20 - You diagnose schizophrenia in a 40 year old man. He asks you what...

    Incorrect

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

      Your Answer:

      Correct Answer: 13%

      Explanation:

      Schizophrenia: Understanding the Risk Factors

      Social class is a significant risk factor for schizophrenia, with people of lower socioeconomic status being more likely to develop the condition. Two hypotheses attempt to explain this relationship, one suggesting that environmental exposures common in lower social class conditions are responsible, while the other suggests that people with schizophrenia tend to drift towards the lower class due to their inability to compete for good jobs.

      While early studies suggested that schizophrenia was more common in black populations than in white, the current consensus is that there are no differences in rates of schizophrenia by race. However, there is evidence that rates are higher in migrant populations and ethnic minorities.

      Gender and age do not appear to be consistent risk factors for schizophrenia, with conflicting evidence on whether males of females are more likely to develop the condition. Marital status may also play a role, with females with schizophrenia being more likely to marry than males.

      Family history is a strong risk factor for schizophrenia, with the risk increasing significantly for close relatives of people with the condition. Season of birth and urban versus rural place of birth have also been shown to impact the risk of developing schizophrenia.

      Obstetric complications, particularly prenatal nutritional deprivation, brain injury, and influenza, have been identified as significant risk factors for schizophrenia. Understanding these risk factors can help identify individuals who may be at higher risk for developing the condition and inform preventative measures.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 21 - When comparing the effectiveness of various psychological therapies, what has consistently been found...

    Incorrect

    • When comparing the effectiveness of various psychological therapies, what has consistently been found to be the most reliable indicator of success in therapy?

      Your Answer:

      Correct Answer: The strength of the therapeutic alliance

      Explanation:

      Studies have consistently found that the most important factor in the effectiveness of psychotherapy is the strength of the relationship between the therapist and client, rather than specific features of the therapy itself. While there has been some questioning of the idea that all psychotherapies are equally effective, common factors such as warmth, empathy, and a strong therapeutic relationship are still better predictors of success than individual patient of therapy factors. While allowing for emotional release may be helpful early on, it can become counterproductive if it occurs too frequently and leads to intense emotional outbursts. While having an above average IQ and being married may be associated with better outcomes, the strength of the therapeutic alliance is still the most important factor. Additionally, having had psychotherapy in the past does not necessarily indicate a positive response to future interventions.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 22 - You diagnose schizophrenia in a 30 year old man. Which of the following...

    Incorrect

    • You diagnose schizophrenia in a 30 year old man. Which of the following relatives is most likely to develop the same condition?

      Your Answer:

      Correct Answer: Child

      Explanation:

      Schizophrenia: Understanding the Risk Factors

      Social class is a significant risk factor for schizophrenia, with people of lower socioeconomic status being more likely to develop the condition. Two hypotheses attempt to explain this relationship, one suggesting that environmental exposures common in lower social class conditions are responsible, while the other suggests that people with schizophrenia tend to drift towards the lower class due to their inability to compete for good jobs.

      While early studies suggested that schizophrenia was more common in black populations than in white, the current consensus is that there are no differences in rates of schizophrenia by race. However, there is evidence that rates are higher in migrant populations and ethnic minorities.

      Gender and age do not appear to be consistent risk factors for schizophrenia, with conflicting evidence on whether males of females are more likely to develop the condition. Marital status may also play a role, with females with schizophrenia being more likely to marry than males.

      Family history is a strong risk factor for schizophrenia, with the risk increasing significantly for close relatives of people with the condition. Season of birth and urban versus rural place of birth have also been shown to impact the risk of developing schizophrenia.

      Obstetric complications, particularly prenatal nutritional deprivation, brain injury, and influenza, have been identified as significant risk factors for schizophrenia. Understanding these risk factors can help identify individuals who may be at higher risk for developing the condition and inform preventative measures.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 23 - Which of the following is an example of a non-random sampling method? ...

    Incorrect

    • Which of the following is an example of a non-random sampling method?

      Your Answer:

      Correct Answer: Quota sampling

      Explanation:

      Sampling Methods in Statistics

      When collecting data from a population, it is often impractical and unnecessary to gather information from every single member. Instead, taking a sample is preferred. However, it is crucial that the sample accurately represents the population from which it is drawn. There are two main types of sampling methods: probability (random) sampling and non-probability (non-random) sampling.

      Non-probability sampling methods, also known as judgement samples, are based on human choice rather than random selection. These samples are convenient and cheaper than probability sampling methods. Examples of non-probability sampling methods include voluntary sampling, convenience sampling, snowball sampling, and quota sampling.

      Probability sampling methods give a more representative sample of the population than non-probability sampling. In each probability sampling technique, each population element has a known (non-zero) chance of being selected for the sample. Examples of probability sampling methods include simple random sampling, systematic sampling, cluster sampling, stratified sampling, and multistage sampling.

      Simple random sampling is a sample in which every member of the population has an equal chance of being chosen. Systematic sampling involves selecting every kth member of the population. Cluster sampling involves dividing a population into separate groups (called clusters) and selecting a random sample of clusters. Stratified sampling involves dividing a population into groups (strata) and taking a random sample from each strata. Multistage sampling is a more complex method that involves several stages and combines two of more sampling methods.

      Overall, probability sampling methods give a more representative sample of the population, but non-probability sampling methods are often more convenient and cheaper. It is important to choose the appropriate sampling method based on the research question and available resources.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 24 - What is the recommended initial medication for treating panic disorder, as per the...

    Incorrect

    • What is the recommended initial medication for treating panic disorder, as per the NICE guidelines?

      Your Answer:

      Correct Answer: SSRI

      Explanation:

      Understanding Panic Disorder: Key Facts, Diagnosis, and Treatment Recommendations

      Panic disorder is a mental health condition characterized by recurrent unexpected panic attacks, which are sudden surges of intense fear of discomfort that reach a peak within minutes. Females are more commonly affected than males, and the disorder typically onsets during the early 20s. Panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      To diagnose panic disorder, the individual must experience recurrent panic attacks that are not restricted to particular stimuli of situations and are unexpected. The panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms are not a manifestation of another medical condition of substance use, and they result in significant impairment in functioning.

      Panic disorder is differentiated from normal fear reactions by the frequent recurrence of panic attacks, persistent worry of concern about the panic attacks of their meaning, and associated significant impairment in functioning. Treatment recommendations vary based on the severity of the disorder, with mild to moderate cases recommended for individual self-help and moderate to severe cases recommended for cognitive-behavioral therapy of antidepressant medication. The classes of antidepressants that have an evidence base for effectiveness are SSRIs, SNRIs, and TCAs. Benzodiazepines are not recommended for the treatment of panic disorder due to their association with a less favorable long-term outcome. Sedating antihistamines of antipsychotics should also not be prescribed for the treatment of panic disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 25 - What is the correct statement about the psychiatric care provided to individuals with...

    Incorrect

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

      Your Answer:

      Correct Answer: Efavirenz is associated with depression and mania

      Explanation:

      HIV and Mental Health: Understanding the Relationship and Treatment Options

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 26 - The combination of hypomania and depression is referred to as a subtype in...

    Incorrect

    • The combination of hypomania and depression is referred to as a subtype in Klerman's expanded classification of bipolar disorders as:

      Your Answer:

      Correct Answer: Bipolar II

      Explanation:

      Bipolar Disorder: Historical Subtypes

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 27 - At what age can a person be diagnosed with the personality disorder that...

    Incorrect

    • At what age can a person be diagnosed with the personality disorder that is specified in DSM-5 as requiring the individual to be at least 18 years old?

      Your Answer:

      Correct Answer: Antisocial

      Explanation:

      Personality Disorder: Understanding the Clinical Diagnosis

      A personality disorder is a long-standing 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, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, clinicians must first establish that the general diagnostic threshold is met before identifying the subtype(s) present. The course of personality disorders varies, with some becoming less evident of remitting with age, while others persist.

      DSM-5 and ICD-11 have different classification systems for personality disorders. DSM-5 divides them into three clusters (A, B, and C), while ICD-11 has a general category with six trait domains that can be added. The prevalence of personality disorders in Great Britain is 4.4%, with Cluster C being the most common. Clinicians are advised to avoid diagnosing personality disorders in children, although a diagnosis can be made in someone under 18 if the features have been present for at least a year (except for antisocial personality disorder).

      Overall, understanding the clinical diagnosis of personality disorders is important for effective treatment and management of these conditions.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 28 - What is the most precise estimation for the occurrence of Charles Bonnet syndrome...

    Incorrect

    • What is the most precise estimation for the occurrence of Charles Bonnet syndrome among individuals with visual impairment?

      Your Answer:

      Correct Answer: 12%

      Explanation:

      Creutzfeldt-Jakob dementia

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 29 - Which of the following checklists would be most helpful in preparing the manuscript...

    Incorrect

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

      Your Answer:

      Correct Answer: COREQ

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 30 - What is the term used to refer to the act of deriving pleasure...

    Incorrect

    • What is the term used to refer to the act of deriving pleasure from touching and rubbing against someone who has not given their consent?

      Your Answer:

      Correct Answer: Frotteurism

      Explanation:

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 31 - Which statement is false regarding an individual's ability to plead fitness? ...

    Incorrect

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

      Your Answer:

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

      Explanation:

      Fitness to Plead: Criteria and Process

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 32 - What is the expected duration of detectability in urine after a one-time use...

    Incorrect

    • What is the expected duration of detectability in urine after a one-time use of cannabis?

      Your Answer:

      Correct Answer: 3 days

      Explanation:

      Drug Screening

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 33 - For what purpose is the Gudjonsson Scale primarily used in assessment? ...

    Incorrect

    • For what purpose is the Gudjonsson Scale primarily used in assessment?

      Your Answer:

      Correct Answer: Suggestibility

      Explanation:

      The Gudjonsson Suggestibility Scale

      The Gudjonsson Suggestibility Scale is a tool used to measure suggestibility in individuals. It involves reading a story to participants, who are then asked to recall as much as they can remember. Afterward, participants are asked 20 questions related to the story, 15 of which are misleading. Once the questions have been answered, participants are given negative feedback on their performance and told that they made several errors. They are then asked to repeat the questions to obtain more accurate answers. Based on the participants’ responses to the misleading questions, a total suggestibility score can be calculated. This scale is useful in understanding how easily individuals can be influenced of manipulated by external factors.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 34 - In which situations might higher doses of clozapine be necessary? ...

    Incorrect

    • In which situations might higher doses of clozapine be necessary?

      Your Answer:

      Correct Answer: Smokers

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 35 - A woman who has had bipolar affective disorder for the past 3 years...

    Incorrect

    • A woman who has had bipolar affective disorder for the past 3 years presents with an episode of mania. She is admitted to hospital to the ward on which you are the resident doctor. She has been taking aripiprazole 20 mg for the past three years and has been compliant. What would be your recommendation in this case?

      Your Answer:

      Correct Answer: Increase the dose of aripiprazole

      Explanation:

      Before implementing any management plan, it is crucial to verify adherence and confirm that the dosage is suitable. In cases of mania, the maximum dosage of aripiprazole can be raised to 30mg per day.

      Bipolar Disorder: Diagnosis and Management

      Bipolar disorder is a lifelong condition characterized by episodes of mania or hypomania and episodes of depressed mood. The peak age of onset is 15-19 years, and the lifetime prevalence of bipolar I disorders is estimated to be around 2.1%. The diagnosis of bipolar disorder is based on the presence of manic or hypomanic episodes, which are characterized by elevated of expansive mood, rapid speech, and increased activity of energy. Psychotic symptoms, such as delusions and hallucinations, may also be present.

      Bipolar depression differs from unipolar depression in several ways, including more rapid onset, more frequent episodes, and shorter duration. Rapid cycling is a qualifier that can be applied to bipolar I of bipolar II disorder and is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode.

      The management of bipolar disorder involves acute and long-term interventions. Acute management of mania or hypomania may involve stopping antidepressants and offering antipsychotics of mood stabilizers. Long-term management may involve psychological interventions and pharmacological treatments such as lithium, valproate, of olanzapine.

      It is important to note that valproate should not be offered to women of girls of childbearing potential for long-term bipolar disorder unless other options are ineffective of not tolerated and a pregnancy prevention program is in place. Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder.

      Overall, the diagnosis and management of bipolar disorder require a comprehensive approach that takes into account the individual’s symptoms, history, and preferences.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 36 - How can histrionic personality disorder be identified? ...

    Incorrect

    • How can histrionic personality disorder be identified?

      Your Answer:

      Correct Answer: Impressionistic and vague speech

      Explanation:

      Impressionistic and vague speech is a diagnostic criterion for histrionic personality disorder according to the DSM-5, while the other listed elements are characteristic of the borderline pattern as defined by the ICD-11.

      Personality Disorder: Histrionic

      A histrionic personality disorder, also known as a dramatic personality disorder, is a psychiatric condition characterized by a consistent pattern of attention-seeking behaviors and exaggerated emotional responses. To diagnose this disorder, the DSM-5 requires the presence of at least five of the following symptoms: discomfort when not the center of attention, seductive of provocative behavior, shallow and shifting emotions, using appearance to draw attention, vague and impressionistic speech, dramatic of exaggerated emotions, suggestibility, and considering relationships to be more intimate than they actually are. However, the ICD-11 has removed the diagnosis of histrionic personality disorder from its list of recognized disorders.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 37 - A young adult who has just begun taking olanzapine reports experiencing dizziness and...

    Incorrect

    • A young adult who has just begun taking olanzapine reports experiencing dizziness and blurred vision upon sudden standing. What would be the most suitable substitute medication?

      Your Answer:

      Correct Answer: Amisulpride

      Explanation:

      The patient’s reported symptoms are indicative of postural hypotension, which is likely a side effect of the olanzapine medication they were given.

      Maudsley Guidelines: Antipsychotics for Postural Hypotension

      When postural hypotension is a concern, it may be necessary to switch to an antipsychotic that is less likely to cause this side effect. The following antipsychotics are recommended by the Maudsley Guidelines:

      – Amisulpride
      – Aripiprazole
      – Haloperidol
      – Sulpiride
      – Trifluoperazine

      These medications have a lower risk of causing postural hypotension compared to other antipsychotics such as risperidone, clozapine, olanzapine, paliperidone, quetiapine, and ziprasidone. It is important to discuss any concerns about side effects with a healthcare provider before making any changes to medication.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 38 - What is the percentage of individuals with alcohol dependence who have attempted of...

    Incorrect

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

      Your Answer:

      Correct Answer: 7%

      Explanation:

      Alcohol Dependence and Suicide Risk

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 39 - What is a distinguishing trait of being intoxicated with phencyclidine? ...

    Incorrect

    • What is a distinguishing trait of being intoxicated with phencyclidine?

      Your Answer:

      Correct Answer: Analgesia

      Explanation:

      PCP Intoxication: A Dangerous Hallucinogenic

      Phencyclidine (PCP), also known as angel dust, is a hallucinogenic drug that is popular for inducing feelings of euphoria, superhuman strength, and social and sexual prowess. It is a NMDA receptor antagonist that has dissociative properties, similar to ketamine. PCP was previously used as an anesthetic and animal tranquilizer, but was soon recalled due to its adverse effects, including psychosis, agitation, and dysphoria post-operatively.

      PCP is available in various forms, including white crystalline powder, tablets, crystals, and liquid. It can be snorted, smoked, ingested, of injected intravenously or subcutaneously. People who have taken PCP often present with violent behavior, nystagmus, tachycardia, hypertension, anesthesia, and analgesia. Other symptoms include impaired motor function, hallucinations, delusions, and paranoia.

      PCP intoxication is best managed with benzodiazepines along with supportive measures for breathing and circulation. Antipsychotics are not recommended as they can amplify PCP-induced hyperthermia, dystonic reactions, and lower the seizure threshold. However, haloperidol may be useful for treating PCP-induced psychosis in patients who are not hyperthermic. Most deaths in PCP-intoxicated patients result from violent behavior rather than direct effects of the drug.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 40 - Which of the following is related to Sigmund Freud's idea of 'dream work'?...

    Incorrect

    • Which of the following is related to Sigmund Freud's idea of 'dream work'?

      Your Answer:

      Correct Answer: The unconscious transformation of the latent to the manifest content

      Explanation:

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 41 - Among the given antidepressants, which one is more likely to cause delirium in...

    Incorrect

    • Among the given antidepressants, which one is more likely to cause delirium in an elderly patient?

      Your Answer:

      Correct Answer: Imipramine

      Explanation:

      Delirium and cognitive impairment are most likely caused by tertiary amine tricyclics.

      Risk Factors for Delirium

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 42 - What is the impact of lithium on the white blood cell count? ...

    Incorrect

    • What is the impact of lithium on the white blood cell count?

      Your Answer:

      Correct Answer: Neutrophil levels are increased

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 43 - What characteristic is associated with Obsessive-compulsive personality disorder? ...

    Incorrect

    • What characteristic is associated with Obsessive-compulsive personality disorder?

      Your Answer:

      Correct Answer: Unwillingness to pass on tasks to others except if they surrender to exactly their way of doing things

      Explanation:

      Individuals with obsessive compulsive personality disorder tend to be hesitant to delegate tasks to others unless they conform to their specific methods and preferences.

      Personality Disorder (Obsessive Compulsive)

      Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control, which can hinder flexibility and efficiency. This pattern typically emerges in early adulthood and can be present in various contexts. The estimated prevalence ranges from 2.1% to 7.9%, with males being diagnosed twice as often as females.

      The DSM-5 diagnosis requires the presence of four of more of the following criteria: preoccupation with details, rules, lists, order, organization, of agenda to the point that the key part of the activity is lost; perfectionism that hampers completing tasks; extreme dedication to work and efficiency to the elimination of spare time activities; meticulous, scrupulous, and rigid about etiquettes of morality, ethics, of values; inability to dispose of worn-out of insignificant things even when they have no sentimental meaning; unwillingness to delegate tasks of work with others except if they surrender to exactly their way of doing things; miserly spending style towards self and others; and rigidity and stubbornness.

      The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder, which can be further specified as “mild,” “moderate,” of “severe.” The anankastic trait domain is characterized by a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behavior and controlling situations to ensure conformity to these standards. Common manifestations of anankastic include perfectionism and emotional and behavioral constraint.

      Differential diagnosis includes OCD, hoarding disorder, narcissistic personality disorder, antisocial personality disorder, and schizoid personality disorder. OCD is distinguished by the presence of true obsessions and compulsions, while hoarding disorder should be considered when hoarding is extreme. Narcissistic personality disorder individuals are more likely to believe that they have achieved perfection, while those with obsessive-compulsive personality disorder are usually self-critical. Antisocial personality disorder individuals lack generosity but will indulge themselves, while those with obsessive-compulsive personality disorder adopt a miserly spending style toward both self and others. Schizoid personality disorder is characterized by a fundamental lack of capacity for intimacy, while in obsessive-compulsive personality disorder, this stems from discomfort with emotions and excessive devotion to work.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 44 - What is a true statement about St John's Wort? ...

    Incorrect

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

      Your Answer:

      Correct Answer: It may cause early development of macular degeneration

      Explanation:

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

      Herbal Remedies for Depression and Anxiety

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 45 - Which of the options below is not included in the DSM-5 criteria for...

    Incorrect

    • Which of the options below is not included in the DSM-5 criteria for diagnosing attention deficit hyperactivity disorder?

      Your Answer:

      Correct Answer: Often loses temper

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 46 - Which of the following treatment options for acute mania has been found to...

    Incorrect

    • Which of the following treatment options for acute mania has been found to be less effective than a placebo?

      Your Answer:

      Correct Answer: Topiramate

      Explanation:

      Antimanic Drugs: Efficacy and Acceptability

      The Lancet published a meta-analysis conducted by Cipriani in 2011, which compared the efficacy and acceptability of various anti-manic drugs. The study found that antipsychotics were more effective than mood stabilizers in treating mania. The drugs that were best tolerated were towards the right of the figure, while the most effective drugs were towards the top. The drugs that were both well-tolerated and effective were considered the best overall, including olanzapine, risperidone, haloperidol, and quetiapine. Other drugs included in the analysis were aripiprazole, asenapine, carbamazepine, valproate, gabapentin, lamotrigine, lithium, placebo, topiramate, and ziprasidone. This study provides valuable information for clinicians in selecting the most appropriate antimanic drug for their patients.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 47 - A 7-year-old girl has been referred to your clinic due to concerns expressed...

    Incorrect

    • A 7-year-old girl has been referred to your clinic due to concerns expressed by her parents and teachers that she has difficulty paying attention, is impulsive, and cannot sit still for more than a few minutes. She also has a diagnosis of Tourette's syndrome with both motor and vocal tics. The parents are worried that her tics may worsen with treatment for her hyperactivity.
      What would be your preferred treatment option?

      Your Answer:

      Correct Answer: Atomoxetine

      Explanation:

      Atomoxetine is a suitable treatment option for individuals with Tourette’s and hyperkinetic disorder (ADHD) as it does not exacerbate tics, which is a common concern with other medications that affect the dopaminergic system. This is because atomoxetine is a highly selective noradrenaline reuptake inhibitor (NARI).

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 48 - Who among these psychosurgeons received the Nobel Prize in medicine? ...

    Incorrect

    • Who among these psychosurgeons received the Nobel Prize in medicine?

      Your Answer:

      Correct Answer: Moniz

      Explanation:

      The History of Psychosurgery

      Psychosurgery, the surgical treatment of mental illness, has a long and controversial history. The modern era of psychosurgery began in the late 19th century with the pioneering work of Swiss neurosurgeon Burckhardt, who removed areas of cortex from the frontal and parietal regions of six patients.

      In 1910, Russian neurosurgeon Puseep ablated the frontoparietal tracts of three bipolar patients. However, it was Egas Moniz who refined psychosurgical techniques and was awarded the Nobel Prize for Medicine in 1949 for his work in the treatment of psychiatric disorders.

      American neurosurgeon Freeman also developed similar procedures and advocated for psychosurgery as a first-line treatment for mental illness. Luver and Bucy described the effect of temporal lobectomy on aggression, further advancing the field of psychosurgery. Despite its controversial history, psychosurgery continues to be used today in select cases as a treatment option for severe mental illness.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 49 - What is the percentage of completed suicides that occur in individuals aged 65...

    Incorrect

    • What is the percentage of completed suicides that occur in individuals aged 65 and above?

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Suicide in the Elderly

      Self-harm in older individuals should be approached with caution as approximately 20% of completed suicides occur in those over the age of 65. Studies have consistently found that more than half of those who commit suicide after the age of 65 are suffering from a depressive disorder at the time of death. Personality traits also appear to play a role, with an association between suicide in older individuals and anankastic (obsessional) and anxious personality traits observed in one study. Dissocial of borderline disorders are more commonly found in younger suicide victims. It is important to be aware of these factors when assessing and treating suicidal behavior in the elderly.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 50 - Caution should be exercised when administering clozapine in which of the following circumstances?...

    Incorrect

    • Caution should be exercised when administering clozapine in which of the following circumstances?

      Your Answer:

      Correct Answer: Susceptibility to angle-closure glaucoma

      Explanation:

      TCAs, low-potency antipsychotics, topiramate, and SSRIs have been linked to angle-closure glaucoma, a severe condition.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 51 - Researchers have conducted a study comparing a new blood pressure medication with a...

    Incorrect

    • Researchers have conducted a study comparing a new blood pressure medication with a standard blood pressure medication. 200 patients are divided equally between the two groups. Over the course of one year, 20 patients in the treatment group experienced a significant reduction in blood pressure, compared to 35 patients in the control group.

      What is the number needed to treat (NNT)?

      Your Answer:

      Correct Answer: 7

      Explanation:

      The Relative Risk Reduction (RRR) is calculated by subtracting the experimental event rate (EER) from the control event rate (CER), dividing the result by the CER, and then multiplying by 100 to get a percentage. In this case, the RRR is (35-20)÷35 = 0.4285 of 42.85%.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 52 - What treatment option would NICE recommend for an adult patient with bipolar affective...

    Incorrect

    • What treatment option would NICE recommend for an adult patient with bipolar affective disorder and moderate depression who is currently on an effective dose of lithium?

      Your Answer:

      Correct Answer: Add fluoxetine combined with olanzapine

      Explanation:

      Bipolar Disorder: Diagnosis and Management

      Bipolar disorder is a lifelong condition characterized by episodes of mania or hypomania and episodes of depressed mood. The peak age of onset is 15-19 years, and the lifetime prevalence of bipolar I disorders is estimated to be around 2.1%. The diagnosis of bipolar disorder is based on the presence of manic or hypomanic episodes, which are characterized by elevated of expansive mood, rapid speech, and increased activity of energy. Psychotic symptoms, such as delusions and hallucinations, may also be present.

      Bipolar depression differs from unipolar depression in several ways, including more rapid onset, more frequent episodes, and shorter duration. Rapid cycling is a qualifier that can be applied to bipolar I of bipolar II disorder and is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode.

      The management of bipolar disorder involves acute and long-term interventions. Acute management of mania or hypomania may involve stopping antidepressants and offering antipsychotics of mood stabilizers. Long-term management may involve psychological interventions and pharmacological treatments such as lithium, valproate, of olanzapine.

      It is important to note that valproate should not be offered to women of girls of childbearing potential for long-term bipolar disorder unless other options are ineffective of not tolerated and a pregnancy prevention program is in place. Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder.

      Overall, the diagnosis and management of bipolar disorder require a comprehensive approach that takes into account the individual’s symptoms, history, and preferences.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 53 - Which of the options below is not a valid means of supporting a...

    Incorrect

    • Which of the options below is not a valid means of supporting a diagnosis of obsessive compulsive personality disorder?

      Your Answer:

      Correct Answer: Views self as inferior to others

      Explanation:

      It is important to note that while individuals with obsessive personality disorder may experience feelings of inferiority, this is not a defining characteristic of the disorder. In contrast, a diagnosis of avoidant personality disorder may be more appropriate for individuals who consistently view themselves as inferior to others.

      Personality Disorder (Obsessive Compulsive)

      Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control, which can hinder flexibility and efficiency. This pattern typically emerges in early adulthood and can be present in various contexts. The estimated prevalence ranges from 2.1% to 7.9%, with males being diagnosed twice as often as females.

      The DSM-5 diagnosis requires the presence of four of more of the following criteria: preoccupation with details, rules, lists, order, organization, of agenda to the point that the key part of the activity is lost; perfectionism that hampers completing tasks; extreme dedication to work and efficiency to the elimination of spare time activities; meticulous, scrupulous, and rigid about etiquettes of morality, ethics, of values; inability to dispose of worn-out of insignificant things even when they have no sentimental meaning; unwillingness to delegate tasks of work with others except if they surrender to exactly their way of doing things; miserly spending style towards self and others; and rigidity and stubbornness.

      The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder, which can be further specified as “mild,” “moderate,” of “severe.” The anankastic trait domain is characterized by a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behavior and controlling situations to ensure conformity to these standards. Common manifestations of anankastic include perfectionism and emotional and behavioral constraint.

      Differential diagnosis includes OCD, hoarding disorder, narcissistic personality disorder, antisocial personality disorder, and schizoid personality disorder. OCD is distinguished by the presence of true obsessions and compulsions, while hoarding disorder should be considered when hoarding is extreme. Narcissistic personality disorder individuals are more likely to believe that they have achieved perfection, while those with obsessive-compulsive personality disorder are usually self-critical. Antisocial personality disorder individuals lack generosity but will indulge themselves, while those with obsessive-compulsive personality disorder adopt a miserly spending style toward both self and others. Schizoid personality disorder is characterized by a fundamental lack of capacity for intimacy, while in obsessive-compulsive personality disorder, this stems from discomfort with emotions and excessive devotion to work.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 54 - How would NICE recommend augmenting treatment for a patient with depression who is...

    Incorrect

    • How would NICE recommend augmenting treatment for a patient with depression who is already taking an SSRI?

      Your Answer:

      Correct Answer: Olanzapine

      Explanation:

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 55 - What is the proportion of individuals with dementia who are younger than 65...

    Incorrect

    • What is the proportion of individuals with dementia who are younger than 65 years old?

      Your Answer:

      Correct Answer: 2%

      Explanation:

      Epidemiological Findings on Dementia

      Dementia is a disease that primarily affects older individuals, with a doubling of cases every five years. While the median survival time from diagnosis to death is approximately 5-6 years, 2% of those affected are under 65 years of age. In the UK, early onset dementia is more prevalent in men aged 50-65, while late onset dementia is marginally more prevalent in women. Approximately 60% of people with dementia live in private households, with 55% having mild dementia, 30% having moderate dementia, and 15% having severe dementia. These international and UK-specific epidemiological findings provide insight into the prevalence and characteristics of dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 56 - What hierarchical language does NLM utilize to enhance search strategies and index articles?...

    Incorrect

    • What hierarchical language does NLM utilize to enhance search strategies and index articles?

      Your Answer:

      Correct Answer: MeSH

      Explanation:

      NLM’s hierarchical vocabulary, known as MeSH (Medical Subject Heading), is utilized for the purpose of indexing articles in PubMed.

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 57 - A pilot program is implemented in a children's hospital that offers HIV testing...

    Incorrect

    • A pilot program is implemented in a children's hospital that offers HIV testing for all new patients upon admission. As part of an economic analysis of the program, a researcher evaluates the expenses linked with providing the testing service. How should the potential stress encountered by children waiting for the test results be categorized?

      Your Answer:

      Correct Answer: Intangible cost

      Explanation:

      Methods of Economic Evaluation

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

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

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

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

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

      Costs in Economic Evaluation Studies

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 58 - What is the active ingredient in subutex? ...

    Incorrect

    • What is the active ingredient in subutex?

      Your Answer:

      Correct Answer: Buprenorphine

      Explanation:

      Suboxone vs. Subutex: What’s the Difference?

      Suboxone and Subutex are both medications used to treat opioid addiction. However, there are some key differences between the two.

      Suboxone is a combination of buprenorphine and naloxone. The naloxone is added to prevent people from injecting the medication, as this was a common problem with pure buprenorphine tablets. If someone tries to inject Suboxone, the naloxone will cause intense withdrawal symptoms. However, if the tablet is swallowed as directed, the naloxone is not absorbed by the gut and does not cause any problems.

      Subutex, on the other hand, contains only buprenorphine and does not include naloxone. This means that it may be more likely to be abused by injection, as there is no deterrent to prevent people from doing so.

      Overall, both Suboxone and Subutex can be effective treatments for opioid addiction, but Suboxone may be a safer choice due to the addition of naloxone.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 59 - What is a true statement about supportive psychotherapy? ...

    Incorrect

    • What is a true statement about supportive psychotherapy?

      Your Answer:

      Correct Answer: It aims to increase the patients self-esteem

      Explanation:

      Supportive Psychotherapy: An Overview

      Supportive psychotherapy is a widely used approach in psychiatry, often reserved for clients who are not suitable for other forms of therapy. It aims to provide emotional support and encouragement to help people cope with overwhelming stress and restore them to their previous level of functioning. This therapy is not based on any specific psychological theory and is eclectic in approach.

      Supportive psychotherapy is generally used with two different patient groups: those who were otherwise functioning well but have become symptomatic due to stress, and those who are not suitable for other forms of therapy. The goal of therapy is to help the patient get on with their life as best as possible, without disrupting reasonable defenses of generating conflicts.

      The therapist avoids confrontation and transference issues are rarely analyzed. However, the therapeutic aims of long-term supportive psychotherapy include establishing a therapeutic alliance, holding and containing, promoting awareness of transference issues, promoting stability, facilitating the maturation of defenses, and promoting better adaptation to reality.

      Supportive psychotherapy has been dismissed as ‘hand holding,’ but it should not be underestimated. It is suitable for most patients and is often the only therapy that can help when others have failed. Much of the work doctors do in outpatient clinics could be classified as supportive psychotherapy.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 60 - What is the focus of assessment in interpersonal psychotherapy? ...

    Incorrect

    • What is the focus of assessment in interpersonal psychotherapy?

      Your Answer:

      Correct Answer: Current relationships

      Explanation:

      Interpersonal Therapy: A Structured Approach to Addressing Social Functioning Problems

      Interpersonal therapy (IPT) is a structured form of psychotherapy that is often used to treat depression. It is based on the belief that social functioning problems have a significant impact on psychological problems. IPT is a time-limited therapy that typically runs for 10-16 one hour sessions. The therapy is organized into three phases, with the first phase involving data collection and formulation. The remaining sessions explore the formulation in more detail.

      IPT focuses on four areas of social functioning problems: grief, role transitions, interpersonal deficits, and interpersonal disputes. The therapy aims to intervene at the level of social functioning, rather than focusing on personality. The therapy has been found to be effective in treating depression, particularly in patients with severe depression. However, it may be less effective in treating people with depression and comorbid personality disorders.

      The evidence base for IPT is most developed for eating disorders, and the intervention is recommended in NICE guidelines for eating disorders. Overall, IPT is a structured approach to addressing social functioning problems that can be effective in treating depression and other psychological problems.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 61 - What term specifically refers to the act of killing a brother? ...

    Incorrect

    • What term specifically refers to the act of killing a brother?

      Your Answer:

      Correct Answer: Fratricide

      Explanation:

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 62 - What is the correct approach to treating tardive dyskinesia? ...

    Incorrect

    • What is the correct approach to treating tardive dyskinesia?

      Your Answer:

      Correct Answer: Reduction of the antipsychotic may worsen tardive dyskinesia

      Explanation:

      Tardive Dyskinesia: Symptoms, Causes, Risk Factors, and Management

      Tardive dyskinesia (TD) is a condition that affects the face, limbs, and trunk of individuals who have been on neuroleptics for months to years. The movements fluctuate over time, increase with emotional arousal, decrease with relaxation, and disappear with sleep. The cause of TD remains theoretical, but the postsynaptic dopamine (D2) receptor supersensitivity hypothesis is the most persistent. Other hypotheses include the presynaptic dopaminergic/noradrenergic hyperactivity hypothesis, the cholinergic interneuron burnout hypothesis, the excitatory/oxidative stress hypothesis, and the synaptic plasticity hypothesis. Risk factors for TD include advancing age, female sex, ethnicity, longer illness duration, intellectual disability and brain damage, negative symptoms in schizophrenia, mood disorders, diabetes, smoking, alcohol and substance misuse, FGA vs SGA treatment, higher antipsychotic dose, anticholinergic co-treatment, and akathisia.

      Management options for TD include stopping any anticholinergic, reducing antipsychotic dose, changing to an antipsychotic with lower propensity for TD, and using tetrabenazine, vitamin E, of amantadine as add-on options. Clozapine is the antipsychotic most likely to be associated with resolution of symptoms. Vesicular monoamine transporter type 2 (VMAT2) inhibitors are agents that cause a depletion of neuroactive peptides such as dopamine in nerve terminals and are used to treat chorea due to neurodegenerative diseases of dyskinesias due to neuroleptic medications (tardive dyskinesia).

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 63 - By implementing a double-blinded randomised controlled trial to evaluate the efficacy of a...

    Incorrect

    • By implementing a double-blinded randomised controlled trial to evaluate the efficacy of a new medication for Lewy Body Dementia, what type of bias can be prevented by ensuring that both the patient and doctor are blinded?

      Your Answer:

      Correct Answer: Expectation bias

      Explanation:

      Types of Bias in Statistics

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 64 - Freud coined a term to describe the unconscious desire of a boy to...

    Incorrect

    • Freud coined a term to describe the unconscious desire of a boy to have his mother's exclusive love, what is this term?

      Your Answer:

      Correct Answer: Oedipus complex

      Explanation:

      Understanding the Oedipus Complex

      The Oedipus complex is a term coined by Sigmund Freud to describe the unconscious desire for exclusive love that a child has for their opposite-sex parent. This phenomenon is believed to occur during the phallic phase of normal development. While Freud initially used the term for both genders, it has since been differentiated into the Electra complex for women and the Oedipus complex for men.

      The Oedipus complex is a crucial concept in psychoanalytic theory, as it is believed to shape a person’s future relationships and personality. According to Freud, unresolved Oedipal conflicts can lead to neuroses and other psychological issues. Understanding this complex can help individuals gain insight into their own behavior and relationships, as well as provide a framework for therapists to address underlying issues in their patients.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 65 - What could be a possible explanation for a low calcium reading during routine...

    Incorrect

    • What could be a possible explanation for a low calcium reading during routine screening of an elderly patient in the memory clinic that may not necessarily indicate an actual calcium deficiency?

      Your Answer:

      Correct Answer: Low albumin

      Explanation:

      Hypocalcaemia and its Symptoms

      Hypocalcaemia is a condition that is often characterized by muscle spasms. These spasms can affect both voluntary and smooth muscles, such as those found in the airways and heart. In the airways, hypocalcaemia can cause bronchospasm, while in the heart, it can lead to angina.

      However, it is important to note that the accuracy of calcium level tests in the blood can be affected by the level of albumin present. If albumin levels are low, the calcium level may appear to be low as well.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 66 - What is another term for case-mix bias? ...

    Incorrect

    • What is another term for case-mix bias?

      Your Answer:

      Correct Answer: Disease spectrum bias

      Explanation:

      Types of Bias in Statistics

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 67 - What is the name of the harmful substance produced by the body when...

    Incorrect

    • What is the name of the harmful substance produced by the body when someone takes too much paracetamol, leading to liver damage?

      Your Answer:

      Correct Answer: Benzoquinoneimine

      Explanation:

      Paracetamol’s main byproduct is benzoquinoneimine, a highly reactive substance that typically binds with glutathione. However, when glutathione levels are low, it can bind to liver protein and result in liver damage.

      Self-Harm and its Management

      Self-harm refers to intentional acts of self-poisoning of self-injury. It is prevalent among younger people, with an estimated 10% of girls and 3% of boys aged 15-16 years having self-harmed in the previous year. Risk factors for non-fatal repetition of self-harm include previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, and drug abuse/dependence. Suicide following an act of self-harm is more likely in those with previous episodes of self-harm, suicidal intent, poor physical health, and male gender.

      Risk assessment tools are not recommended for predicting future suicide of repetition of self-harm. The recommended interventions for self-harm include 4-10 sessions of CBT specifically structured for people who self-harm and considering DBT for adolescents with significant emotional dysregulation. Drug treatment as a specific intervention to reduce self-harm should not be offered.

      In the management of ingestion, activated charcoal can help if used early, while emetics and cathartics should not be used. Gastric lavage should generally not be used unless recommended by TOXBASE. Paracetamol is involved in 30-40% of acute presentations with poisoning. Intravenous acetylcysteine is the treatment of choice, and pseudo-allergic reactions are relatively common. Naloxone is used as an antidote for opioid overdose, while flumazenil can help reduce the need for admission to intensive care in benzodiazepine overdose.

      For superficial uncomplicated skin lacerations of 5 cm of less in length, tissue adhesive of skin closure strips could be used as a first-line treatment option. All children who self-harm should be admitted for an overnight stay at a pediatric ward.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 68 - What is the most dependable risk factor that has been demonstrated for autism...

    Incorrect

    • What is the most dependable risk factor that has been demonstrated for autism spectrum disorder?

      Your Answer:

      Correct Answer: Valproate use during pregnancy

      Explanation:

      Autism Spectrum Disorder (ASD) is a lifelong disorder characterized by deficits in communication and social understanding, as well as restrictive and repetitive behaviors. The distinction between autism and Asperger’s has been abandoned, and they are now grouped together under the ASD category. Intellectual ability is difficult to assess in people with ASD, with an estimated 33% having an intellectual disability. ASD was first described in Europe and the United States using different terms, with Leo Kanner and Hans Asperger being the pioneers. Diagnosis is based on persistent deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior. The worldwide population prevalence is about 1%, with comorbidity being common. Heritability is estimated at around 90%, and both genetic and environmental factors seem to cause ASD. Currently, there are no validated pharmacological treatments that alleviate core ASD symptoms, but second-generation antipsychotics are the first-line pharmacological treatment for children and adolescents with ASD and associated irritability.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 69 - What resource is committed to offering complete articles of systematic reviews on the...

    Incorrect

    • What resource is committed to offering complete articles of systematic reviews on the impacts of healthcare interventions?

      Your Answer:

      Correct Answer: CDSR

      Explanation:

      When faced with a question, it’s helpful to consider what the letters in the question might represent, even if you don’t know the answer right away. Don’t become overwhelmed and keep this strategy in mind.

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 70 - In a cohort study investigating the association between smoking and Alzheimer's dementia, what...

    Incorrect

    • In a cohort study investigating the association between smoking and Alzheimer's dementia, what is the typical variable used to measure the outcome?

      Your Answer:

      Correct Answer: Relative risk

      Explanation:

      The odds ratio is used in case-control studies to measure the association between exposure and outcome, while the relative risk is used in cohort studies to measure the risk of developing an outcome in the exposed group compared to the unexposed group. To convert the odds ratio to a relative risk, one can use the formula: relative risk = odds ratio / (1 – incidence in the unexposed group x odds ratio).

      Types of Primary Research Studies and Their Advantages and Disadvantages

      Primary research studies can be categorized into six types based on the research question they aim to address. The best type of study for each question type is listed in the table below. There are two main types of study design: experimental and observational. Experimental studies involve an intervention, while observational studies do not. The advantages and disadvantages of each study type are summarized in the table below.

      Type of Question Best Type of Study

      Therapy Randomized controlled trial (RCT), cohort, case control, case series
      Diagnosis Cohort studies with comparison to gold standard test
      Prognosis Cohort studies, case control, case series
      Etiology/Harm RCT, cohort studies, case control, case series
      Prevention RCT, cohort studies, case control, case series
      Cost Economic analysis

      Study Type Advantages Disadvantages

      Randomized Controlled Trial – Unbiased distribution of confounders – Blinding more likely – Randomization facilitates statistical analysis – Expensive – Time-consuming – Volunteer bias – Ethically problematic at times
      Cohort Study – Ethically safe – Subjects can be matched – Can establish timing and directionality of events – Eligibility criteria and outcome assessments can be standardized – Administratively easier and cheaper than RCT – Controls may be difficult to identify – Exposure may be linked to a hidden confounder – Blinding is difficult – Randomization not present – For rare disease, large sample sizes of long follow-up necessary
      Case-Control Study – Quick and cheap – Only feasible method for very rare disorders of those with long lag between exposure and outcome – Fewer subjects needed than cross-sectional studies – Reliance on recall of records to determine exposure status – Confounders – Selection of control groups is difficult – Potential bias: recall, selection
      Cross-Sectional Survey – Cheap and simple – Ethically safe – Establishes association at most, not causality – Recall bias susceptibility – Confounders may be unequally distributed – Neyman bias – Group sizes may be unequal
      Ecological Study – Cheap and simple – Ethically safe – Ecological fallacy (when relationships which exist for groups are assumed to also be true for individuals)

      In conclusion, the choice of study type depends on the research question being addressed. Each study type has its own advantages and disadvantages, and researchers should carefully consider these when designing their studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 71 - How should problem gambling associated with impulse control disorders be managed? ...

    Incorrect

    • How should problem gambling associated with impulse control disorders be managed?

      Your Answer:

      Correct Answer: Naltrexone

      Explanation:

      Problem Gambling: Screening and Interventions

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 72 - Which of the following options is considered the least appropriate for managing behavioral...

    Incorrect

    • Which of the following options is considered the least appropriate for managing behavioral difficulties associated with dementia, as per the Maudsley Guidelines?

      Your Answer:

      Correct Answer: Lorazepam

      Explanation:

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 73 - Which term is used to refer to the alternative hypothesis in hypothesis testing?...

    Incorrect

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

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

      Your Answer:

      Correct Answer: Research hypothesis

      Explanation:

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 74 - A 50-year-old man presents in the early hours of the morning with a...

    Incorrect

    • A 50-year-old man presents in the early hours of the morning with a high fever of 39.5°C. He complains of a stiff neck and headache. He quickly becomes confused and there is evidence of hallucinations in both taste and smell. He then begins to have frequent seizures.
      He has a history of good health except for a pacemaker implanted when he was 40 years old. He has not traveled outside of the United States recently. The medical team requests your assistance as the consulting psychiatrist.
      What would you suggest as the initial investigation to assist with the diagnosis?

      Your Answer:

      Correct Answer: CT scan of the head

      Explanation:

      The patient’s symptoms indicate possible viral encephalitis, likely caused by herpes. To confirm the diagnosis and rule out other infections, a diagnostic examination of the cerebrospinal fluid (CSF) is necessary. However, it is important to ensure the safety of the patient before performing the CSF examination, as there is a risk of herniation. Therefore, a CT scan of the head should be the initial investigation to be carried out, as it can also detect any abscesses that may be present.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 75 - A teenage patient is admitted to a secure hospital from school due to...

    Incorrect

    • A teenage patient is admitted to a secure hospital from school due to a deterioration in their mental state. They have been charged with assault and awaits trial. On admission, they present with odd delusional beliefs, thought disorder, and apparent disorientation. They complain of hearing voices and say that the hospital is a secret government facility and that the consultant is a spy in disguise. Their consultant requests that the nurses make intermittent observations of them to assess their mental state.

      During one such observation, the patient is seen to be conversing with their parents over the phone in their native language. The observing staff member also speaks the same language and notices that the patient's presentation is very different and that they are speaking clearly, without any evidence of bizarre content. When the patient notices that they are being observed, their presentation changes abruptly and they start pacing and muttering to themselves.

      Which of the following diagnoses is most likely?

      Your Answer:

      Correct Answer: Malingering

      Explanation:

      In somatic symptom disorder and conversion disorder, there is no deliberate attempt to deceive others.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 76 - The Maudsley Guidelines suggest a particular treatment option to enhance the effectiveness of...

    Incorrect

    • The Maudsley Guidelines suggest a particular treatment option to enhance the effectiveness of clozapine.

      Your Answer:

      Correct Answer: Amisulpride

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 77 - What is the appropriate denominator to use when computing the sample variance? ...

    Incorrect

    • What is the appropriate denominator to use when computing the sample variance?

      Your Answer:

      Correct Answer: n-1

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 78 - A newly admitted elderly patient on the ward attends ward round. They are...

    Incorrect

    • A newly admitted elderly patient on the ward attends ward round. They are found to have been on lorazepam 4 mg QDS for a number of years. Your consultant asks you to convert this to diazepam so that the patient can be slowly weaned off benzodiazepines. Select the correct equivalent dose of diazepam:

      Your Answer:

      Correct Answer: 40mg QDS

      Explanation:

      Benzodiazepines and Addiction

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 79 - What is the most frequently reported side-effect of methylphenidate? ...

    Incorrect

    • What is the most frequently reported side-effect of methylphenidate?

      Your Answer:

      Correct Answer: Insomnia

      Explanation:

      It is important to note that while these side-effects are listed as very common, not everyone will experience them. It is also important to discuss any concerns of side-effects with a healthcare professional before making any changes to medication. Additionally, it is important to weigh the potential benefits of medication in treating ADHD symptoms against the potential side-effects.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 80 - Which of the following behavioral signs is absent in individuals with semantic dementia?...

    Incorrect

    • Which of the following behavioral signs is absent in individuals with semantic dementia?

      Your Answer:

      Correct Answer: Reduced sociability

      Explanation:

      FTD is more likely to impact social behavior, resulting in decreased sociability. Meanwhile, SD primarily affects conceptual knowledge.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 81 - A 10 year old boy has been referred by his GP due to...

    Incorrect

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

      Your Answer:

      Correct Answer: Atomoxetine

      Explanation:

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

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 82 - A woman with bipolar disorder presents as manic. She is taking lithium and...

    Incorrect

    • A woman with bipolar disorder presents as manic. She is taking lithium and you request levels which come back as 1.1 mmol/L. Which of the following should you do?:

      Your Answer:

      Correct Answer: Add in olanzapine

      Explanation:

      Achieving a level of 1.1 mmol/L indicates that the appropriate therapeutic level of lithium has been reached, and any further increase in dosage would be unsafe (as per the Maudsley 14th guidelines, which recommend a level between 1.0-1.2). To address this, the guidelines suggest adding an antipsychotic medication, preferably one that is licensed for bipolar disorder, such as olanzapine, risperidone, quetiapine, of aripiprazole.

      Bipolar Disorder: Diagnosis and Management

      Bipolar disorder is a lifelong condition characterized by episodes of mania or hypomania and episodes of depressed mood. The peak age of onset is 15-19 years, and the lifetime prevalence of bipolar I disorders is estimated to be around 2.1%. The diagnosis of bipolar disorder is based on the presence of manic or hypomanic episodes, which are characterized by elevated of expansive mood, rapid speech, and increased activity of energy. Psychotic symptoms, such as delusions and hallucinations, may also be present.

      Bipolar depression differs from unipolar depression in several ways, including more rapid onset, more frequent episodes, and shorter duration. Rapid cycling is a qualifier that can be applied to bipolar I of bipolar II disorder and is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode.

      The management of bipolar disorder involves acute and long-term interventions. Acute management of mania or hypomania may involve stopping antidepressants and offering antipsychotics of mood stabilizers. Long-term management may involve psychological interventions and pharmacological treatments such as lithium, valproate, of olanzapine.

      It is important to note that valproate should not be offered to women of girls of childbearing potential for long-term bipolar disorder unless other options are ineffective of not tolerated and a pregnancy prevention program is in place. Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder.

      Overall, the diagnosis and management of bipolar disorder require a comprehensive approach that takes into account the individual’s symptoms, history, and preferences.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 83 - What potential adverse effect on the neonate may be linked to the use...

    Incorrect

    • What potential adverse effect on the neonate may be linked to the use of SSRIs after 20 weeks of gestation?

      Your Answer:

      Correct Answer: Persistent pulmonary hypertension

      Explanation:

      According to the 13th edition of Maudsley, taking SSRIs after 20 weeks of pregnancy may be linked to a higher chance of persistent pulmonary hypertension in newborns. However, the risk is relatively low and may only be present if the exposure occurs in late pregnancy. It’s important to note that this increased risk is based on comparisons with the general population, not women who have depression, for whom the risk is unknown.

      Paroxetine Use During Pregnancy: Is it Safe?

      Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 84 - Which statement accurately reflects the NICE guidelines on self-harm? ...

    Incorrect

    • Which statement accurately reflects the NICE guidelines on self-harm?

      Your Answer:

      Correct Answer: Flumazenil is not currently licensed for the treatment of benzodiazepine overdose in the UK

      Explanation:

      The NICE guidelines on Self-Harm advise against the use of emetics, such as ipecac, in the management of self-poisoning. Flumazenil, although not currently licensed for the treatment of benzodiazepine overdose in the UK, should be considered if poisoning with benzodiazepines is suspected. Intravenous acetylcysteine is recommended as the treatment of choice for paracetamol overdose. It is important to conduct a psychosocial assessment as soon as possible, unless the patient requires life-saving medical treatment of is unable to be assessed. Plasma paracetamol levels should be measured between 4 and 15 hours after ingestion for reliable risk assessment.

      Self-Harm and its Management

      Self-harm refers to intentional acts of self-poisoning of self-injury. It is prevalent among younger people, with an estimated 10% of girls and 3% of boys aged 15-16 years having self-harmed in the previous year. Risk factors for non-fatal repetition of self-harm include previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, and drug abuse/dependence. Suicide following an act of self-harm is more likely in those with previous episodes of self-harm, suicidal intent, poor physical health, and male gender.

      Risk assessment tools are not recommended for predicting future suicide of repetition of self-harm. The recommended interventions for self-harm include 4-10 sessions of CBT specifically structured for people who self-harm and considering DBT for adolescents with significant emotional dysregulation. Drug treatment as a specific intervention to reduce self-harm should not be offered.

      In the management of ingestion, activated charcoal can help if used early, while emetics and cathartics should not be used. Gastric lavage should generally not be used unless recommended by TOXBASE. Paracetamol is involved in 30-40% of acute presentations with poisoning. Intravenous acetylcysteine is the treatment of choice, and pseudo-allergic reactions are relatively common. Naloxone is used as an antidote for opioid overdose, while flumazenil can help reduce the need for admission to intensive care in benzodiazepine overdose.

      For superficial uncomplicated skin lacerations of 5 cm of less in length, tissue adhesive of skin closure strips could be used as a first-line treatment option. All children who self-harm should be admitted for an overnight stay at a pediatric ward.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 85 - A 45-year-old male complains of headaches, weakness in his arms and legs, and...

    Incorrect

    • A 45-year-old male complains of headaches, weakness in his arms and legs, and body aches. He reports feeling like his condition is deteriorating. He has no significant medical history except for a surgery for appendicitis 10 years ago.
      Upon examination, his neurological and musculoskeletal systems appear normal. There are no alarming symptoms associated with his headaches. His primary care physician orders a complete blood count, which returns with normal results.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Somatoform disorder

      Explanation:

      This young woman is experiencing physical symptoms, but there is no evidence of any underlying disease. This could be a manifestation of somatisation/somatoform disorder, where patients develop various symptoms such as pain, memory problems, visual problems, of neurological issues without any apparent cause. Often, there is an underlying psychological distress that may lead to depression of anxiety. It is possible that this women’s history, such as her miscarriage, may reveal underlying depression. It is important to differentiate somatisation disorder from hypochondriasis, where patients believe they have a severe disorder, and Münchhausen syndrome, where patients mimic a particular disorder to gain attention of sympathy. To diagnose Münchhausen syndrome, there must be evidence that the patient is causing their own physical illness. Malingering is another condition where patients purposefully generate symptoms for personal gain, such as time off work. In somatisation disorder, patients may have no clinical evidence of illness of injury, but they believe they are experiencing symptoms and are often quite worried about it.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 86 - Based on the patient's symptoms and examination findings, the most likely diagnosis is...

    Incorrect

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

      Your Answer:

      Correct Answer: Factitious disorder

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 87 - What is a true statement about eating disorders? ...

    Incorrect

    • What is a true statement about eating disorders?

      Your Answer:

      Correct Answer: When treating anorexia nervosa, helping people to reach a healthy body weight of BMI for their age is a key goal

      Explanation:

      A key objective in the treatment of anorexia nervosa is to assist individuals in achieving a healthy body weight of BMI appropriate for their age. It is not recommended to rely solely on screening tools like SCOFF to diagnose eating disorders. While eating disorders can occur at any age, it is important to note that the risk is greatest for adolescents between the ages of 13 and 17, particularly young men and women. It is not advisable to use a single metric such as BMI of duration of illness to determine whether treatment for an eating disorder is necessary.

      Eating Disorders: NICE Guidelines

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

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

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

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

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

      Note: These guidelines are taken from NICE guidelines 2017.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 88 - What is the approximate occurrence rate of schizophrenia among individuals under the age...

    Incorrect

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

      Your Answer:

      Correct Answer: 1 in 2000

      Explanation:

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 89 - For which of the following research areas are qualitative methods least effective? ...

    Incorrect

    • For which of the following research areas are qualitative methods least effective?

      Your Answer:

      Correct Answer: Treatment evaluation

      Explanation:

      While quantitative methods are typically used for treatment evaluation, qualitative studies can also provide valuable insights by interpreting, qualifying, of illuminating findings. This is especially beneficial when examining unexpected results, as they can help to test the primary hypothesis.

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 90 - A middle-aged woman experiences a sudden loss of vision after witnessing her husband...

    Incorrect

    • A middle-aged woman experiences a sudden loss of vision after witnessing her husband get knocked down by a car. No medical cause can be found to explain this. She is surprisingly unconcerned by her symptoms.
      Select the most likely diagnosis:

      Your Answer:

      Correct Answer: Dissociative neurological symptom disorder

      Explanation:

      The apparent disregard for her visual impairment is indicative of La belle indifference, a common characteristic of conversion disorder. Based on this presentation, a possible diagnosis according to the ICD-11 would be dissociative neurological symptom disorder with accompanying visual disturbances.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 91 - A 56-year-old man who recently retired and lives in a residential home reports...

    Incorrect

    • A 56-year-old man who recently retired and lives in a residential home reports seeing ghosts. He has decreased vision in both eyes and a slit lamp exam shows cataracts in both eyes. There is no evidence of any secondary gain related to his complaints. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Charles Bonnet syndrome

      Explanation:

      Charles Bonnet syndrome (CBS) is a condition where mentally healthy individuals experience vivid and recurring visual hallucinations, also known as fictive visual percepts. These hallucinations are typically small in size, known as lilliputian hallucinations. CBS is commonly found in individuals who have visual impairments due to old age of damage to the eyes of optic pathways. However, not all individuals with such deficits develop CBS. In some cases, CBS may be triggered by a combination of central vision loss due to conditions like macular degeneration and peripheral vision loss from glaucoma. In this context, bilateral lenticular opacities refer to cataracts. For more information on CBS, please refer to the Royal National Institute of Blind People (RNIB).

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 92 - What is the most frequently observed symptom in individuals diagnosed with schizophrenia? ...

    Incorrect

    • What is the most frequently observed symptom in individuals diagnosed with schizophrenia?

      Your Answer:

      Correct Answer: Lack of insight

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 93 - What is the most frequently reported side effect of varenicline? ...

    Incorrect

    • What is the most frequently reported side effect of varenicline?

      Your Answer:

      Correct Answer: Nausea

      Explanation:

      Smoking cessation can be achieved through various methods, including nicotine replacement therapy (NRT), bupropion, and varenicline. NRT is available in different forms, including patches, gum, lozenges, inhalators, and nasal spray. Combination treatment with NRT has been found to be more effective than a single product of placebo. Bupropion is a selective inhibitor of dopamine and noradrenaline reuptake and is presumed to work directly on the brain pathways involved in addiction and withdrawal. It is recommended to start bupropion while still smoking and to discontinue after 7-9 weeks. Varenicline is a partial nicotinic receptor agonist that reduces the rewarding and reinforcing effects of smoking. It is recommended to start varenicline while still smoking and to continue for 12 weeks. Nausea is the most common adverse effect of varenicline, and depression has been reported in some users. Bupropion and varenicline should be avoided in certain populations, including those with a history of bipolar disorder, epilepsy, and pregnancy of breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 94 - What is the estimated percentage of individuals with an autistic spectrum disorder who...

    Incorrect

    • What is the estimated percentage of individuals with an autistic spectrum disorder who also have an intellectual disability?

      Your Answer:

      Correct Answer: 30%

      Explanation:

      Autism Spectrum Disorder (ASD) is a lifelong disorder characterized by deficits in communication and social understanding, as well as restrictive and repetitive behaviors. The distinction between autism and Asperger’s has been abandoned, and they are now grouped together under the ASD category. Intellectual ability is difficult to assess in people with ASD, with an estimated 33% having an intellectual disability. ASD was first described in Europe and the United States using different terms, with Leo Kanner and Hans Asperger being the pioneers. Diagnosis is based on persistent deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior. The worldwide population prevalence is about 1%, with comorbidity being common. Heritability is estimated at around 90%, and both genetic and environmental factors seem to cause ASD. Currently, there are no validated pharmacological treatments that alleviate core ASD symptoms, but second-generation antipsychotics are the first-line pharmacological treatment for children and adolescents with ASD and associated irritability.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 95 - What type of data is required to compute the relative risk of odds...

    Incorrect

    • What type of data is required to compute the relative risk of odds ratio?

      Your Answer:

      Correct Answer: Dichotomous

      Explanation:

      When outcomes are binary (such as dead of alive), there are various ways to report them, including proportions, percentages, risk, odds, risk ratios, odds ratios, number needed to treat, likelihood ratios, sensitivity, specificity, and pre-test and post-test probability. However, for non-binary data types, different methods of reporting are required.

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 96 - A 10-year-old boy staying with foster parents starts eating pieces of chalk.

    This...

    Incorrect

    • A 10-year-old boy staying with foster parents starts eating pieces of chalk.

      This behaviour lasts for 6 weeks. Which of the following do you suspect?:

      Your Answer:

      Correct Answer: Pica

      Explanation:

      Based on her actions, it can be inferred that she displays symptoms of pica.

      Pica: Eating Non-Nutritive Substances

      Pica is a condition where a person persistently eats non-nutritive substances for at least a month. The name pica comes from the Latin word for magpie, a bird known for its large and random appetite. To be diagnosed with pica, the behavior must be developmentally inappropriate, not culturally sanctioned, and severe enough to require clinical attention. It is more common in young people than adults and is often associated with mental retardation.

      There are various causes of pica, including mental disorders such as autism and schizophrenia, iron and zinc deficiency (although this is rare and not clear if it is a cause of effect), and pregnancy. The DSM-5 requires a minimum age of 2 before a diagnosis can be made. Pregnant women have been reported to experience certain forms of pica, such as geophagia (clay eating) and amylophagia (starch eating).

      Pica affects both sexes equally and is estimated to occur in up to 15% of those with severe intellectual disability. However, aside from cases of autistic spectrum disorder of intellectual disability, pica usually remits by adolescence.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 97 - What is the first-line recommendation by NICE for the long-term management of adult...

    Incorrect

    • What is the first-line recommendation by NICE for the long-term management of adult bipolar disorder?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      Bipolar Disorder: Diagnosis and Management

      Bipolar disorder is a lifelong condition characterized by episodes of mania or hypomania and episodes of depressed mood. The peak age of onset is 15-19 years, and the lifetime prevalence of bipolar I disorders is estimated to be around 2.1%. The diagnosis of bipolar disorder is based on the presence of manic or hypomanic episodes, which are characterized by elevated of expansive mood, rapid speech, and increased activity of energy. Psychotic symptoms, such as delusions and hallucinations, may also be present.

      Bipolar depression differs from unipolar depression in several ways, including more rapid onset, more frequent episodes, and shorter duration. Rapid cycling is a qualifier that can be applied to bipolar I of bipolar II disorder and is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode.

      The management of bipolar disorder involves acute and long-term interventions. Acute management of mania or hypomania may involve stopping antidepressants and offering antipsychotics of mood stabilizers. Long-term management may involve psychological interventions and pharmacological treatments such as lithium, valproate, of olanzapine.

      It is important to note that valproate should not be offered to women of girls of childbearing potential for long-term bipolar disorder unless other options are ineffective of not tolerated and a pregnancy prevention program is in place. Aripiprazole is recommended as an option for treating moderate to severe manic episodes in adolescents with bipolar I disorder.

      Overall, the diagnosis and management of bipolar disorder require a comprehensive approach that takes into account the individual’s symptoms, history, and preferences.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 98 - A 35 year old male is seen in clinic with depression. He has...

    Incorrect

    • A 35 year old male is seen in clinic with depression. He has no past psychiatric history and has never self-harmed. He denies suicidal ideation. He is commenced on citalopram. After what period of time do NICE guidelines suggest he is reviewed?

      Your Answer:

      Correct Answer: 2 weeks

      Explanation:

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 99 - A study is conducted to investigate whether a new exercise program has any...

    Incorrect

    • A study is conducted to investigate whether a new exercise program has any impact on weight loss. A total of 300 participants are enrolled from various locations and are randomly assigned to either the exercise group of the control group. Weight measurements are taken at the beginning of the study and at the end of a six-month period.

      What is the most effective method of visually presenting the data?

      Your Answer:

      Correct Answer: Kaplan-Meier plot

      Explanation:

      The Kaplan-Meier plot is the most effective graphical representation of survival probability. It presents the overall likelihood of an individual’s survival over time from a baseline, and the comparison of two lines on the plot can indicate whether there is a survival advantage. To determine if the distinction between the two groups is significant, a log rank test can be employed.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 100 - A 60 year old lady is brought to A&E by her daughter who...

    Incorrect

    • A 60 year old lady is brought to A&E by her daughter who has noticed that her memory and personality have changed dramatically over the past 2-3 months. Prior to that she had been ok and was in relatively good health. Further questioning reveals fluctuating levels of consciousness. Which of the following would you suspect?

      Your Answer:

      Correct Answer: Chronic subdural haematoma

      Explanation:

      While any of the possibilities could explain the shift in personality and cognitive function, the presence of varying levels of consciousness indicates a probable chronic subdural hematoma.

      Depression is an important differential diagnosis to consider in a person presenting with dementia. Depression can cause cognitive impairment, memory problems, and difficulty concentrating, which can mimic the symptoms of dementia. It is important to differentiate between depression and dementia, as depression is treatable with medication and therapy, whereas dementia is a progressive and irreversible condition. Therefore, a thorough evaluation of the patient’s medical history, physical examination, and cognitive testing is necessary to make an accurate diagnosis and provide appropriate treatment.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 101 - Which tricyclic antidepressant should breastfeeding women avoid using? ...

    Incorrect

    • Which tricyclic antidepressant should breastfeeding women avoid using?

      Your Answer:

      Correct Answer: Doxepin

      Explanation:

      Paroxetine Use During Pregnancy: Is it Safe?

      Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 102 - What symptom is commonly observed in individuals with anorexia nervosa? ...

    Incorrect

    • What symptom is commonly observed in individuals with anorexia nervosa?

      Your Answer:

      Correct Answer: Constipation

      Explanation:

      Anorexia nervosa often leads to constipation as a common complication.

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 103 - At what stage of behaviour change, as defined by Prochaska and DiClemente (1993),...

    Incorrect

    • At what stage of behaviour change, as defined by Prochaska and DiClemente (1993), is a patient ready to receive constructive advice, commit to planned behaviour change, establish objectives, and evaluate past achievements and setbacks?

      Your Answer:

      Correct Answer: Preparation

      Explanation:

      Their preparedness suggests that they are getting ready to make a change.

      Stages of Change Model

      Prochaska and DiClemente’s Stages of Change Model identifies five stages that individuals go through when making a change. The first stage is pre-contemplation, where the individual is not considering change. There are different types of precontemplators, including those who lack knowledge about the problem, those who are afraid of losing control, those who feel hopeless, and those who rationalize their behavior.

      The second stage is contemplation, where the individual is ambivalent about change and is sitting on the fence. The third stage is preparation, where the individual has some experience with change and is trying to change, testing the waters. The fourth stage is action, where the individual has started to introduce change, and the behavior is defined as action during the first six months of change.

      The final stage is maintenance, where the individual is involved in ongoing efforts to maintain change. Action becomes maintenance once six months have elapsed. Understanding these stages can help individuals and professionals in supporting behavior change.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 104 - What is a true statement about frontotemporal lobar degeneration? ...

    Incorrect

    • What is a true statement about frontotemporal lobar degeneration?

      Your Answer:

      Correct Answer: Behavioural variant is the most common subtype of frontotemporal lobar degeneration

      Explanation:

      Frontotemporal Lobar Degeneration

      Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.

      The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).

      As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.

      In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 105 - What tool is utilized to detect depression in individuals who have dementia? ...

    Incorrect

    • What tool is utilized to detect depression in individuals who have dementia?

      Your Answer:

      Correct Answer: Cornell Scale

      Explanation:

      Screening for Depression in Dementia using the Cornell Scale

      MCI and dementia have been linked to increased rates of depression. To screen for depression in dementia, the Cornell Scale is commonly used. However, it is important to note that this scale is not diagnostic. The screening process involves two steps: an interview with a caregiver using a 19-item scale, followed by an interview with the patient. The total time required for administration is approximately 30 minutes. By using the Cornell Scale, healthcare professionals can identify potential cases of depression in patients with dementia, allowing for early intervention and treatment.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 106 - A 29-year-old woman, who was prescribed venlafaxine for depression, reports that she has...

    Incorrect

    • A 29-year-old woman, who was prescribed venlafaxine for depression, reports that she has stopped having periods and has started lactating. A pregnancy test has ruled out pregnancy. The patient is distressed by these symptoms. As investigations are being conducted, which alternative antidepressant would you recommend switching her to?

      Your Answer:

      Correct Answer: Mirtazapine

      Explanation:

      The women’s symptoms are indicative of hyperprolactinemia, which is likely caused by venlafaxine. To avoid exacerbating this condition, mirtazapine is the recommended treatment option as it is thought to have no impact on prolactin levels.

      Management of Hyperprolactinaemia

      Hyperprolactinaemia is often associated with the use of antipsychotics and occasionally antidepressants. Dopamine inhibits prolactin, and dopamine antagonists increase prolactin levels. Almost all antipsychotics cause changes in prolactin, but some do not increase levels beyond the normal range. The degree of prolactin elevation is dose-related. Hyperprolactinaemia is often asymptomatic but can cause galactorrhoea, menstrual difficulties, gynaecomastia, hypogonadism, sexual dysfunction, and an increased risk of osteoporosis and breast cancer in psychiatric patients.

      Patients should have their prolactin measured before antipsychotic therapy and then monitored for symptoms at three months. Annual testing is recommended for asymptomatic patients. Antipsychotics that increase prolactin should be avoided in patients under 25, patients with osteoporosis, patients with a history of hormone-dependent cancer, and young women. Samples should be taken at least one hour after eating of waking, and care must be taken to avoid stress during the procedure.

      Treatment options include referral for tests to rule out prolactinoma if prolactin is very high, making a joint decision with the patient about continuing if prolactin is raised but not symptomatic, switching to an alternative antipsychotic less prone to hyperprolactinaemia if prolactin is raised and the patient is symptomatic, adding aripiprazole 5mg, of adding a dopamine agonist such as amantadine of bromocriptine. Mirtazapine is recommended for symptomatic hyperprolactinaemia associated with antidepressants as it does not raise prolactin levels.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 107 - What statement accurately describes the mean? ...

    Incorrect

    • What statement accurately describes the mean?

      Your Answer:

      Correct Answer: Is sensitive to a change in any value in the data set

      Explanation:

      Measures of Central Tendency

      Measures of central tendency are used in descriptive statistics to summarize the middle of typical value of a data set. There are three common measures of central tendency: the mean, median, and mode.

      The median is the middle value in a data set that has been arranged in numerical order. It is not affected by outliers and is used for ordinal data. The mode is the most frequent value in a data set and is used for categorical data. The mean is calculated by adding all the values in a data set and dividing by the number of values. It is sensitive to outliers and is used for interval and ratio data.

      The appropriate measure of central tendency depends on the measurement scale of the data. For nominal and categorical data, the mode is used. For ordinal data, the median of mode is used. For interval data with a normal distribution, the mean is preferable, but the median of mode can also be used. For interval data with skewed distribution, the median is used. For ratio data, the mean is preferable, but the median of mode can also be used for skewed data.

      In addition to measures of central tendency, the range is also used to describe the spread of a data set. It is calculated by subtracting the smallest value from the largest value.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 108 - Which of the following has the greatest number of risk factors associated with...

    Incorrect

    • Which of the following has the greatest number of risk factors associated with completed suicide?

      Your Answer:

      Correct Answer: 45-year-old male, divorced, unemployed, social class V

      Explanation:

      Suicide Risk Factors

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 109 - How can somatoform disorder be best defined? ...

    Incorrect

    • How can somatoform disorder be best defined?

      Your Answer:

      Correct Answer: Da Costa's syndrome

      Explanation:

      Psychalgia refers to pain that has a psychological origin.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 110 - Which statement accurately describes alcoholic blackouts? ...

    Incorrect

    • Which statement accurately describes alcoholic blackouts?

      Your Answer:

      Correct Answer: Blackouts do not predict long term cognitive impairment

      Explanation:

      Alcoholic Blackouts: Definition and Causes

      Alcoholic blackouts are temporary memory loss episodes caused by alcohol intoxication. They do not involve loss of consciousness and are not exclusive to individuals with alcohol dependence. In fact, they can occur in a significant number of social drinkers. The risk factors for experiencing alcoholic blackouts include starting drinking at an early age, consuming high levels of alcohol, and having a history of head injury. However, experiencing blackouts does not necessarily predict long-term cognitive impairment.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 111 - Which term is Donald Winnicott known for? ...

    Incorrect

    • Which term is Donald Winnicott known for?

      Your Answer:

      Correct Answer: Holding environment

      Explanation:

      Winnicott is known for his concept of the ‘good enough mother’, rather than referring to the mother as absent.

      Winnicott: An Overview

      Donald Winnicott, a British paediatrician and psychotherapist, is known for his contributions to the field of child development and psychoanalysis. He introduced several concepts that are still relevant today.

      Good Enough Mother: Winnicott emphasised the importance of being a good enough mother rather than a perfect one. He believed that children needed someone who would attend to them but not immediately so that they could learn to tolerate frustration.

      Holding Environment: This refers to the psychic and physical space between the mother and infant that ensures the mother is there for the child when needed but allows them to explore independently when ready.

      Transitional Object: Winnicott talked about the two separate realities for a child, the ‘me’ and the ‘not me’. The transitional object is one that represents another (e.g. Mother) and is regarded as the first ‘not me’ possession.

      False Self: Winnicott described the situation of ‘not good-enough mothering’ as one in which the mother (consciously of unconsciously) is unable to respond adequately to her infant’s spontaneous behaviour (true self), but tends to impose her own wishes and desires (e.g. for an ‘ideal’ child). This may lead the infant to an adaptation on the basis of ’compliance’ (false self) and later, in adulthood, to the loss of a sense of personal autonomy and integrity.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 112 - A team of scientists plans to carry out a placebo-controlled randomized trial to...

    Incorrect

    • A team of scientists plans to carry out a placebo-controlled randomized trial to assess the effectiveness of a new medication for treating hypertension in elderly patients. They aim to prevent patients from knowing whether they are receiving the medication of the placebo.
      What type of bias are they trying to eliminate?

      Your Answer:

      Correct Answer: Performance bias

      Explanation:

      To prevent bias in the study, the researchers are implementing patient blinding to prevent performance bias, as knowledge of whether they are taking venlafaxine of a placebo, of which arm of the study they are in, could impact the patient’s behavior. Additionally, investigators must also be blinded to avoid measurement bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 113 - What interventions have been proven to be effective in preventing postoperative delirium and...

    Incorrect

    • What interventions have been proven to be effective in preventing postoperative delirium and reducing its intensity and duration?

      Your Answer:

      Correct Answer: Haloperidol

      Explanation:

      In elderly patients undergoing hip surgery, haloperidol has been found to decrease the intensity and length of postoperative delirium. However, it did not have an effect on the occurrence of delirium.

      Delirium Management

      Pharmacological management of delirium includes the use of haloperidol as a prophylactic measure. NICE guidelines recommend short-term use of haloperidol in cases where delirium is associated with distress of risk to self/others. Quetiapine is also considered a first-choice option in many units. Lorazepam can be used as an alternative if haloperidol is contraindicated, but it is more likely to cause respiratory depression, over-sedation, and paradoxical excitement.

      Non-pharmacological management of delirium includes appropriate lighting and clear signage, talking to the person to reorient them, cognitively stimulating activities, regular visits from family and friends, and promoting good sleep patterns. Additional options such as donepezil, rivastigmine, melatonin, trazodone, and sodium valproate are not recommended. It is important to carefully consider the individual’s needs and medical history when choosing a management plan for delirium.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 114 - Which statement accurately describes the court process in the UK? ...

    Incorrect

    • Which statement accurately describes the court process in the UK?

      Your Answer:

      Correct Answer: All criminal cases will first go to the Magistrates Court

      Explanation:

      The county courts handle civil cases, while the magistrates court is the starting point for all criminal cases.

      Court Structure in England and Wales

      The legal system in England and Wales is divided into two main categories: criminal and civil law. Criminal law governs the rules set by the state for citizens, while civil law regulates the relationships and transactions between citizens.

      All criminal cases begin in the Magistrates’ Court. Criminal offenses are classified into three main categories: summary offenses, triable either way offenses, and indictable offenses. Summary offenses are the least serious and are tried in the Magistrates’ Court, with a maximum penalty of six months imprisonment and/of a fine of up to £5,000. Triable either way offenses are the middle range of crimes and can be tried in either the Magistrates’ Court of Crown Court. Indictable offenses are the most serious crimes, including murder, manslaughter, and rape, and must be tried in the Crown Court, with the first hearing at the Magistrates’ Court.

      Magistrates’ courts handle 95% of cases, including many civil cases such as family matters, liquor licensing, and betting and gaming. Magistrates cannot typically order sentences of imprisonment exceeding six months (of 12 months for consecutive sentences) of fines exceeding £5,000. In cases triable either way, the offender may be committed by the magistrates to the Crown Court for sentencing if a more severe sentence is deemed necessary.

      The Crown Court deals with serious criminal cases, some of which are on appeal of referred from Magistrates’ courts. Trials are heard by a Judge and a 12-person jury. The Crown Court is located at 77 centers across England and Wales and handles cases transferred from the Magistrates’ Courts. It also hears appeals against decisions of Magistrate’s Courts and deals with cases sent for sentence from Magistrates’ Courts.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 115 - If a patient with depression is resistant to conventional medicine, which herbal remedy...

    Incorrect

    • If a patient with depression is resistant to conventional medicine, which herbal remedy has been proven to be effective in treating depression?

      Your Answer:

      Correct Answer: Hypericum perforatum

      Explanation:

      Herbal Remedies for Depression and Anxiety

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 116 - A new treatment for elderly patients with hypertension is investigated. The study looks...

    Incorrect

    • A new treatment for elderly patients with hypertension is investigated. The study looks at the incidence of stroke after 1 year. The following data is obtained:
      Number who had a stroke vs Number without a stroke
      New drug: 40 vs 160
      Placebo: 100 vs 300
      What is the relative risk reduction?

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 117 - For which condition was interpersonal psychotherapy originally developed as a form of treatment?...

    Incorrect

    • For which condition was interpersonal psychotherapy originally developed as a form of treatment?

      Your Answer:

      Correct Answer: Major depression

      Explanation:

      In the 1970s, IPT was developed as a remedy for major depression and was initially tested through a study. The study compared the effectiveness of interpersonal psychotherapy alone, amitriptyline alone, interpersonal psychotherapy plus amitriptyline, interpersonal psychotherapy plus placebo, and no medication (clinical management). The results of the trial showed that interpersonal psychotherapy plus amitriptyline had a greater potential to sustain an initial positive reaction to medication, and interpersonal psychotherapy had a distinct but delayed impact on social functioning.

      Interpersonal Therapy: A Structured Approach to Addressing Social Functioning Problems

      Interpersonal therapy (IPT) is a structured form of psychotherapy that is often used to treat depression. It is based on the belief that social functioning problems have a significant impact on psychological problems. IPT is a time-limited therapy that typically runs for 10-16 one hour sessions. The therapy is organized into three phases, with the first phase involving data collection and formulation. The remaining sessions explore the formulation in more detail.

      IPT focuses on four areas of social functioning problems: grief, role transitions, interpersonal deficits, and interpersonal disputes. The therapy aims to intervene at the level of social functioning, rather than focusing on personality. The therapy has been found to be effective in treating depression, particularly in patients with severe depression. However, it may be less effective in treating people with depression and comorbid personality disorders.

      The evidence base for IPT is most developed for eating disorders, and the intervention is recommended in NICE guidelines for eating disorders. Overall, IPT is a structured approach to addressing social functioning problems that can be effective in treating depression and other psychological problems.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 118 - A study looks into the effects of alcohol consumption on female psychiatrists. A...

    Incorrect

    • A study looks into the effects of alcohol consumption on female psychiatrists. A group are selected and separated by the amount they drink into four groups. The first group drinks no alcohol, the second occasionally, the third often, and the fourth large and regular amounts. The group is followed up over the next ten years and the rates of cirrhosis are recorded.
      What is the dependent variable in the study?

      Your Answer:

      Correct Answer: Rates of liver cirrhosis

      Explanation:

      Understanding Stats Variables

      Variables are characteristics, numbers, of quantities that can be measured of counted. They are also known as data items. Examples of variables include age, sex, business income and expenses, country of birth, capital expenditure, class grades, eye colour, and vehicle type. The value of a variable may vary between data units in a population. In a typical study, there are three main variables: independent, dependent, and controlled variables.

      The independent variable is something that the researcher purposely changes during the investigation. The dependent variable is the one that is observed and changes in response to the independent variable. Controlled variables are those that are not changed during the experiment. Dependent variables are affected by independent variables but not by controlled variables, as these do not vary throughout the study.

      For instance, a researcher wants to test the effectiveness of a new weight loss medication. Participants are divided into three groups, with the first group receiving a placebo (0mg dosage), the second group a 10 mg dose, and the third group a 40 mg dose. After six months, the participants’ weights are measured. In this case, the independent variable is the dosage of the medication, as that is what is being manipulated. The dependent variable is the weight, as that is what is being measured.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 119 - What is the correct approach to treating dementia? ...

    Incorrect

    • What is the correct approach to treating dementia?

      Your Answer:

      Correct Answer: Memantine is considered a second-line option for the treatment of dementia with Lewy bodies

      Explanation:

      Treatment of Dementia: AChE Inhibitors and Memantine

      Dementia is a debilitating condition that affects millions of people worldwide. Acetylcholinesterase inhibitors (AChE inhibitors) and memantine are two drugs used in the management of dementia. AChE inhibitors prevent cholinesterase from breaking down acetylcholine, which is deficient in Alzheimer’s due to loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are AChE inhibitors used in the management of Alzheimer’s. Memantine is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.

      NICE guidelines recommend the use of AChE inhibitors for managing mild to moderate Alzheimer’s and memantine for managing moderate to severe Alzheimer’s. For those already taking an AChE inhibitor, memantine can be added if the disease is moderate of severe. AChE inhibitors are also recommended for managing mild, moderate, and severe dementia with Lewy bodies, while memantine is considered if AChE inhibitors are not tolerated of contraindicated. AChE inhibitors and memantine are not recommended for vascular dementia, frontotemporal dementia, of cognitive impairment due to multiple sclerosis.

      The British Association for Psychopharmacology recommends AChE inhibitors as the first choice for Alzheimer’s and mixed dementia, while memantine is the second choice. AChE inhibitors and memantine are also recommended for dementia with Parkinson’s and dementia with Lewy bodies.

      In summary, AChE inhibitors and memantine are important drugs used in the management of dementia. The choice of drug depends on the type and severity of dementia, as well as individual patient factors.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 120 - What is the initial medication prescribed for a 9 year old boy with...

    Incorrect

    • What is the initial medication prescribed for a 9 year old boy with ADHD and no other medical conditions?

      Your Answer:

      Correct Answer: Methylphenidate

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 121 - What is the most effective way to distinguish between dementia and delirium? ...

    Incorrect

    • What is the most effective way to distinguish between dementia and delirium?

      Your Answer:

      Correct Answer: Fluctuating consciousness

      Explanation:

      The primary distinction between delirium and dementia is the variability of consciousness levels.

      Delirium (also known as acute confusional state) is a condition characterized by a sudden decline in consciousness and cognition, with a particular impairment in attention. It often involves perceptual disturbances, abnormal psychomotor activity, and sleep-wake cycle impairment. Delirium typically develops over a few days and has a fluctuating course. The causes of delirium are varied, ranging from metabolic disturbances to medications. It is important to differentiate delirium from dementia, as delirium has a brief onset, early disorientation, clouding of consciousness, fluctuating course, and early psychomotor changes. Delirium can be classified into three subtypes: hypoactive, hyperactive, and mixed. Patients with hyperactive delirium demonstrate restlessness, agitation, and hyper vigilance, while those with hypoactive delirium present with lethargy and sedation. Mixed delirium demonstrates both hyperactive and hypoactive features. The hypoactive form is most common in elderly patients and is often misdiagnosed as depression of dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 122 - Which statement about confounding is incorrect? ...

    Incorrect

    • Which statement about confounding is incorrect?

      Your Answer:

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

      Explanation:

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

      Stats Confounding

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 123 - According to Klerman's bipolar subtypes, what term is used to describe a state...

    Incorrect

    • According to Klerman's bipolar subtypes, what term is used to describe a state of mania without depression?

      Your Answer:

      Correct Answer: Bipolar VI

      Explanation:

      Bipolar Disorder: Historical Subtypes

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 124 - Calculate the median value from the following values:
    1, 3, 3, 3, 4, 5,...

    Incorrect

    • Calculate the median value from the following values:
      1, 3, 3, 3, 4, 5, 5, 6, 6, 6, 6

      Your Answer:

      Correct Answer: 5

      Explanation:

      Measures of Central Tendency

      Measures of central tendency are used in descriptive statistics to summarize the middle of typical value of a data set. There are three common measures of central tendency: the mean, median, and mode.

      The median is the middle value in a data set that has been arranged in numerical order. It is not affected by outliers and is used for ordinal data. The mode is the most frequent value in a data set and is used for categorical data. The mean is calculated by adding all the values in a data set and dividing by the number of values. It is sensitive to outliers and is used for interval and ratio data.

      The appropriate measure of central tendency depends on the measurement scale of the data. For nominal and categorical data, the mode is used. For ordinal data, the median of mode is used. For interval data with a normal distribution, the mean is preferable, but the median of mode can also be used. For interval data with skewed distribution, the median is used. For ratio data, the mean is preferable, but the median of mode can also be used for skewed data.

      In addition to measures of central tendency, the range is also used to describe the spread of a data set. It is calculated by subtracting the smallest value from the largest value.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 125 - What was the percentage of restricted patients who were convicted again within 2...

    Incorrect

    • What was the percentage of restricted patients who were convicted again within 2 years of transitioning into the community, based on UK data from 1998 to 2006?

      Your Answer:

      Correct Answer: 7%

      Explanation:

      Recidivism Rates of Restricted Patients vs. UK Prison Population

      Restricted patients are individuals who are under the risk management of the Secretary of State for Justice and receive care in secure hospitals. From 1998 to 2006, less than 500 restricted cases per year were reintegrated into the community, and their two-year re-conviction rates were 7% for all offenses and 1% for serious offenses. In contrast, the UK prison population had a much higher recidivism rate. In the first quarter of 2004, out of 20,000 individuals released from prison, 65% were convicted again for any offense. These findings suggest that the risk management strategies for restricted patients may be more effective in reducing recidivism rates compared to the general prison population.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 126 - What is a true statement about exhibitionism? ...

    Incorrect

    • What is a true statement about exhibitionism?

      Your Answer:

      Correct Answer: Exhibitionism is highly unusual in females

      Explanation:

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

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 127 - A middle-aged patient in a psychiatric hospital is prescribed quetiapine for treatment-resistant aggressive...

    Incorrect

    • A middle-aged patient in a psychiatric hospital is prescribed quetiapine for treatment-resistant aggressive behaviour. What potential adverse effects are associated with antipsychotic use in this age group?

      Your Answer:

      Correct Answer: Stroke

      Explanation:

      Elderly individuals who take antipsychotic medications have a higher likelihood of experiencing a stroke.

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 128 - What is the best course of action for a 32-year-old pregnant woman with...

    Incorrect

    • What is the best course of action for a 32-year-old pregnant woman with a heroin addiction who is interested in detoxing?

      Your Answer:

      Correct Answer: Methadone

      Explanation:

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 129 - A teenager is involved in an attack on his school in which he...

    Incorrect

    • A teenager is involved in an attack on his school in which he sees his friend hit and killed with a gun. He sustains minor injuries and is taken to a nearby hospital.

      Within 48 hours he develops flashbacks of the scene which are vivid and intrusive. He also experiences nightmares which wake him from his sleep. He becomes extremely distressed and startles easily to any nearby noise.

      He is initially very reluctant to return to the school as he feels this is too stark a remainder of the trauma.

      Within one week he is feeling much better and whilst still somewhat shaken he is able to return to the school and the flashbacks and nightmares cease.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute stress reaction

      Explanation:

      Typical immediate responses to traumatic events may involve the full range of symptoms associated with Post-Traumatic Stress Disorder, including reliving the experience. However, these symptoms tend to diminish rapidly (for example, within one week of the event’s conclusion of removal from the dangerous environment, of within one month for ongoing stressors).

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 130 - Which statement accurately describes the diagnosis of PTSD according to the ICD-11 criteria?...

    Incorrect

    • Which statement accurately describes the diagnosis of PTSD according to the ICD-11 criteria?

      Your Answer:

      Correct Answer: The traumatic event must be of a degree that would considered horrific in nature

      Explanation:

      The ICD-11 requires that the traumatic event be of an extremely threatening of horrific nature, which can be experienced directly of indirectly. There is no specific timeframe for when symptoms must occur after the event. To diagnose PTSD, three core elements must be present: re-experiencing the traumatic event, deliberate avoidance of reminders, and persistent perceptions of heightened current threat. Flashbacks can range from mild to severe, with mild flashbacks involving a brief sense of the event occurring again and severe flashbacks resulting in a complete loss of awareness of present surroundings.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 131 - What is the purpose of using the Kolmogorov-Smirnov and Jarque-Bera tests? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Normality

      Explanation:

      Normality Testing in Statistics

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 132 - A 50 year old man, with a long history of alcohol dependence and...

    Incorrect

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

      Your Answer:

      Correct Answer: Oxazepam

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 133 - Which of the following behaviors of traits may indicate the presence of schizoid...

    Incorrect

    • Which of the following behaviors of traits may indicate the presence of schizoid personality disorder?

      Your Answer:

      Correct Answer: Lack of desire for companionship

      Explanation:

      Schizoid Personality Disorder: A Description of Symptoms

      Schizoid personality disorder is a type of personality disorder that falls under cluster A. People with this disorder are often seen as distant, isolated, and emotionally detached. They tend to have a restricted range of emotions and struggle to form close relationships with others. Symptoms typically begin in early adulthood and can be observed in various contexts. To be diagnosed with schizoid personality disorder, an individual must exhibit at least four of the following symptoms:

      1. Lack of desire for close relationships
      2. Preferring solitary activities
      3. Little interest in sexual experiences
      4. Finding pleasure in few activities
      5. Lack of close friends of confidants
      6. Indifference to praise of criticism
      7. Emotional coldness, detachment, of flattened affectivity
      8. Symptoms cannot be attributed to another medical condition and do not occur in the context of schizophrenia, manic depression, autism spectrum disorder, of another affective disorder with psychotic features.

      It is important to note that the ICD-11 does not have a specific category for schizoid personality disorder. Instead, it has adopted a dimensional approach to diagnosis.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 134 - Which of the following conditions is not associated with the Wernicke-Korsakoff syndrome? ...

    Incorrect

    • Which of the following conditions is not associated with the Wernicke-Korsakoff syndrome?

      Your Answer:

      Correct Answer: Motor neuron disease

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 135 - Which statement accurately describes the measurement of serum potassium in 1,000 patients with...

    Incorrect

    • Which statement accurately describes the measurement of serum potassium in 1,000 patients with anorexia nervosa, where the mean potassium is 4.6 mmol/l and the standard deviation is 0.3 mmol/l?

      Your Answer:

      Correct Answer: 68.3% of values lie between 4.3 and 4.9 mmol/l

      Explanation:

      Standard Deviation and Standard Error of the Mean

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 136 - What is the maintenance treatment used for individuals with opioid dependence syndrome? ...

    Incorrect

    • What is the maintenance treatment used for individuals with opioid dependence syndrome?

      Your Answer:

      Correct Answer: Buprenorphine

      Explanation:

      Synthetic opioids like methadone and buprenorphine are utilized as a replacement for heroin. Alpha2 adrenergic agonists such as clonidine and lofexidine are employed in detox settings to alleviate a range of opioid withdrawal symptoms.

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 137 - A pediatrician becomes interested in a newly identified and rare pediatric syndrome. They...

    Incorrect

    • A pediatrician becomes interested in a newly identified and rare pediatric syndrome. They are interested to investigate if previous exposure to herpes viruses may put children at increased risk. Which of the following study designs would be most appropriate?

      Your Answer:

      Correct Answer: Case-control study

      Explanation:

      Case-control studies are useful in studying rare diseases as it would be impractical to follow a large group of people for a long period of time to accrue enough incident cases. For instance, if a disease occurs very infrequently, say 1 in 1,000,000 per year, it would require following 1,000,000 people for ten years of 1000 people for 1000 years to accrue ten total cases. However, this is not feasible. Therefore, a case-control study provides a more practical approach to studying rare diseases.

      Types of Primary Research Studies and Their Advantages and Disadvantages

      Primary research studies can be categorized into six types based on the research question they aim to address. The best type of study for each question type is listed in the table below. There are two main types of study design: experimental and observational. Experimental studies involve an intervention, while observational studies do not. The advantages and disadvantages of each study type are summarized in the table below.

      Type of Question Best Type of Study

      Therapy Randomized controlled trial (RCT), cohort, case control, case series
      Diagnosis Cohort studies with comparison to gold standard test
      Prognosis Cohort studies, case control, case series
      Etiology/Harm RCT, cohort studies, case control, case series
      Prevention RCT, cohort studies, case control, case series
      Cost Economic analysis

      Study Type Advantages Disadvantages

      Randomized Controlled Trial – Unbiased distribution of confounders – Blinding more likely – Randomization facilitates statistical analysis – Expensive – Time-consuming – Volunteer bias – Ethically problematic at times
      Cohort Study – Ethically safe – Subjects can be matched – Can establish timing and directionality of events – Eligibility criteria and outcome assessments can be standardized – Administratively easier and cheaper than RCT – Controls may be difficult to identify – Exposure may be linked to a hidden confounder – Blinding is difficult – Randomization not present – For rare disease, large sample sizes of long follow-up necessary
      Case-Control Study – Quick and cheap – Only feasible method for very rare disorders of those with long lag between exposure and outcome – Fewer subjects needed than cross-sectional studies – Reliance on recall of records to determine exposure status – Confounders – Selection of control groups is difficult – Potential bias: recall, selection
      Cross-Sectional Survey – Cheap and simple – Ethically safe – Establishes association at most, not causality – Recall bias susceptibility – Confounders may be unequally distributed – Neyman bias – Group sizes may be unequal
      Ecological Study – Cheap and simple – Ethically safe – Ecological fallacy (when relationships which exist for groups are assumed to also be true for individuals)

      In conclusion, the choice of study type depends on the research question being addressed. Each study type has its own advantages and disadvantages, and researchers should carefully consider these when designing their studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 138 - What is the estimated percentage of 10 year olds affected by encopresis? ...

    Incorrect

    • What is the estimated percentage of 10 year olds affected by encopresis?

      Your Answer:

      Correct Answer: 1.60%

      Explanation:

      Elimination Disorders

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 139 - A 65 kg male patient is brought to the emergency department after taking...

    Incorrect

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

      Your Answer:

      Correct Answer: Administer IV acetylcysteine without delay

      Explanation:

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

      Self-Harm and its Management

      Self-harm refers to intentional acts of self-poisoning of self-injury. It is prevalent among younger people, with an estimated 10% of girls and 3% of boys aged 15-16 years having self-harmed in the previous year. Risk factors for non-fatal repetition of self-harm include previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, and drug abuse/dependence. Suicide following an act of self-harm is more likely in those with previous episodes of self-harm, suicidal intent, poor physical health, and male gender.

      Risk assessment tools are not recommended for predicting future suicide of repetition of self-harm. The recommended interventions for self-harm include 4-10 sessions of CBT specifically structured for people who self-harm and considering DBT for adolescents with significant emotional dysregulation. Drug treatment as a specific intervention to reduce self-harm should not be offered.

      In the management of ingestion, activated charcoal can help if used early, while emetics and cathartics should not be used. Gastric lavage should generally not be used unless recommended by TOXBASE. Paracetamol is involved in 30-40% of acute presentations with poisoning. Intravenous acetylcysteine is the treatment of choice, and pseudo-allergic reactions are relatively common. Naloxone is used as an antidote for opioid overdose, while flumazenil can help reduce the need for admission to intensive care in benzodiazepine overdose.

      For superficial uncomplicated skin lacerations of 5 cm of less in length, tissue adhesive of skin closure strips could be used as a first-line treatment option. All children who self-harm should be admitted for an overnight stay at a pediatric ward.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 140 - A 65-year-old patient has long standing hyperprolactinaemia but does not experience symptoms. They...

    Incorrect

    • A 65-year-old patient has long standing hyperprolactinaemia but does not experience symptoms. They are keen to continue on the prescribed antipsychotic which has proved very effective. Which of the following risks must you make them aware of?

      Your Answer:

      Correct Answer: Breast cancer

      Explanation:

      This risk is purely hypothetical and can affect individuals of any gender.

      Management of Hyperprolactinaemia

      Hyperprolactinaemia is often associated with the use of antipsychotics and occasionally antidepressants. Dopamine inhibits prolactin, and dopamine antagonists increase prolactin levels. Almost all antipsychotics cause changes in prolactin, but some do not increase levels beyond the normal range. The degree of prolactin elevation is dose-related. Hyperprolactinaemia is often asymptomatic but can cause galactorrhoea, menstrual difficulties, gynaecomastia, hypogonadism, sexual dysfunction, and an increased risk of osteoporosis and breast cancer in psychiatric patients.

      Patients should have their prolactin measured before antipsychotic therapy and then monitored for symptoms at three months. Annual testing is recommended for asymptomatic patients. Antipsychotics that increase prolactin should be avoided in patients under 25, patients with osteoporosis, patients with a history of hormone-dependent cancer, and young women. Samples should be taken at least one hour after eating of waking, and care must be taken to avoid stress during the procedure.

      Treatment options include referral for tests to rule out prolactinoma if prolactin is very high, making a joint decision with the patient about continuing if prolactin is raised but not symptomatic, switching to an alternative antipsychotic less prone to hyperprolactinaemia if prolactin is raised and the patient is symptomatic, adding aripiprazole 5mg, of adding a dopamine agonist such as amantadine of bromocriptine. Mirtazapine is recommended for symptomatic hyperprolactinaemia associated with antidepressants as it does not raise prolactin levels.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 141 - In which therapeutic model are reciprocal role procedures included? ...

    Incorrect

    • In which therapeutic model are reciprocal role procedures included?

      Your Answer:

      Correct Answer: Cognitive analytic therapy

      Explanation:

      Understanding Cognitive Analytic Therapy

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

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

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 142 - Which studies are most susceptible to the Hawthorne effect? ...

    Incorrect

    • Which studies are most susceptible to the Hawthorne effect?

      Your Answer:

      Correct Answer: Compliance with antipsychotic medication

      Explanation:

      The Hawthorne effect is a phenomenon where individuals may alter their actions of responses when they are aware that they are being monitored of studied. Out of the given choices, the only one that pertains to a change in behavior is the adherence to medication. The remaining options related to outcomes that are not under conscious control.

      Types of Bias in Statistics

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 143 - A 42-year-old woman has been referred to you by her primary care physician....

    Incorrect

    • A 42-year-old woman has been referred to you by her primary care physician. She has been struggling with compulsive gambling and has accumulated significant debt. She spends most of her time at the casino and her relationships with family and friends have suffered as a result. The referring doctor suspects that she may have a gambling disorder as she is distressed by her inability to control her gambling behavior. What pharmacological interventions would you suggest in conjunction with cognitive behavioral therapy?

      Your Answer:

      Correct Answer: Selective serotonin reuptake inhibitor (SSRI)

      Explanation:

      Selective serotonin reuptake inhibitors (SSRIs) are a class of medications commonly used to treat depression, anxiety disorders, and other mental health conditions. They work by increasing the levels of serotonin, a neurotransmitter that regulates mood, in the brain.

      SSRIs selectively block the reuptake of serotonin by the presynaptic neuron, which means that more serotonin is available to bind to the postsynaptic neuron and transmit signals. This leads to an increase in serotonin activity in the brain, which can help alleviate symptoms of depression and anxiety.

      Some common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). They are generally well-tolerated and have fewer side effects than older antidepressants such as tricyclics and monoamine oxidase inhibitors (MAOIs).

      However, like all medications, SSRIs can have side effects, including nausea, insomnia, sexual dysfunction, and weight gain. They can also interact with other medications, so it is important to talk to a healthcare provider before starting of stopping any medication.

      Overall, SSRIs are an effective treatment option for many people with depression and anxiety disorders. They can help improve mood and quality of life, but it is important to work closely with a healthcare provider to find the right medication and dosage for each individual.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 144 - What is the likelihood of women with bipolar disorder experiencing a relapse during...

    Incorrect

    • What is the likelihood of women with bipolar disorder experiencing a relapse during the postpartum period?

      Your Answer:

      Correct Answer: 40%

      Explanation:

      Bipolar Disorder in Women of Childbearing Potential

      Prophylaxis is recommended for women with bipolar disorder, as postpartum relapse rates are high. Women without prophylactic pharmacotherapy during pregnancy have a postpartum relapse rate of 66%, compared to 23% for women with prophylaxis. Antipsychotics are recommended for pregnant women with bipolar disorder, according to NICE Guidelines (CG192) and the Maudsley. Women taking valproate, lithium, carbamazepine, of lamotrigine should discontinue treatment and start an antipsychotic, especially if taking valproate. If a woman with bipolar disorder is taking lithium and becomes pregnant, she should gradually stop lithium over a 4 week period and start an antipsychotic. If this is not possible, lithium levels must be taken regularly, and the dose adjusted accordingly. For acute mania, an antipsychotic should be considered. For mild depressive symptoms, self-help approaches, brief psychological interventions, and antidepressant medication can be considered. For moderate to severe depressive symptoms, psychological treatment (CBT) for moderate depression and combined medication and structured psychological interventions for severe depression should be considered.

      Reference: Wesseloo, R., Kamperman, A. M., Munk-Olsen, T., Pop, V. J., Kushner, S. A., & Bergink, V. (2016). Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. The American Journal of Psychiatry, 173(2), 117-127.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 145 - What assessment tool would be most suitable for determining if a 55-year-old patient...

    Incorrect

    • What assessment tool would be most suitable for determining if a 55-year-old patient with Down's syndrome is showing signs of Alzheimer's disease?

      Your Answer:

      Correct Answer: DLD

      Explanation:

      The CAMDEX assessment is not effective in detecting dementia in adults with learning disabilities, whose developmental ages are typically between 2 and 10 years. However, the Dementia Questionnaire for People with Learning Disabilities (DLD) is a useful tool for early detection of dementia in this population. For individuals with Down’s syndrome, an adapted version of the CAMDEX called the CAMDEX-DS can be utilized.

      Assessment of Dementia in Down’s Syndrome

      Individuals with Down’s syndrome are at a higher risk of developing Alzheimer’s disease. However, the commonly used MMSE test is not effective in assisting diagnosis in this population. Instead, two alternative tests are recommended: the Dementia Questionnaire for people with Learning Disabilities (DLD), previously known as the Dementia Questionnaire for Persons with Mental Retardation (DMR), and the Dementia Scale for Down Syndrome (DSDS). These tests are specifically designed to assess cognitive decline in individuals with Down’s syndrome and can aid in the early detection and management of dementia in this population.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 146 - Which of the following lacks a verified scientific basis for its application in...

    Incorrect

    • Which of the following lacks a verified scientific basis for its application in attention deficit hyperactivity disorder?

      Your Answer:

      Correct Answer: Olanzapine

      Explanation:

      According to the Maudsley Guidelines 14th Edition, there is no proof that second generation antipsychotics are effective in treating ADHD symptoms. However, there is some evidence to support the use of all other listed options. Bupropion has shown to be effective and well-tolerated, but there is a lack of evidence compared to standard treatments.

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 147 - A middle-aged individual develops depression shortly after suffering a stroke and is currently...

    Incorrect

    • A middle-aged individual develops depression shortly after suffering a stroke and is currently taking warfarin. What medication is advised in this situation?

      Your Answer:

      Correct Answer: Citalopram

      Explanation:

      For patients with post stroke depression who are taking warfarin, citalopram is the recommended treatment option. However, caution should be exercised if the stroke was hemorrhagic as SSRIs can increase the risk of de novo hemorrhagic stroke, especially when combined with antiplatelet drugs of warfarin. In such cases, citalopram or escitalopram may be preferred as they have the lowest potential for interaction. It is not clear how direct-acting oral anticoagulants (DOACs) interact with SSRIs, but citalopram or escitalopram may still be preferred as they do not affect the enzymes associated with DOAC metabolism.

      Depression is a common occurrence after a stroke, affecting 30-40% of patients. The location of the stroke lesion can play a crucial role in the development of major depression. Treatment for post-stroke depression must take into account the cause of the stroke, medical comorbidities, and potential interactions with other medications. The Maudsley guidelines recommend SSRIs as the first-line treatment, with paroxetine being the preferred choice. Nortriptyline is also an option, as it does not increase the risk of bleeding. If the patient is on anticoagulants, citalopram and escitalopram may be preferred. Antidepressant prophylaxis has been shown to be effective in preventing post-stroke depression, with nortriptyline, fluoxetine, escitalopram, duloxetine, sertraline, and mirtazapine being effective options. Mianserin, however, appears to be ineffective.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 148 - What is a true statement about the SCOFF questionnaire? ...

    Incorrect

    • What is a true statement about the SCOFF questionnaire?

      Your Answer:

      Correct Answer: The negative predictive value of the SCOFF is 99.3%

      Explanation:

      The SCOFF Questionnaire for Screening Eating Disorders

      The SCOFF questionnaire is a tool used to screen for eating disorders. It consists of five questions that aim to identify symptoms of anorexia nervosa or bulimia. The questions include whether the individual makes themselves sick because they feel uncomfortably full, worries about losing control over how much they eat, has recently lost more than one stone in a three-month period, believes themselves to be fat when others say they are too thin, and whether food dominates their life.

      A score of two or more positive responses indicates a likely case of anorexia nervosa or bulimia. The questionnaire has a sensitivity of 84.6% and specificity of 98.6% when two or more questions are answered positively. This means that if a patient responds positively to two of more questions, there is a high likelihood that they have an eating disorder. The negative predictive value of the questionnaire is 99.3%, which means that if a patient responds negatively to the questions, there is a high probability that they do not have an eating disorder.

      Overall, the SCOFF questionnaire is a useful tool for healthcare professionals to quickly screen for eating disorders and identify individuals who may require further assessment and treatment.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 149 - A new drug is trialled for the treatment of heart disease. Drug A...

    Incorrect

    • A new drug is trialled for the treatment of heart disease. Drug A is given to 500 people with early stage heart disease and a placebo is given to 450 people with the same condition. After 5 years, 300 people who received drug A had survived compared to 225 who received the placebo. What is the number needed to treat to save one life?

      Your Answer:

      Correct Answer: 10

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 150 - What are the essential components that should be considered in the initial assessment...

    Incorrect

    • What are the essential components that should be considered in the initial assessment of dementia for all cases?

      Your Answer:

      Correct Answer: Folate levels

      Explanation:

      As an AI language model, I do not have the ability to perform investigations of provide medical advice. However, I can provide information on the NICE guidelines for investigations in people with dementia. The guidelines suggest routine blood tests to exclude reversible causes, such as full blood count, ESR, CRP, urea and electrolytes, calcium, HbA1c, liver function tests, thyroid function tests, and serum B12 and folate levels. Other investigations that may be appropriate if clinically indicated include urine microscopy and culture, chest X-ray, ECG, syphilis serology, and HIV testing. Structural imaging and CSF analysis may also be necessary to exclude other cerebral pathologies and establish the subtype diagnosis. Magnetic resonance imaging (MRI) is preferred over CT if the subtype is unclear and vascular is suspected. FDG-PET of perfusion SPECT may be considered if the diagnosis is uncertain and frontotemporal dementia of dementia with Lewy bodies is suspected. However, it is important to note that Apolipoprotein E genotyping and electroencephalography should not be used to diagnose Alzheimer’s disease. It is recommended to consult with a healthcare professional for proper evaluation and management of dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 151 - A 45-year-old man presents with a high fever of 39.5°C. He reports a...

    Incorrect

    • A 45-year-old man presents with a high fever of 39.5°C. He reports a stiff neck and complains of a severe headache. He quickly becomes confused and there is evidence that he is experiencing hallucinations related to taste and smell.

      He has a history of being in good health, but had a pacemaker implanted at the age of 30. He has not traveled outside of the country recently. The medical team has requested your assistance as the consulting psychiatrist.

      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Herpes simplex virus (HSV) encephalitis

      Explanation:

      The patient’s symptoms indicate possible HSV encephalitis, with specific damage to the temporal and orbitofrontal regions causing hallucinations, loss of smell, and significant memory problems. Immediate treatment with acyclovir and dexamethasone is necessary, and referral for decompression may be necessary depending on the severity of the condition.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 152 - What is the most significant risk factor for developing Alzheimer's disease? ...

    Incorrect

    • What is the most significant risk factor for developing Alzheimer's disease?

      Your Answer:

      Correct Answer: Age

      Explanation:

      The development of Alzheimer’s disease is most strongly associated with increasing age.

      Alzheimer’s Association: Risk Factors

      The Alzheimer’s Association has identified several risk factors for the development of Alzheimer’s disease. These include age, family history, head trauma (especially if associated with loss of consciousness), hypertension, heart disease, diabetes, CVA, high cholesterol, lower educational level, and female gender. Increasing age is a significant risk factor, as is having a family history of the disease. Head trauma, particularly if it results in loss of consciousness, can also increase the risk of developing Alzheimer’s. Other medical conditions such as hypertension, heart disease, and diabetes have also been linked to an increased risk of Alzheimer’s. Additionally, individuals with lower levels of education and females may be at higher risk. It is important to be aware of these risk factors and take steps to reduce them where possible.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 153 - What is the accuracy of the standardised mortality ratio for individuals with schizophrenia?...

    Incorrect

    • What is the accuracy of the standardised mortality ratio for individuals with schizophrenia?

      Your Answer:

      Correct Answer: It falls with age

      Explanation:

      Schizophrenia and Mortality

      Schizophrenia is associated with a reduced life expectancy, according to a meta-analysis of 37 studies. The analysis found that people with schizophrenia have a mean SMR (standardised mortality ratio) of 2.6, meaning that their risk of dying over the next year is 2.6 times higher than that of people without the condition. Suicide and accidents contribute significantly to the increased SMR, while cardiovascular disease is the leading natural cause of death. SMR decreases with age due to the early peak of suicides and the gradual rise in population mortality. There is no sex difference in SMR, but patients who are unmarried, unemployed, and of lower social class have higher SMRs. The majority of deaths in people with schizophrenia are due to natural causes, with circulatory disease being the most common. Other linked causes include diabetes, epilepsy, and respiratory disease.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 154 - Which of the following is not a gastrointestinal side-effect of opiate use? ...

    Incorrect

    • Which of the following is not a gastrointestinal side-effect of opiate use?

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      Opiate withdrawal is more likely to result in diarrhoea than opiate use.

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 155 - Which personality disorder is best treated with Dialectical Behavioural Therapy? ...

    Incorrect

    • Which personality disorder is best treated with Dialectical Behavioural Therapy?

      Your Answer:

      Correct Answer: Borderline

      Explanation:

      DBT is a specialized version of CBT designed specifically for individuals with borderline personality disorder.

      Dialectical Behavioural Therapy (DBT) is a form of psychotherapy that is tailored for patients with borderline personality disorder. It combines behavioural therapy with aspects of Zen Buddhism and dialectical thinking to help patients develop important interpersonal and emotional regulation skills. DBT has five functions, including enhancing behavioural capabilities, improving motivation to change, assuring new capabilities generalise to the natural environment, structuring the environment so that appropriate behaviours are reinforced, and enhancing motivation of the therapist.

      DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are life-threatening behaviours, therapy-interfering behaviours, quality of life behaviours, and skills acquisition. DBT skills include mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. Overall, DBT is an effective form of therapy for patients with multiple problems, and it helps them develop the skills they need to achieve their goals and improve their quality of life.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 156 - How can we best demonstrate 'Rose's paradox'? ...

    Incorrect

    • How can we best demonstrate 'Rose's paradox'?

      Your Answer:

      Correct Answer: A situation where the majority of cases of a disease come from a population at low of moderate risk of that disease, and only a minority of cases come from the high risk population

      Explanation:

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 157 - A 25-year-old marathon runner who is currently training for a regional race requests...

    Incorrect

    • A 25-year-old marathon runner who is currently training for a regional race requests to meet with the team physician due to an unusual sensation in her legs. She reports feeling a numbness below her knee. Upon examination, the physician observes sensory loss below the left knee in a non-dermatomal distribution. After conducting further investigations, which all come back normal, the physician concludes that the symptoms are not consistent with neurological disease. During a discussion with the patient's parents, the physician learns that the patient recently lost her sister in a tragic accident. Despite this, the patient appears strangely indifferent to her symptoms. What is the most likely diagnosis at this point?

      Your Answer:

      Correct Answer: Dissociative neurological symptom disorder

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 158 - A 7-year-old girl is brought to your clinic by her parents who are...

    Incorrect

    • A 7-year-old girl is brought to your clinic by her parents who are worried about her excessive need for order and cleanliness. Upon examination, you observe signs of obsessive rumination and compulsions. The girl has a history of streptococcal sore throat, leading you to suspect that it may have played a role in the development of her condition. Which of the following serum titres would be most likely to be elevated if this is the case?

      Your Answer:

      Correct Answer: Anti-DNAse

      Explanation:

      Elevated ASLO of antistreptolysin O titres, which are anti-DNAse, are often present in cases of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), a syndrome that may be linked to the development of childhood obsessive-compulsive disorder (OCD).

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 159 - The patient inquires about the likelihood of developing neutropenia while taking clozapine. What...

    Incorrect

    • The patient inquires about the likelihood of developing neutropenia while taking clozapine. What is the estimated risk of neutropenia associated with the use of clozapine?

      Your Answer:

      Correct Answer: 3%

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 160 - A 68-year-old woman is referred to your clinic. Her husband has noticed that...

    Incorrect

    • A 68-year-old woman is referred to your clinic. Her husband has noticed that she has become more forgetful over the last six months and has also noticed that there are episodes of confusion.
      There is a history of repeated falls but no serious head injury. She does not drink alcohol but has a tremor and is slow in her movements. Her elderly husband is also perplexed as she frequently states that she sees a bird in the living room, which he cannot see.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Lewy body dementia

      Explanation:

      The individual is exhibiting typical symptoms of Lewy body dementia, such as cognitive decline, fluctuating confusion, Parkinson’s-like motor symptoms, frequent falls, and early onset visual hallucinations. Treatment with the cholinesterase inhibitor rivastigmine has been found to be effective in managing the associated delusions and hallucinations.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 161 - Which principle was not mentioned by Yalom as a therapeutic aspect of group...

    Incorrect

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

      Your Answer:

      Correct Answer: Autonomy

      Explanation:

      Group Psychotherapy: Yalom’s Therapeutic Principles

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

      Bion and Basic Assumption Groups

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 162 - In a study, the null hypothesis posits that there is no disparity between...

    Incorrect

    • In a study, the null hypothesis posits that there is no disparity between the mean values of group A and group B. Upon analysis, the study discovers a difference and presents a p-value of 0.04. Which statement below accurately reflects this scenario?

      Your Answer:

      Correct Answer: Assuming the null hypothesis is correct, there is a 4% chance that the difference detected between A and B has arisen by chance

      Explanation:

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 163 - A medical colleague contacts you for advice regarding the management of a teenage...

    Incorrect

    • A medical colleague contacts you for advice regarding the management of a teenage patient with HIV. You have previously looked after this patient due to her having borderline personality disorder and mania. The patient has a long history of self-harm and remains at high risk of suicide. Which of the following antiretrovirals would you suggest your colleague specifically avoid in this case?:

      Your Answer:

      Correct Answer: Efavirenz

      Explanation:

      For exams, it is important to be aware that Efavirenz, an antiretroviral, has been associated with both mania and fatal suicide.

      HIV and Mental Health: Understanding the Relationship and Treatment Options

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 164 - When conducting a literature review, it is advisable to do the following: ...

    Incorrect

    • When conducting a literature review, it is advisable to do the following:

      Your Answer:

      Correct Answer: Include grey literature

      Explanation:

      When conducting a literature review, it is important to broaden your search beyond traditional academic sources. This means including grey literature, such as reports, conference proceedings, and government documents. Additionally, it is crucial to consider both primary and secondary sources of evidence, as they can provide different perspectives and insights on your research topic. To ensure a comprehensive review, it is recommended to use multiple databases and search engines, rather than relying on a single source.

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 165 - To address the increasing suicidal tendencies of a patient with bipolar disorder, what...

    Incorrect

    • To address the increasing suicidal tendencies of a patient with bipolar disorder, what would be the most suitable medication for stabilizing their mood?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      Among mood stabilizers, lithium has the most notable impact on decreasing suicidal tendencies in individuals diagnosed with bipolar disorder.

      Lithium’s Effectiveness in Reducing Suicide in Bipolar Disorder Patients

      Lithium has been found to be more effective than other mood stabilizers in reducing completed suicide in individuals with bipolar disorder. This effect is significant, with estimates suggesting that lithium can reduce both attempted and completed suicide by 80% in this patient population.

      According to the Maudsley Guidelines 10th Edition, lithium is a highly effective treatment option for bipolar disorder patients who are at risk of suicide. Its ability to reduce suicidal behavior is a crucial factor in its use as a mood stabilizer. The guidelines recommend that lithium be considered as a first-line treatment option for patients with bipolar disorder who are at high risk of suicide.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 166 - What factor is the most probable cause of neural tube defects? ...

    Incorrect

    • What factor is the most probable cause of neural tube defects?

      Your Answer:

      Correct Answer: Sodium valproate

      Explanation:

      Paroxetine Use During Pregnancy: Is it Safe?

      Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 167 - A 70 year old woman is referred by her general practitioner due to...

    Incorrect

    • A 70 year old woman is referred by her general practitioner due to a concern about cognitive impairment confirmed by a score of 20 on the MMSE. Her MRI shows atrophy and white matter hyperintensities. What would be the most appropriate course of action for management?

      Your Answer:

      Correct Answer: Donepezil

      Explanation:

      The CT scan commonly shows mixed dementia in patients with Alzheimer’s, making it challenging to distinguish from vascular dementia even with imaging. NICE recommends using AChE-I for mixed dementia cases. A previous Cochrane review (Rands 2000) found no proof to support the use of aspirin in vascular dementia.

      Treatment of Dementia: AChE Inhibitors and Memantine

      Dementia is a debilitating condition that affects millions of people worldwide. Acetylcholinesterase inhibitors (AChE inhibitors) and memantine are two drugs used in the management of dementia. AChE inhibitors prevent cholinesterase from breaking down acetylcholine, which is deficient in Alzheimer’s due to loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are AChE inhibitors used in the management of Alzheimer’s. Memantine is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.

      NICE guidelines recommend the use of AChE inhibitors for managing mild to moderate Alzheimer’s and memantine for managing moderate to severe Alzheimer’s. For those already taking an AChE inhibitor, memantine can be added if the disease is moderate of severe. AChE inhibitors are also recommended for managing mild, moderate, and severe dementia with Lewy bodies, while memantine is considered if AChE inhibitors are not tolerated of contraindicated. AChE inhibitors and memantine are not recommended for vascular dementia, frontotemporal dementia, of cognitive impairment due to multiple sclerosis.

      The British Association for Psychopharmacology recommends AChE inhibitors as the first choice for Alzheimer’s and mixed dementia, while memantine is the second choice. AChE inhibitors and memantine are also recommended for dementia with Parkinson’s and dementia with Lewy bodies.

      In summary, AChE inhibitors and memantine are important drugs used in the management of dementia. The choice of drug depends on the type and severity of dementia, as well as individual patient factors.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 168 - The clinical director of a pediatric unit conducts an economic evaluation study to...

    Incorrect

    • The clinical director of a pediatric unit conducts an economic evaluation study to determine which type of treatment results in the greatest improvement in asthma symptoms (as measured by the Asthma Control Test). She compares the costs of three different treatment options against the average improvement in asthma symptoms achieved by each. What type of economic evaluation method did she employ?

      Your Answer:

      Correct Answer: Cost-effectiveness analysis

      Explanation:

      Methods of Economic Evaluation

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

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

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

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

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

      Costs in Economic Evaluation Studies

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 169 - Which statement accurately describes box and whisker plots? ...

    Incorrect

    • Which statement accurately describes box and whisker plots?

      Your Answer:

      Correct Answer: Each whisker represents approximately 25% of the data

      Explanation:

      Box and whisker plots are a useful tool for displaying information about the range, median, and quartiles of a data set. The whiskers only contain values within 1.5 times the interquartile range (IQR), and any values outside of this range are considered outliers and displayed as dots. The IQR is the difference between the 3rd and 1st quartiles, which divide the data set into quarters. Quartiles can also be used to determine the percentage of observations that fall below a certain value. However, quartiles and ranges have limitations because they do not take into account every score in a data set. To get a more representative idea of spread, measures such as variance and standard deviation are needed. Box plots can also provide information about the shape of a data set, such as whether it is skewed or symmetric. Notched boxes on the plot represent the confidence intervals of the median values.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 170 - Which statement about disease rates is incorrect? ...

    Incorrect

    • Which statement about disease rates is incorrect?

      Your Answer:

      Correct Answer: The odds ratio is synonymous with the risk ratio

      Explanation:

      Disease Rates and Their Interpretation

      Disease rates are a measure of the occurrence of a disease in a population. They are used to establish causation, monitor interventions, and measure the impact of exposure on disease rates. The attributable risk is the difference in the rate of disease between the exposed and unexposed groups. It tells us what proportion of deaths in the exposed group were due to the exposure. The relative risk is the risk of an event relative to exposure. It is calculated by dividing the rate of disease in the exposed group by the rate of disease in the unexposed group. A relative risk of 1 means there is no difference between the two groups. A relative risk of <1 means that the event is less likely to occur in the exposed group, while a relative risk of >1 means that the event is more likely to occur in the exposed group. The population attributable risk is the reduction in incidence that would be observed if the population were entirely unexposed. It can be calculated by multiplying the attributable risk by the prevalence of exposure in the population. The attributable proportion is the proportion of the disease that would be eliminated in a population if its disease rate were reduced to that of the unexposed group.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 171 - What is the term coined by Robert Rosenthal that refers to the bias...

    Incorrect

    • What is the term coined by Robert Rosenthal that refers to the bias that can result from the non-publication of a few studies with negative of inconclusive results, leading to a significant impact on research in a specific field?

      Your Answer:

      Correct Answer: File drawer problem

      Explanation:

      Publication bias refers to the tendency of researchers, editors, and pharmaceutical companies to favor the publication of studies with positive results over those with negative of inconclusive results. This bias can have various causes and can result in a skewed representation of the literature. The file drawer problem refers to the phenomenon of unpublished negative studies. HARKing, of hypothesizing after the results are known, is a form of outcome reporting bias where outcomes are selectively reported based on the strength and direction of observed associations. Begg’s funnel plot is an analytical tool used to quantify the presence of publication bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 172 - A study reports that 76 percent of the subjects receiving fluvoxamine versus 29...

    Incorrect

    • A study reports that 76 percent of the subjects receiving fluvoxamine versus 29 percent of the placebo group were treatment responders. Based on this data, what is the number needed to treat?

      Your Answer:

      Correct Answer: 2.12

      Explanation:

      To determine the number needed to treat (NNT), we first calculated the absolute risk reduction (ARR) using the formula ARR = CER – EER, where CER is the control event rate and EER is the experimental event rate. In this case, the ARR was 0.47, which is the reciprocal of the NNT. Therefore, the NNT was calculated as 2.12. This means that for every two patients treated with the active medication, at least one patient will have a better outcome compared to those treated with a placebo.

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 173 - What is the most effective method for distinguishing between Alzheimer's disease and Lewy...

    Incorrect

    • What is the most effective method for distinguishing between Alzheimer's disease and Lewy body dementia?

      Your Answer:

      Correct Answer: Dat scan

      Explanation:

      It’s important to note that DaT-SCAN and SPECT are not the same thing. DaT-SCAN specifically refers to the radioactive isotope called Ioflupane, which is utilized in the creation of a SPECT image.

      SPECT Imaging for Alzheimer’s Diagnosis

      SPECT imaging has been found to be a useful tool in differentiating between patients with Alzheimer’s disease and healthy older individuals. Studies have shown that temporal and parietal hypoperfusion can be indicative of Alzheimer’s disease. Additionally, SPECT imaging has been effective in distinguishing between Alzheimer’s disease and Lewy body dementia. A SPECT scan of a patient with Alzheimer’s disease versus one with Lewy body dementia showed lower perfusion in medial temporal areas for Alzheimer’s disease and lower perfusion in occipital cortex for Lewy body dementia. These findings suggest that SPECT imaging can be a valuable diagnostic tool for Alzheimer’s disease and related dementias.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 174 - What is the term used to describe the proposed idea that a researcher...

    Incorrect

    • What is the term used to describe the proposed idea that a researcher is attempting to validate?

      Your Answer:

      Correct Answer: Alternative hypothesis

      Explanation:

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 175 - A 30-year-old female who has experienced Herpes encephalitis presents with significant weight gain...

    Incorrect

    • A 30-year-old female who has experienced Herpes encephalitis presents with significant weight gain and intense cravings for carbohydrates. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Klüver-Bucy syndrome

      Explanation:

      Kluver-Bucy Syndrome: Causes and Symptoms

      Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.

      The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 176 - What factors affect the statistical power of a study? ...

    Incorrect

    • What factors affect the statistical power of a study?

      Your Answer:

      Correct Answer: Sample size

      Explanation:

      A study that has a greater sample size is considered to have higher power, meaning it is capable of detecting a significant difference of effect that is clinically relevant.

      The Importance of Power in Statistical Analysis

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 177 - What is the term used to describe the likelihood of correctly rejecting the...

    Incorrect

    • What is the term used to describe the likelihood of correctly rejecting the null hypothesis when it is actually false?

      Your Answer:

      Correct Answer: Power of the test

      Explanation:

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 178 - Which statement accurately describes the differences in schizophrenia between genders? ...

    Incorrect

    • Which statement accurately describes the differences in schizophrenia between genders?

      Your Answer:

      Correct Answer: Expressed emotion has a greater negative impact on males

      Explanation:

      Schizophrenia presents differently in men and women. Women tend to have a later onset and respond better to treatment, requiring lower doses of antipsychotics. Men, on the other hand, have an earlier onset, poorer premorbid functioning, and more negative symptoms and cognitive deficits. They also have greater structural brain and neurophysiological abnormalities. Females display more affective symptoms, auditory hallucinations, and persecutory delusions, but have a more favorable short- and middle-term course of illness with less smoking and substance abuse. Families of males are more critical, and expressed emotion has a greater negative impact on them. Certain neurological soft signs may be more prevalent in males. There are no clear sex differences in family history, obstetric complications, and minor physical anomalies.

      Schizophrenia Epidemiology

      Prevalence:
      – In England, the estimated annual prevalence for psychotic disorders (mostly schizophrenia) is around 0.4%.
      – Internationally, the estimated annual prevalence for psychotic disorders is around 0.33%.
      – The estimated lifetime prevalence for psychotic disorders in England is approximately 0.63% at age 43, consistent with the typically reported 1% prevalence over the life course.
      – Internationally, the estimated lifetime prevalence for psychotic disorders is around 0.48%.

      Incidence:
      – In England, the pooled incidence rate for non-affective psychosis (mostly schizophrenia) is estimated to be 15.2 per 100,000 years.
      – Internationally, the incidence of schizophrenia is about 0.20/1000/year.

      Gender:
      – The male to female ratio is 1:1.

      Course and Prognosis:
      – Long-term follow-up studies suggest that after 5 years of illness, one quarter of people with schizophrenia recover completely, and for most people, the condition gradually improves over their lifetime.
      – Schizophrenia has a worse prognosis with onset in childhood of adolescence than with onset in adult life.
      – Younger age of onset predicts a worse outcome.
      – Failure to comply with treatment is a strong predictor of relapse.
      – Over a 2-year period, one-third of patients with schizophrenia showed a benign course, and two-thirds either relapsed of failed to recover.
      – People with schizophrenia have a 2-3 fold increased risk of premature death.

      Winter Births:
      – Winter births are associated with an increased risk of schizophrenia.

      Urbanicity:
      – There is a higher incidence of schizophrenia associated with urbanicity.

      Migration:
      – There is a higher incidence of schizophrenia associated with migration.

      Class:
      – There is a higher prevalence of schizophrenia among lower socioeconomic classes.

      Learning Disability:
      – Prevalence rates for schizophrenia in people with learning disabilities are approximately three times greater than for the general population.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 179 - What is the recommended treatment for alcohol withdrawal in a patient with liver...

    Incorrect

    • What is the recommended treatment for alcohol withdrawal in a patient with liver impairment?

      Your Answer:

      Correct Answer: Lorazepam

      Explanation:

      Patients with impaired liver function, such as those with liver failure of elderly individuals, may be prescribed oxazepam, temazepam, of lorazepam.

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 180 - A client inquires about the concept of transference, what would be your best...

    Incorrect

    • A client inquires about the concept of transference, what would be your best answer?

      Your Answer:

      Correct Answer: The effect of past relationships on current relationships

      Explanation:

      Transference and Countertransference

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

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 181 - For what is Carl Jung most well-known? ...

    Incorrect

    • For what is Carl Jung most well-known?

      Your Answer:

      Correct Answer: Differentiating between the personal and collective unconscious

      Explanation:

      Neo-Freudians were therapists who developed their own theories while still retaining core Freudian components. Some important neo-Freudians include Alfred Adler, Carl Jung, Erik Erickson, Harry Stack Sullivan, Wilfred Bion, John Bowlby, Anna Freud, Otto Kernberg, Margaret Mahler, and Donald Winnicott. Each of these individuals contributed unique ideas to the field of psychology. For example, Carl Jung introduced the concept of the persona and differentiated between the personal and collective unconscious, while Erik Erickson is known for his stages of psychosocial development. Margaret Mahler developed theories on child development, including the three main phases of autistic, symbiotic, and separation-individuation. Donald Winnicott introduced the concept of the transitional object and the good enough mother. Overall, neo-Freudians expanded upon Freud’s ideas and helped to shape modern psychotherapy.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 182 - What is a true statement about supranuclear palsy? ...

    Incorrect

    • What is a true statement about supranuclear palsy?

      Your Answer:

      Correct Answer: It is associated with dystonia

      Explanation:

      Individuals with PSP typically maintain an upright posture of may even lean their heads backwards (and have a tendency to fall backwards), whereas those with Parkinson’s disease tend to hunch forward.

      Understanding Progressive Supranuclear Palsy

      Progressive supranuclear palsy (PSP), also known as Steele-Richardson-Olszewski syndrome, is a type of neurodegenerative disease that affects various aspects of a person’s health. This condition is characterized by problems with cognition, eye movements, and posture. One of the most notable features of PSP is the supranuclear gaze dysfunction, which primarily affects vertical gaze. Additionally, individuals with PSP may experience extrapyramidal symptoms and cognitive dysfunction. PSP typically develops after the age of 60, and unfortunately, there is currently no effective treatment available for this condition.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 183 - What is the most probable cause of withdrawal symptoms in an opioid-dependent patient...

    Incorrect

    • What is the most probable cause of withdrawal symptoms in an opioid-dependent patient who has not completed their detox program when starting a particular medication?

      Your Answer:

      Correct Answer: Buprenorphine

      Explanation:

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 184 - A 30-year old woman is brought to the outpatient clinic by her sister...

    Incorrect

    • A 30-year old woman is brought to the outpatient clinic by her sister who is concerned about her. She reports concern that she has no friends and that even her contact with her family is minimal and superficial. She reports that she has been this way all her life. She is concerned that this is now affecting her ability to work and leave home.
      The woman engages to a limited extent with the interview. She explains that she does not enjoy social contact and avoids socialising where possible, this also includes avoiding the workplace in view of the social demands. She is avoidant of eye contact but is able to maintain reasonable reciprocal conversation. There is no evidence of restrictive of repetitive behaviours.
      You note on interview that she appears aloof and lacking in any emotional expression.
      Which ICD-11 condition is most likely to be present according to this history and assessment?

      Your Answer:

      Correct Answer: Personality disorder with detachment

      Explanation:

      It should be noted that there is no indication of impaired reciprocal interaction of restrictive/repetitive behaviors, which would not support a diagnosis of autism spectrum disorder. Additionally, Asperger’s and infantile autism are no longer recognized as diagnoses in the ICD-11. Based on the presented case, it appears that the individual may have a personality disorder with detachment, which requires evidence of long standing interpersonal dysfunction and social/emotional distance. It is important to note that while this may share similarities with avoidant personality disorder in the DSM-5, it is not the same diagnosis.

      Personality Disorder: Avoidant

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 185 - How can the correlation between violent recidivism and the items on the VRAG...

    Incorrect

    • How can the correlation between violent recidivism and the items on the VRAG be ranked in terms of strength?

      Your Answer:

      Correct Answer: PCL-R score

      Explanation:

      The correlation between the PCL-R (Psychopathy Checklist-Revised, also known as Hare Psychopathy Checklist) score and violent recidivism is the strongest.

      Methods of Risk Assessment

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 186 - What is the accurate diagnosis and classification of bipolar disorder as per the...

    Incorrect

    • What is the accurate diagnosis and classification of bipolar disorder as per the ICD-11?

      Your Answer:

      Correct Answer: A diagnosis of bipolar II cannot be applied if there has ever been a manic episode regardless of the current presentation

      Explanation:

      To receive a diagnosis of bipolar II, it is necessary to never have experienced a manic episode. Rapid cycling can be present in both bipolar I and II. Most individuals who experience mania will have recurring mood episodes. A diagnosis of bipolar I only requires the presence of mania, not depression. Cyclothymia is characterized by mood instability lasting for at least two years.

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 187 - What is a true statement about opioid withdrawal? ...

    Incorrect

    • What is a true statement about opioid withdrawal?

      Your Answer:

      Correct Answer: Withdrawal symptoms may develop upon abrupt discontinuation of opioids after 5 days of regular and uninterrupted opioid use

      Explanation:

      The fact that even brief periods of opiate use can lead to withdrawal symptoms highlights the addictive nature of these drugs.

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 188 - The ICER is utilized in the following methods of economic evaluation: ...

    Incorrect

    • The ICER is utilized in the following methods of economic evaluation:

      Your Answer:

      Correct Answer: Cost-effectiveness analysis

      Explanation:

      The acronym ICER stands for incremental cost-effectiveness ratio.

      Methods of Economic Evaluation

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

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

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

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

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

      Costs in Economic Evaluation Studies

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 189 - Which statement about IPT is incorrect? ...

    Incorrect

    • Which statement about IPT is incorrect?

      Your Answer:

      Correct Answer: It involves homework for the client

      Explanation:

      Interpersonal Therapy: A Structured Approach to Addressing Social Functioning Problems

      Interpersonal therapy (IPT) is a structured form of psychotherapy that is often used to treat depression. It is based on the belief that social functioning problems have a significant impact on psychological problems. IPT is a time-limited therapy that typically runs for 10-16 one hour sessions. The therapy is organized into three phases, with the first phase involving data collection and formulation. The remaining sessions explore the formulation in more detail.

      IPT focuses on four areas of social functioning problems: grief, role transitions, interpersonal deficits, and interpersonal disputes. The therapy aims to intervene at the level of social functioning, rather than focusing on personality. The therapy has been found to be effective in treating depression, particularly in patients with severe depression. However, it may be less effective in treating people with depression and comorbid personality disorders.

      The evidence base for IPT is most developed for eating disorders, and the intervention is recommended in NICE guidelines for eating disorders. Overall, IPT is a structured approach to addressing social functioning problems that can be effective in treating depression and other psychological problems.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 190 - What are the factors that have been demonstrated to elevate the likelihood of...

    Incorrect

    • What are the factors that have been demonstrated to elevate the likelihood of suicide among prisoners?

      Your Answer:

      Correct Answer: Having a mental illness

      Explanation:

      Suicide in Prison: High Rates and Risk Factors

      Suicide rates among prisoners are significantly higher than in the general population, with an average rate of 133 per 100,000 population per year in England and Wales in 1999-2000. Remand prisoners had an even higher rate of 339 per 100,000 population per year. Early suicides were more common in drug-dependent prisoners, with 59% occurring within 7 days of reception into prison.

      The most common method of suicide was hanging of self-strangulation, with bedclothes being the most common ligature used. Window bars, beds, and cell fittings such as lights, pipes, cupboards, sinks, toilets, of doors were the main ligature points. 72% of prisoners had at least one known psychiatric diagnosis, with drug dependence being the most common primary diagnosis at 27%. Schizophrenia was diagnosed in 6% of prisoners, and affective disorder in 18%.

      Risk factors for suicide in prisoners include being in a single cell, being male, having a psychiatric illness, having a history of substance misuse, having a history of previous self-harm of attempted suicide, recent suicidal ideation, and being on remand. Surprisingly, being married was found to be a risk factor for suicide in prisoners, in contrast to the general population where it is a protective factor.

      Overall, these findings highlight the urgent need for effective suicide prevention strategies in prisons, particularly for those at higher risk. This may include improved mental health services, better screening and assessment of risk factors, and measures to reduce access to means of suicide such as ligature points.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 191 - What is the most appropriate term to describe a national initiative that focuses...

    Incorrect

    • What is the most appropriate term to describe a national initiative that focuses on enhancing community support systems to prevent individuals from developing depression?

      Your Answer:

      Correct Answer: Primary

      Explanation:

      This intervention is designed to prevent depression in a broad population, making it applicable to everyone and can be categorized as either a universal of primary prevention strategy.

      Prevention measures can be classified into different levels, depending on the stage at which they are implemented. The first model, developed in the 1960s, includes primary, secondary, and tertiary prevention. Primary prevention aims to intervene before a disease of problem begins, and can be universal (targeted to the general public), selective (targeted to a high-risk population), of indicated (targeted to individuals with minimal but detectable signs of a disorder). Secondary prevention aims to detect and treat disease that has not yet become symptomatic, while tertiary prevention involves the care of established disease.

      A newer model, developed in 1992, focuses on prevention interventions used before the initial onset of a disorder. This model also includes three levels: universal prevention (targeted to the general population), selective prevention (targeted to a high-risk population), and indicated prevention (targeted to individuals with minimal but detectable signs of a disorder). Examples of prevention measures include cognitive interventions for adolescents with cognitive deficits to prevent the later phases of schizophrenia, screening procedures for early detection and treatment of disease, and the use of low-dose atypical antipsychotics and CBT for patients with prodromal symptoms of schizophrenia to delay of prevent disease onset.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 192 - What study method would be most suitable for a researcher tasked with comparing...

    Incorrect

    • What study method would be most suitable for a researcher tasked with comparing the cost-effectiveness of olanzapine and haloperidol in reducing symptom severity of schizophrenia, as measured by the Positive and Negative Syndrome Scale?

      Your Answer:

      Correct Answer: Cost-effectiveness analysis

      Explanation:

      The task assigned to the researcher is to conduct a cost-effectiveness analysis, which involves comparing two interventions based on their costs and their impact on a single clinical measure of effectiveness, specifically the reduction in symptom severity as measured by the PANSS.

      Methods of Economic Evaluation

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

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

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

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

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

      Costs in Economic Evaluation Studies

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 193 - Which item is excluded from the Violence Risk Assessment Guide? ...

    Incorrect

    • Which item is excluded from the Violence Risk Assessment Guide?

      Your Answer:

      Correct Answer: History of illicit drug use

      Explanation:

      The VRAG takes into account the misuse of alcohol but does not factor in the use of illegal drugs.

      Overview of the Violence Risk Assessment Guide

      The Violence Risk Assessment Guide (VRAG) is a commonly used actuarial tool for predicting the likelihood of violence offence recidivism. It consists of 12 items that are used to assess an individual’s risk of committing violent acts in the future. These items include factors such as the individual’s score on the Revised Psychopathy Checklist, their history of alcohol problems, criminal history for non-violent offences, and age at the time of the index offence.

      Each factor is assigned a weight based on how different the individual’s score is from the base rate. For example, if an individual has a high score on the Revised Psychopathy Checklist, this factor would be given a higher weight than if they had a low score. The VRAG is designed to provide a standardized and objective assessment of an individual’s risk of committing violent acts, which can be used to inform decisions about their treatment and management.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 194 - What BMI range would be considered 'significantly low' for an adult with anorexia...

    Incorrect

    • What BMI range would be considered 'significantly low' for an adult with anorexia nervosa, as per the ICD-11 classification?

      Your Answer:

      Correct Answer: 15

      Explanation:

      According to ICD-11, a BMI between 18.5 and 14.0 is considered significantly low for adults, while a BMI under 14.0 is classified as dangerously low. Therefore, it is important to remember that a BMI of 14 is the threshold for dangerously low BMI in adults.

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 195 - In which conditions has Cotard's syndrome been reported? ...

    Incorrect

    • In which conditions has Cotard's syndrome been reported?

      Your Answer:

      Correct Answer: All of the above

      Explanation:

      Cotard’s syndrome is a delusion where an individual believes they do not exist of have lost their blood, internal organs, of soul. It is commonly seen in depression, schizophrenia, and bipolar disorder, and can also occur after trauma. The condition is more prevalent in females and the elderly.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 196 - Which of the following symptoms is most indicative of anxiety? ...

    Incorrect

    • Which of the following symptoms is most indicative of anxiety?

      Your Answer:

      Correct Answer: Tightness in the throat

      Explanation:

      Globus, a sensation of tightness of feeling of something stuck in the throat, can be caused by stress of anxiety. It is a common symptom that often improves after eating and is not considered a serious condition. Despite being bothersome, globus is generally harmless.

      Generalised Anxiety Disorder: Symptoms and Diagnosis

      Generalised anxiety disorder is a condition characterized by persistent symptoms of anxiety that last for several months and occur on most days. The symptoms can be either general apprehension of excessive worry about multiple everyday events, such as family, health, finances, and work of school. In addition to these symptoms, individuals with generalised anxiety disorder may experience muscular tension, motor restlessness, sympathetic autonomic overactivity, nervousness, difficulty concentrating, irritability, of sleep disturbance.

      To diagnose generalised anxiety disorder, healthcare professionals look for specific essential features. These include marked symptoms of anxiety that are not restricted to any particular environmental circumstance, and are accompanied by additional characteristic symptoms such as muscle tension, autonomic overactivity, nervousness, difficulty concentrating, irritability, and sleep disturbances. The symptoms must persist for at least several months, for more days than not, and cannot be better accounted for by another mental disorder of medical condition. The symptoms must also result in significant distress of impairment in personal, family, social, educational, occupational, of other important areas of functioning.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 197 - Which of the following statements is not an example of change talk observed...

    Incorrect

    • Which of the following statements is not an example of change talk observed in motivational interviewing?

      Your Answer:

      Correct Answer: Regret

      Explanation:

      Motivational Interviewing: A Model for Resolving Ambivalence and Facilitating Change

      Motivational interviewing (MI) is an evidence-based method used for people with substance misuse problems. It was introduced by William Miller in 1983, based on his experience with alcoholics. MI focuses on exploring and resolving ambivalence and centres on the motivational process that facilitates change. It is based on three key elements: collaboration, evocation, and autonomy.

      There are four principles of MI: expressing empathy, supporting self-efficacy, rolling with resistance, and developing discrepancy. MI involves the use of micro-counseling skills called OARS, which stands for open-ended questions, affirmations, reflections, and summaries.

      Change talk is defined as statements by the client that reveal consideration of, motivation for, of commitment to change. In MI, the therapist aims to guide the client to expression of change talk. Types of change talk can be remembered by the mnemonic DARN-CAT, which stands for desire, ability, reason, need, commitment, activation, and taking steps.

      Overall, MI is a model for resolving ambivalence and facilitating change that emphasizes collaboration, evocation, and autonomy. It is a useful tool for therapists working with clients with substance misuse problems.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 198 - What factor is most likely to cause difficulty with swallowing in an individual...

    Incorrect

    • What factor is most likely to cause difficulty with swallowing in an individual with a learning disability?

      Your Answer:

      Correct Answer: Clonazepam

      Explanation:

      While this question may not be ideal, it does occasionally appear on exams. If you encounter it, choose clonazepam and disregard the possibility that other choices may also cause dysphagia.

      Swallowing Difficulties Caused by Certain Medications

      Swallowing difficulties, also known as dysphagia, can be caused by various factors, including certain medications. Benzodiazepines, commonly used to treat anxiety and sleep disorders, have been found to cause swallowing problems in patients with learning difficulties. Additionally, other drugs such as metoclopramide, haloperidol, and phenothiazines have also been linked to dysphagia.

      Diagnosis and management of dysphagia is crucial to prevent complications such as aspiration pneumonia and malnutrition. Patients experiencing swallowing difficulties should undergo a thorough evaluation by a healthcare professional, including a clinical examination and imaging studies. Treatment options may include modifying the consistency of food and liquids, swallowing exercises, and medication adjustments. It is important for healthcare providers to be aware of the potential side effects of certain medications and to monitor patients for any signs of dysphagia.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 199 - What is a true statement about Charles Bonnet syndrome? ...

    Incorrect

    • What is a true statement about Charles Bonnet syndrome?

      Your Answer:

      Correct Answer: Visual hallucinations are not normally associated with an auditory component

      Explanation:

      While Charles Bonnet Syndrome (CBS) typically only presents with visual hallucinations, some experts have proposed diagnostic criteria that require the absence of hallucinations in other sensory modalities. However, there have been documented cases of CBS with auditory hallucinations, so the presence of such hallucinations should not necessarily exclude a diagnosis of CBS.

      Charles Bonnet Syndrome: A Condition of Complex Visual Hallucinations

      Charles Bonnet Syndrome (CBS) is a condition characterized by persistent of recurrent complex visual hallucinations that occur in clear consciousness. This condition is observed in individuals who have suffered damage to the visual pathway, which can be caused by damage to any part of the pathway from the eye to the cortex. The hallucinations are thought to result from a release phenomenon secondary to the deafferentation of the cerebral cortex. CBS is equally distributed between sexes and does not show any familial predisposition. The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.

      Risk factors for CBS include advanced age, peripheral visual impairment, social isolation, sensory deprivation, and early cognitive impairment. Well-formed complex visual hallucinations are thought to occur in 10-30 percent of individuals with severe visual impairment. Only around a third of individuals find the hallucinations themselves an unpleasant or disturbing experience. The most effective treatment is reversal of the visual impairment. Antipsychotic drugs are commonly prescribed but are largely ineffective. CBS is a long-lasting condition, with 88% of individuals experiencing it for two years of more, and only 25% resolving at nine years.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 200 - Which of the following is cognitive distortion? ...

    Incorrect

    • Which of the following is cognitive distortion?

      Your Answer:

      Correct Answer: Personalisation

      Explanation:

      Personalisation can be considered a type of cognitive distortion, while the other options are classified as defence mechanisms.

      Cognitive Therapy and Negative Automatic Thoughts

      Cognitive therapy is a present-focused approach that aims to help clients overcome difficulties by identifying and changing dysfunctional thinking. This therapy is based on collaboration between the client and therapist and on testing beliefs through collaborative empiricism. One of the techniques used in cognitive therapy is Socratic questioning, which helps elicit false beliefs called negative automatic thoughts.

      Negative automatic thoughts, also known as cognitive distortions, can be categorized into different types. Dichotomous thinking is the tendency to see things as black and white rather than shades of grey. Personalization is the incorrect assumption that things happen due to us, while overgeneralization involves coming to a general conclusion based on a single piece of evidence. Arbitrary inference is drawing an unjustified conclusion, while selective abstraction involves concentrating on the negative while ignoring the positives. Catastrophizing is expecting disaster from relatively trivial events, while filtering involves selecting out only negative aspects of a situation and leaving out the positive.

      Control fallacies involve believing that we are responsible for everything (internal control fallacy) of nothing (external control fallacy). The fallacy of fairness is believing that life is fair, while blaming involves holding others responsible for our distress. Shoulds are preconceived rules we believe (often incorrect) which makes us angry when others don’t obey them. Magnification is a tendency to exaggerate the importance of negative information of experiences, while trivializing of reducing the significance of positive information of experiences. Minimization involves an undervaluation of positive attributes, while emotional reasoning is believing what we feel must be true.

      The fallacy of change involves expecting others to change just because it suits us, while global labeling involves exaggerating and labeling behavior (e.g. when you fail at something, saying ‘I’m a loser’). Always being right is when the need to be right dominates all other needs, while the heaven’s reward fallacy involves expecting our sacrifices will pay off. Finally, magical thinking is incorrectly believing that our actions influence the outcomes.

      Overall, cognitive therapy helps individuals identify and challenge negative automatic thoughts to improve their mental health and well-being.

    • This question is part of the following fields:

      • Psychotherapy
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SESSION STATS - PERFORMANCE PER SPECIALTY

General Adult Psychiatry (0/1) 0%
Passmed