-
Question 1
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
-
-
Question 2
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
-
-
Question 3
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
-
-
Question 4
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
-
-
Question 5
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
-
-
Question 6
Incorrect
-
Question 7
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
-
-
Question 8
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 analysisStudy 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
-
-
Question 9
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
-
-
Question 10
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
-
-
Question 11
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
-
-
Question 12
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
-
-
Question 13
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
-
-
Question 14
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
-
-
Question 15
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
-
-
Question 16
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
-
-
Question 17
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
-
-
Question 18
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
-
-
Question 19
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
-
-
Question 20
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
-
-
Question 21
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
-
-
Question 22
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
-
-
Question 23
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
-
-
Question 24
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
-
-
Question 25
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
-
-
Question 26
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
-
-
Question 27
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
-
-
Question 28
Incorrect
-
Question 29
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
-
-
Question 30
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
-
-
Question 31
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
-
-
Question 32
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
-
-
Question 33
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
-
-
Question 34
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
-
-
Question 35
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
-
-
Question 36
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
-
-
Question 37
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
– TrifluoperazineThese 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
-
-
Question 38
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
-
-
Question 39
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
-
-
Question 40
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
-
-
Question 41
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
-
-
Question 42
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
-
-
Question 43
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
-
-
Question 44
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
-
-
Question 45
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
-
-
Question 46
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
-
-
Question 47
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
-
-
Question 48
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
-
-
Question 49
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
-
-
Question 50
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
-
-
Question 51
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
-
-
Question 52
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
-
-
Question 53
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
-
-
Question 54
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
-
-
Question 55
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
-
-
Question 56
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
-
-
Question 57
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
-
-
Question 58
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
-
-
Question 59
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
-
-
Question 60
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
-
-
Question 61
Incorrect
-
Question 62
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
-
-
Question 63
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
-
-
Question 64
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
-
-
Question 65
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
-
-
Question 66
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
-
-
Question 67
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
-
-
Question 68
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
-
-
Question 69
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
-
-
Question 70
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 analysisStudy 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
-
-
Question 71
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
-
-
Question 72
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
-
-
Question 73
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 hypothesisYour 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
-
-
Question 74
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
-
-
Question 75
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
-
-
Question 76
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
-
-
Question 77
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
-
-
Question 78
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
-
-
Question 79
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
-
-
Question 80
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
-
-
Question 81
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
-
-
Question 82
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
-
-
Question 83
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
-
-
Question 84
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
-
-
Question 85
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
-
-
Question 86
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
-
-
Question 87
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
-
-
Question 88
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
-
-
Question 89
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
-
-
Question 90
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
-
-
Question 91
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
-
-
Question 92
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
-
-
Question 93
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
-
-
Question 94
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
-
-
Question 95
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
-
-
Question 96
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
-
-
Question 97
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
-
-
Question 98
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
-
-
Question 99
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
-
-
Question 100
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
-
-
Question 101
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
-
-
Question 102
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
-
-
Question 103
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
-
-
Question 104
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
-
-
Question 105
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
-
-
Question 106
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
-
-
Question 107
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
-
-
Question 108
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
-
-
Question 109
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
-
-
Question 110
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
-
-
Question 111
Incorrect
-
Which term is Donald Winnicott known for?
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)