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  • Question 1 - What is a substance that activates GABA-B receptors called? ...

    Correct

    • What is a substance that activates GABA-B receptors called?

      Your Answer: Baclofen

      Explanation:

      Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

    • This question is part of the following fields:

      • Neurosciences
      27.3
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  • Question 2 - You are asked to speak to a minor about ECT.
    Which of the following...

    Incorrect

    • You are asked to speak to a minor about ECT.
      Which of the following is not a requirement for a minor to be deemed to have the capacity to consent to ECT?

      Your Answer:

      Correct Answer: Sign a consent form

      Explanation:

      In order for a patient to give consent, they must be able to communicate their decision. It is important to note that a patient’s ability to sign a form does not necessarily determine their mental capacity to consent to a treatment. It is assumed that a patient has capacity unless proven otherwise, and efforts should be made to enhance their capacity (such as considering different communication methods of involving family members of interpreters). A patient is considered to lack capacity for a specific decision if they are unable to understand, retain, weigh up, of communicate information related to that decision.

    • This question is part of the following fields:

      • Basic Ethics And Philosophy Of Psychiatry
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  • Question 3 - One statement that is false regarding the genetics of ADHD is: ADHD is...

    Incorrect

    • One statement that is false regarding the genetics of ADHD is: ADHD is caused by a single gene mutation.

      Your Answer:

      Correct Answer: ADHD has been associated with the neuregulin 1 gene

      Explanation:

      While ADHD has been linked to various genes, neuregulin 1 is not among them. However, it has been suggested to play a role in schizophrenia.

      ADHD and Genetics

      Decades of research have shown that genetics play a crucial role in the development of attention deficit hyperactivity disorder (ADHD) and its comorbidity with other disorders. However, twin estimates of heritability being less than 100% suggest that environmental factors also play a role. Parents and siblings of a child with ADHD are more likely to have ADHD themselves, but the way ADHD is inherited is complex and not related to a single genetic fault. The heritability of ADHD is around 74%, and longitudinal studies show that two-thirds of ADHD youth will continue to have impairing symptoms of ADHD in adulthood. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors. The heritability is similar in males and females, and studies suggest that the diagnosis of ADHD is the extreme of a continuous distribution of ADHD symptoms in the population. Several candidate genes, including DAT1, DRD4, DRD5, 5 HTT, HTR1B, and SNAP25, have been identified as significantly associated with ADHD.

      Source: Faraone (2019) Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry volume 24, pages 562–575 (2019).

    • This question is part of the following fields:

      • Genetics
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  • Question 4 - What was one of the 'four humours' in classical Greek medicine? ...

    Incorrect

    • What was one of the 'four humours' in classical Greek medicine?

      Your Answer:

      Correct Answer: Black bile

      Explanation:

      The ancient Greeks believed that the body’s health of illness was determined by the balance of four humours: black bile, yellow bile, blood, and phlegm. Each humour was linked to a specific mental state, with an excess of black bile being associated with a melancholic mood, which is where we get the word melancholy from.

    • This question is part of the following fields:

      • History Of Psychiatry
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  • Question 5 - Which ion channel blockade is believed to be the primary cause of the...

    Incorrect

    • Which ion channel blockade is believed to be the primary cause of the arrhythmogenic potential of tricyclic antidepressants?

      Your Answer:

      Correct Answer: Sodium

      Explanation:

      Antidepressants and Their Cardiac Effects

      SSRIs are generally recommended for patients with cardiac disease as they may protect against myocardial infarction (MI). Untreated depression worsens prognosis in cardiovascular disease. Post MI, SSRIs and mirtazapine have either a neutral of beneficial effect on mortality. Sertraline is recommended post MI, but other SSRIs and mirtazapine are also likely to be safe. However, citalopram is associated with Torsades de pointes (mainly in overdose). Bupropion, citalopram, escitalopram, moclobemide, lofepramine, and venlafaxine should be used with caution of avoided in those at risk of serious arrhythmia (those with heart failure, left ventricular hypertrophy, previous arrhythmia, of MI).

      Tricyclic antidepressants (TCAs) have established arrhythmogenic activity which arises as a result of potent blockade of cardiac sodium channels and variable activity at potassium channels. ECG changes produced include PR, QRS, and QT prolongation and the Brugada syndrome. Lofepramine is less cardiotoxic than other TCAs and seems to lack the overdose arrhythmogenicity of other TCAs. QT changes are not usually seen at normal clinical doses of antidepressants (but can occur, particularly with citalopram/escitalopram). The arrhythmogenic potential of TCAs and other antidepressants is dose-related.

      Overall, SSRIs are recommended for patients with cardiac disease, while caution should be exercised when prescribing TCAs and other antidepressants, especially in those at risk of serious arrhythmia. It is important to monitor patients closely for any cardiac effects when prescribing antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 6 - What is the cause of Kluver-Bucy syndrome, which occurs as a result of...

    Incorrect

    • What is the cause of Kluver-Bucy syndrome, which occurs as a result of damage to which part of the brain?

      Your Answer:

      Correct Answer: Temporal lobe

      Explanation:

      Kluver-Bucy syndrome is a neurological disorder that results from dysfunction in both the right and left medial temporal lobes of the brain. This condition is characterized by a range of symptoms, including docility, altered dietary habits, hyperorality, and changes in sexual behavior. Additionally, individuals with Kluver-Bucy syndrome may experience visual agnosia, which is a condition that impairs their ability to recognize and interpret visual stimuli.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 7 - An elevation in Brain-derived neurotrophic factor levels in cortical regions compared to healthy...

    Incorrect

    • An elevation in Brain-derived neurotrophic factor levels in cortical regions compared to healthy individuals has been observed for which of the following disorders?

      Your Answer:

      Correct Answer: Schizophrenia

      Explanation:

      Neurotrophins: Crucial for Neuronal Growth and Development

      Neurotrophins are essential for the growth and development of neurons. However, disturbances in neurotrophic factors may contribute to some neurodevelopmental aspects of schizophrenia and major depression.

      Studies have shown that patients with schizophrenia have increased concentrations of Brain-derived neurotrophic factor (BDNF) in cortical areas, but decreased levels in the hippocampus compared to controls. Additionally, patients with schizophrenia have lower concentrations of neurotrophin-3 in frontal and parietal areas than controls.

      These findings suggest that neurotrophins play a critical role in the pathophysiology of schizophrenia and major depression. Further research is needed to fully understand the mechanisms underlying these disturbances in neurotrophic factors.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 8 - Which statement about pharmacokinetics in the elderly is incorrect? ...

    Incorrect

    • Which statement about pharmacokinetics in the elderly is incorrect?

      Your Answer:

      Correct Answer: The volume of distribution for lipid-soluble drugs decreases

      Explanation:

      With aging, there is an increase in lean body weight and body water and a decrease in the proportion of fat. As a result, water-soluble drugs are distributed to a greater extent. Lipid-soluble drugs have a lower volume of distribution in the elderly due to the lower proportion of body fat.

      Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.

      In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 9 - What is the experience that the lady in A&E is going through when...

    Incorrect

    • What is the experience that the lady in A&E is going through when she covers her head with cloth and claims that people can hear her thoughts?

      Your Answer:

      Correct Answer: Thought broadcast

      Explanation:

      First Rank Symptoms: Their Significance in Identifying Schizophrenia

      First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.

      A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.

      The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 10 - Which of the following is most likely to result from use of carbamazepine?...

    Incorrect

    • Which of the following is most likely to result from use of carbamazepine?

      Your Answer:

      Correct Answer: Leucopenia

      Explanation:

      Carbamazepine use can result in leucopenia, which is a reduction in white blood cell count, affecting 1 in 10 individuals. Although other side effects can occur with carbamazepine, they are rare of very rare. The decrease in WBC is believed to be due to the inhibition of colony-stimulating factor in the bone marrow. However, the co-administration of lithium, which stimulates colony-stimulating factor, may potentially reverse the effects of carbamazepine (Daughton, 2006).

      Carbamazepine: Uses, Mechanism of Action, Contraindications, Warnings, and Side-Effects

      Carbamazepine, also known as Tegretol, is a medication commonly used in the treatment of epilepsy, particularly partial seizures. It is also used for neuropathic pain, bipolar disorder, and other conditions. The drug works by binding to sodium channels and increasing their refractory period.

      However, carbamazepine has notable contraindications, including a history of bone marrow depression and combination with monoamine oxidase inhibitors (MAOIs). It also carries warnings for serious dermatological reactions such as toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome.

      Common side-effects of carbamazepine include leucopenia, ataxia, dizziness, somnolence, vomiting, nausea, urticaria, and fatigue. Other side-effects include thrombocytopenia, eosinophilia, oedema, fluid retention, weight increase, hyponatraemia, and blood osmolarity decreased due to an antidiuretic hormone (ADH)-like effect, leading in rare cases to water intoxication accompanied by lethargy, vomiting, headache, confusional state, neurological disorders, diplopia, accommodation disorders (e.g. blurred vision), and dry mouth.

      In summary, carbamazepine is a medication with multiple uses, but it also carries significant contraindications, warnings, and side-effects that should be carefully considered before use.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 11 - What is a true statement about valproate? ...

    Incorrect

    • What is a true statement about valproate?

      Your Answer:

      Correct Answer: The risk of congenital malformations is dose dependent

      Explanation:

      Valproate can pass through the placenta, increasing the likelihood of birth defects. The extent of risk during pregnancy is not fully understood, but it is believed to be influenced by the dosage. Children who were exposed to valproate in the womb may have a lower IQ, with those aged 6 showing an average decrease of 7-10 points compared to those exposed to other antiepileptic medications.

      Valproate: Forms, Doses, and Adverse Effects

      Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.

      Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.

      Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 12 - Which option is not included in Vaillant's categories of defence mechanisms? ...

    Incorrect

    • Which option is not included in Vaillant's categories of defence mechanisms?

      Your Answer:

      Correct Answer: Depressive

      Explanation:

      Intermediate Mechanism: Rationalisation

      Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

      Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

      Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

      Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 13 - Who is the originator of the term 'cheese effect' in reference to the...

    Incorrect

    • Who is the originator of the term 'cheese effect' in reference to the negative effects associated with MAOI antidepressants?

      Your Answer:

      Correct Answer: Blackwell

      Explanation:

      A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor

      In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.

      Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 14 - What is a characteristic of typical grief? ...

    Incorrect

    • What is a characteristic of typical grief?

      Your Answer:

      Correct Answer: Anger towards the deceased

      Explanation:

      Understanding Grief: Normal and Abnormal Phases

      Grief is a natural response to loss, and it is a complex process that can take different forms and durations. John Bowlby and Kubler-Ross have proposed models to describe the typical phases of grief, which can vary in intensity and duration for each individual. Bowlby’s model includes shock-numbness, yearning-searching, disorganization-despair, and reorganization, while Kubler-Ross’s model includes denial-dissociation-isolation, anger, bargaining, depression, and acceptance.

      However, some people may experience abnormal grief, which can be categorized as inhibited, delayed, of chronic/prolonged. Inhibited grief refers to the absence of expected grief symptoms at any stage, while delayed grief involves avoiding painful symptoms within two weeks of loss. Chronic/prolonged grief is characterized by continued significant grief-related symptoms six months after loss.

      It is important to distinguish between normal grief and major depression, as a high proportion of people may meet the criteria for major depression in the first year following bereavement. Some features that can help differentiate between the two include generalized guilt, thoughts of death unrelated to the deceased, feelings of worthlessness, psychomotor retardation, and prolonged functional impairment.

      Overall, understanding the phases and types of grief can help individuals and their loved ones navigate the grieving process and seek appropriate support and resources.

    • This question is part of the following fields:

      • Social Psychology
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  • Question 15 - Which of the following combinations is the safest in terms of avoiding serotonin...

    Incorrect

    • Which of the following combinations is the safest in terms of avoiding serotonin syndrome?

      Your Answer:

      Correct Answer: MAOI and amitriptyline

      Explanation:

      It is not recommended to combine MAOIs with SSRIs, clomipramine, of ephedrine.

      MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

      First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

      MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

      The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

      Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

      Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 16 - What is the more commonly used name for Trisomy 18 syndrome? ...

    Incorrect

    • What is the more commonly used name for Trisomy 18 syndrome?

      Your Answer:

      Correct Answer: Edwards syndrome

      Explanation:

      Genetic Conditions and Their Features

      Genetic conditions are disorders caused by abnormalities in an individual’s DNA. These conditions can affect various aspects of a person’s health, including physical and intellectual development. Some of the most common genetic conditions and their features are:

      – Downs (trisomy 21): Short stature, almond-shaped eyes, low muscle tone, and intellectual disability.
      – Angelman syndrome (Happy puppet syndrome): Flapping hand movements, ataxia, severe learning disability, seizures, and sleep problems.
      – Prader-Willi: Hyperphagia, excessive weight gain, short stature, and mild learning disability.
      – Cri du chat: Characteristic cry, hypotonia, down-turned mouth, and microcephaly.
      – Velocardiofacial syndrome (DiGeorge syndrome): Cleft palate, cardiac problems, and learning disabilities.
      – Edwards syndrome (trisomy 18): Severe intellectual disability, kidney malformations, and physical abnormalities.
      – Lesch-Nyhan syndrome: Self-mutilation, dystonia, and writhing movements.
      – Smith-Magenis syndrome: Pronounced self-injurious behavior, self-hugging, and a hoarse voice.
      – Fragile X: Elongated face, large ears, hand flapping, and shyness.
      – Wolf Hirschhorn syndrome: Mild to severe intellectual disability, seizures, and physical abnormalities.
      – Patau syndrome (trisomy 13): Severe intellectual disability, congenital heart malformations, and physical abnormalities.
      – Rett syndrome: Regression and loss of skills, hand-wringing movements, and profound learning disability.
      – Tuberous sclerosis: Hamartomatous tumors, epilepsy, and behavioral issues.
      – Williams syndrome: Elfin-like features, social disinhibition, and advanced verbal skills.
      – Rubinstein-Taybi syndrome: Short stature, friendly disposition, and moderate learning disability.
      – Klinefelter syndrome: Extra X chromosome, low testosterone, and speech and language issues.
      – Jakob’s syndrome: Extra Y chromosome, tall stature, and lower mean intelligence.
      – Coffin-Lowry syndrome: Short stature, slanting eyes, and severe learning difficulty.
      – Turner syndrome: Short stature, webbed neck, and absent periods.
      – Niemann Pick disease (types A and B): Abdominal swelling, cherry red spot, and feeding difficulties.

      It is important to note that these features may vary widely among individuals with the same genetic condition. Early diagnosis and intervention can help individuals with genetic conditions reach their full potential and improve their quality of life.

    • This question is part of the following fields:

      • Genetics
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  • Question 17 - What drug acts as an alpha 2 antagonist? ...

    Incorrect

    • What drug acts as an alpha 2 antagonist?

      Your Answer:

      Correct Answer: Mirtazapine

      Explanation:

      The pharmacodynamics of Mirtazapine are complex and have received conflicting feedback. However, according to the manufacturer’s leaflet and preclinical studies, Mirtazapine is a potent antagonist of 5-HT2 and 5-HT3 receptors, with no significant affinity for the 5-HT1A and 5-HT1B receptors. It is also a potent antagonist of histamine (H1) receptors, which may explain its sedative effects, and a moderate peripheral a1 adrenergic antagonist, which may cause occasional orthostatic hypotension. Additionally, it is a moderate antagonist at muscarinic receptors, which may explain the low incidence of anticholinergic side effects. Although not stated by the manufacturer, there is considerable evidence that Mirtazapine is also an alpha 2 antagonist, which was likely discovered after the preclinical studies.

      Mechanisms of Action of Different Drugs

      Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 18 - In which of the following therapeutic approaches are the three flawed processes 'traps,...

    Incorrect

    • In which of the following therapeutic approaches are the three flawed processes 'traps, snags, and dilemmas' identified?

      Your Answer:

      Correct Answer: Cognitive analytical therapy

      Explanation:

      Mentalisation therapy is a psychotherapy approach that is particularly helpful for individuals with borderline personality disorder. It is psychodynamically-oriented and focuses on helping individuals develop the ability to mentalise, of understand their own and others’ thoughts, feelings, and intentions. This therapy approach aims to improve interpersonal relationships and reduce impulsive and self-destructive behaviors.

    • This question is part of the following fields:

      • Advanced Psychological Processes And Treatments
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  • Question 19 - Which substance follows zero order kinetics during metabolism? ...

    Incorrect

    • Which substance follows zero order kinetics during metabolism?

      Your Answer:

      Correct Answer: Phenytoin

      Explanation:

      The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 20 - The shift towards a more typical existence for individuals with developmental disabilities, away...

    Incorrect

    • The shift towards a more typical existence for individuals with developmental disabilities, away from institutionalized care, is known as what?

      Your Answer:

      Correct Answer: Normalisation

      Explanation:

      Normalisation in Learning Disability Care

      Normalisation is a concept that is widely used in the field of learning disability care. It refers to the principles of providing individuals with a life experience that is as normal as possible. This approach is a departure from the traditional model of institutionalised care, which often isolates individuals from the wider community. Normalisation aims to create an environment that is inclusive and supportive, where individuals can participate in everyday activities and have access to the same opportunities as everyone else. By promoting independence and social integration, normalisation helps to improve the quality of life for people with learning disabilities.

    • This question is part of the following fields:

      • Psychological Development
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  • Question 21 - What is the most probable side effect of clomipramine usage? ...

    Incorrect

    • What is the most probable side effect of clomipramine usage?

      Your Answer:

      Correct Answer: Drowsiness

      Explanation:

      Tricyclic antidepressants are known to cause various side effects, which can be attributed to their mechanisms of action. These include antimuscarinic effects, which can lead to dry mouth and urinary retention, antihistaminergic effects, which can cause weight gain and drowsiness, antiadrenergic effects, which can result in postural hypotension, sexual dysfunction, and cognitive impairment, and antiserotonergic effects, which can lead to weight gain. Additionally, tricyclic antidepressants can cause cardiotoxicity and reduce the seizure threshold due to their membrane stabilizing effects. Other important side effects of these drugs include arrhythmias and ECG changes, black tongue, tremor, altered liver function tests, paralytic ileus, and neuroleptic malignant syndrome. Black hairy tongue, a harmless condition where the tongue appears black and hairy due to elongated filiform papillae, is also a possible side effect of tricyclic antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 22 - Which symptom would indicate a hydrocephalus that is communicating rather than non-communicating? ...

    Incorrect

    • Which symptom would indicate a hydrocephalus that is communicating rather than non-communicating?

      Your Answer:

      Correct Answer: Ataxia

      Explanation:

      Normal Pressure Hydrocephalus

      Normal pressure hydrocephalus is a type of chronic communicating hydrocephalus, which occurs due to the impaired reabsorption of cerebrospinal fluid (CSF) by the arachnoid villi. Although the CSF pressure is typically high, it remains within the normal range, and therefore, it does not cause symptoms of high intracranial pressure (ICP) such as headache and nausea. Instead, patients with normal pressure hydrocephalus usually present with a classic triad of symptoms, including incontinence, gait ataxia, and dementia, which is often referred to as wet, wobbly, and wacky. Unfortunately, this condition is often misdiagnosed as Parkinson’s of Alzheimer’s disease.

      The classic triad of normal pressure hydrocephalus, also known as Hakim’s triad, includes gait instability, urinary incontinence, and dementia. On the other hand, non-communicating hydrocephalus results from the obstruction of CSF flow in the third of fourth ventricle, which causes symptoms of raised intracranial pressure, such as headache, vomiting, hypertension, bradycardia, altered consciousness, and papilledema.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 23 - A 65-year-old woman presents with concerns about her recent memory difficulties following a...

    Incorrect

    • A 65-year-old woman presents with concerns about her recent memory difficulties following a mini-stroke. Imaging reveals vascular changes in the temporal lobe and evidence of infarct in the left temporal lobe. She scores 24 out of 30 on the MMSE and has hypercholesterolemia. What is the most suitable course of treatment?

      Your Answer:

      Correct Answer: Simvastatin

      Explanation:

      This individual is exhibiting symptoms of vascular dementia, likely caused by a stroke and exacerbated by hypercholesterolemia. To prevent further strokes and memory problems, it is recommended to control his cholesterol levels by starting him on a statin. Vascular dementia accounts for up to 20% of dementia cases and can coexist with Alzheimer’s disease. Managing vascular risk factors such as hypertension, diabetes, and hypercholesterolemia is crucial in treating vascular dementia. Additionally, lifestyle changes such as quitting smoking, regular exercise, a healthy diet, and moderate alcohol consumption should be encouraged. Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) are approved in the UK for treating mild to moderately severe Alzheimer’s disease, while memantine is approved for moderate to severe Alzheimer’s disease, with its license extended in November 2005.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 24 - Which food should be consumed with caution by patients taking tranylcypromine? ...

    Incorrect

    • Which food should be consumed with caution by patients taking tranylcypromine?

      Your Answer:

      Correct Answer: Cheese

      Explanation:

      MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

      First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

      MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

      The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

      Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

      Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 25 - What is the personality trait that is not included in the big five?...

    Incorrect

    • What is the personality trait that is not included in the big five?

      Your Answer:

      Correct Answer: Generosity

      Explanation:

      The Big Five Personality Traits, also known as OCEAN, are five broad categories that can be used to describe an individual’s personality. These categories include Openness to Experience, Conscientiousness, Extraversion (also known as Surgency), Agreeableness, and Neuroticism (also known as Emotional Stability). Each of these traits can be further broken down into specific characteristics that help to define an individual’s personality. For example, Openness to Experience includes traits such as imagination, creativity, and a willingness to try new things. Conscientiousness includes traits such as organization, responsibility, and dependability. Extraversion includes traits such as sociability, assertiveness, and energy level. Agreeableness includes traits such as kindness, empathy, and cooperation. Finally, Neuroticism includes traits such as anxiety, moodiness, and emotional instability. Understanding these personality traits can be helpful in a variety of settings, such as in the workplace of in personal relationships.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 26 - A 45-year-old woman is in a car accident where several individuals lose their...

    Incorrect

    • A 45-year-old woman is in a car accident where several individuals lose their lives. Although she is not physically harmed, she experiences a sense of detachment, confusion, and disorientation in the days that ensue, along with physical symptoms of trembling and perspiration. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Acute stress disorder

      Explanation:

      Acute stress disorder is a brief yet intense condition triggered by a highly distressing event that can cause a range of symptoms. Although the symptoms can appear quickly, they typically subside within a few days. These symptoms may include psychological effects like feeling disconnected of confused, as well as physical symptoms such as sweating, trembling, heart palpitations, and difficulty sleeping. In some cases, individuals may progress to develop post-traumatic stress disorder.

    • This question is part of the following fields:

      • Diagnosis
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  • Question 27 - A 40-year-old individual who has been struggling with opioid addiction is experiencing symptoms...

    Incorrect

    • A 40-year-old individual who has been struggling with opioid addiction is experiencing symptoms of opioid dependence. What electroencephalographic alterations are commonly observed in cases of opioid dependence?

      Your Answer:

      Correct Answer: Decreased alpha activity

      Explanation:

      Opioid dependence is characterized by a decrease in alpha activity on electroencephalography (EEG). Other drugs have distinct EEG changes, such as increased beta activity with benzodiazepines, decreased alpha activity and increased theta activity with alcohol, and increased beta activity with barbiturates. Marijuana use is associated with increased alpha activity in the frontal area of the brain and overall slow alpha activity. During opioid overdose, slow waves may be observed on EEG, while barbiturate withdrawal may result in generalized paroxysmal activity and spike discharges.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 28 - Which cranial nerve is solely responsible for either sensory of motor functions and...

    Incorrect

    • Which cranial nerve is solely responsible for either sensory of motor functions and does not have a combination of both?

      Your Answer:

      Correct Answer: Abducens

      Explanation:

      Overview of Cranial Nerves and Their Functions

      The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.

      The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.

      The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.

      The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.

      The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.

      The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.

      The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.

      The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.

    • This question is part of the following fields:

      • Neurosciences
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  • Question 29 - A 70 year old woman with post-stroke cognitive deficits is referred for an...

    Incorrect

    • A 70 year old woman with post-stroke cognitive deficits is referred for an assessment of intelligence. Which test would give the best indication of her intelligence as it was before she had a stroke?

      Your Answer:

      Correct Answer: The National Adult Reading Test

      Explanation:

      The National Adult Reading Test as a Valid Measure of Premorbid Intelligence

      The National Adult Reading Test (NART) is a reliable and valid assessment tool for measuring premorbid intelligence. It comprises 50 words with irregular spellings, and the test-taker must correctly pronounce each word to receive a point. The NART is a useful tool for assessing cognitive function in individuals with neurological disorders of brain injuries, as it provides a baseline measure of their intellectual abilities before the onset of their condition. The NART is a widely used and respected measure of premorbid intelligence, and its results can inform clinical decision-making and treatment planning.

    • This question is part of the following fields:

      • Classification And Assessment
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  • Question 30 - What is the most frequently observed endocrine abnormality in sick euthyroid syndrome? ...

    Incorrect

    • What is the most frequently observed endocrine abnormality in sick euthyroid syndrome?

      Your Answer:

      Correct Answer: Low T3

      Explanation:

      Sick Euthyroid Syndrome: Abnormal Thyroid Function in Non-Thyroidal Illness

      Sick euthyroid syndrome, also known as low T3 syndrome, is a condition where thyroid function tests show abnormal results, typically low T3 levels, while T4 and TSH levels remain normal. This condition is commonly observed in patients with non-thyroidal illness. For instance, individuals with anorexia who have undergone prolonged starvation may develop this syndrome.

    • This question is part of the following fields:

      • Classification And Assessment
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