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Question 1
Correct
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A 28-year-old woman is admitted to the psychiatric ward under section 2 of the mental health act for suspected bipolar disorder. She has a 4-month history of manic episodes and has been experiencing delusions of grandeur. She started lithium 3 weeks ago. She has no other medical conditions and takes no other medications. Today, staff on the ward raised concerns due to her abnormal behaviour. She was found in the common room dancing and singing loudly, despite it being late at night. It is reported that she has been like this for the last hour. Her observations are normal. She has not responded to attempts to engage her in conversation or to calm her down. What is the most appropriate description of her current presentation?
Your Answer: Catatonia
Explanation:The most likely cause of the woman’s presentation, who is suspected to have schizophrenia and has been sitting in an uncomfortable position for the last 2 hours, is catatonia. Catatonia is a condition where voluntary movement is stopped or the person stays in an unusual position. It is believed to occur due to abnormalities in the balance of neurotransmitter systems, particularly dopamine, and is commonly associated with certain types of schizophrenia. Treatment for catatonia includes benzodiazepines and electroconvulsive therapy.
Extrapyramidal side effects, neuroleptic malignant syndrome, and serotonin syndrome are not the correct answers for this scenario. Extrapyramidal side effects can occur with antipsychotic medications but would not present with the withdrawn status described. Neuroleptic malignant syndrome is a life-threatening reaction to antipsychotic medications and presents with different symptoms than catatonia. Serotonin syndrome is caused by excess serotonin in the body and is not associated with the patient’s medication or presentation.
Schizophrenia is a mental disorder that is characterized by various symptoms. Schneider’s first rank symptoms are divided into four categories: auditory hallucinations, thought disorders, passivity phenomena, and delusional perceptions. Auditory hallucinations can include hearing two or more voices discussing the patient in the third person, thought echo, or voices commenting on the patient’s behavior. Thought disorders can involve thought insertion, thought withdrawal, or thought broadcasting. Passivity phenomena can include bodily sensations being controlled by external influence or actions/impulses/feelings that are imposed on the individual or influenced by others. Delusional perceptions involve a two-stage process where a normal object is perceived, and then there is a sudden intense delusional insight into the object’s meaning for the patient.
Other features of schizophrenia include impaired insight, incongruity/blunting of affect (inappropriate emotion for circumstances), decreased speech, neologisms (made-up words), catatonia, and negative symptoms such as incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), and avolition (poor motivation). It is important to note that schizophrenia can manifest differently in each individual, and not all symptoms may be present.
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This question is part of the following fields:
- Psychiatry
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Question 2
Incorrect
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An 85-year-old man with early-stage dementia is brought to see the General Practitioner (GP) by his daughter to discuss appointing a Lasting Power of Attorney.
Which one of the following statements is true regarding the Mental Capacity Act (MCA)?Your Answer: All patients with severe learning disability or a brain injury can be assumed to lack capacity
Correct Answer: If a person lacks capacity to make a decision, the Act states that a decision should be made that is in their best interests
Explanation:Understanding the Mental Capacity Act: Myths and Facts
The Mental Capacity Act (MCA) is a crucial piece of legislation that outlines how decisions should be made for individuals who lack capacity. However, there are several myths surrounding the MCA that can lead to confusion and misunderstandings. Here are some common myths and the facts that debunk them:
Myth: If a person has a severe learning disability or brain injury, they automatically lack capacity.
Fact: Capacity should be assessed on an individual basis, and a diagnosis alone does not determine whether someone lacks capacity. If there is any doubt, a capacity assessment should be performed.Myth: Relatives who have not been appointed as a Lasting Power of Attorney have no role in decision-making for people who lack capacity.
Fact: Any relative who has knowledge of the person’s wishes and beliefs can be consulted for their opinion on which treatment they feel the person would find the least restrictive and in their best interests.Myth: There are only four statutory principles in the MCA.
Fact: There are five principles of the MCA, which include the presumption of capacity, supporting individuals to make their own decisions whenever possible, recognizing the right to make unwise decisions, prioritizing the best interests of the person, and choosing the least restrictive treatment option.Myth: The MCA only applies to people aged 18 years and over.
Fact: The MCA applies to anyone aged 16 years or over. In individuals under the age of 16, capacity can be assessed using the Gillick competence.Myth: If a person lacks capacity, decisions should be made based solely on what healthcare professionals think is best.
Fact: If a person lacks capacity, decisions should be made that are thought to be in their best interests. This should take into account any expressed wishes from the person previously and advice about the person’s opinions from anyone who is close to the person, including relatives or carers.By understanding the facts about the MCA, we can ensure that individuals who lack capacity receive the best possible care and support.
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This question is part of the following fields:
- Psychiatry
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Question 3
Incorrect
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A 38-year-old woman and her 14-year-old daughter are apprehended after being caught trying to destroy a statue in the town square. When asked why, they both explain how the statue comes to life and terrorizes them at night, breaking things in their house, whispering violent thoughts in their minds and urging them to kill themselves. The police officer brings them to the Emergency Department where you evaluate them. The mother is a well-known psychiatric patient, but the daughter has never been seen before.
Which of the following is most likely to acutely reverse the psychosis in at least one of the patients?Your Answer: Benzodiazepines
Correct Answer: Separate the patients
Explanation:Treatment Approach for Shared Delusional Disorder
Shared delusional disorder, also known as folie à deux, is a rare psychiatric condition where two individuals develop a paired delusion. In cases where one of the individuals has a history of psychiatric illness, separating the patients is the first step in treating the disorder. This is because the dominant force in the duo may be the source of the delusion, and separating them may resolve the delusion in the other individual.
While benzodiazepines can sedate the patients, they will not acutely reverse psychosis. Similarly, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are not indicated as they take time to work and are not effective in acutely reversing psychosis.
Cognitive behavioural therapy (CBT) is a treatment approach that takes time and is not effective in acutely reversing psychosis in either of the patients. Therefore, in cases of shared delusional disorder, separating the patients and providing anti-psychotic therapy to the dominant individual may be the most effective treatment approach.
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This question is part of the following fields:
- Psychiatry
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Question 4
Correct
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A 35-year-old woman complains that she is unable to leave the house and as a result, her children are missing out and she is a bad mother. She reports feeling anxious most of the time, but when she is in public, she experiences a rapid heartbeat, fast breathing, and believes that everyone is staring at her. These symptoms began approximately three weeks after she lost her job when the company she worked for shut down. Since then, she has been unable to find enjoyment in anything and feels constantly fatigued. What is her diagnosis?
Your Answer: Depression with secondary anxiety
Explanation:Understanding the Relationship Between Depression and Anxiety: A Clinical Perspective
Depression and anxiety are two common mental health conditions that often co-occur. However, it is important to distinguish between the two and determine which is the primary diagnosis, as this will guide treatment. In cases where depression is the underlying main diagnosis, patients may develop secondary symptoms such as anxiety and panic attacks. On the other hand, in cases where anxiety is the primary diagnosis, patients may also experience secondary depressive symptoms.
One key factor in determining the primary diagnosis is the temporal development of symptoms. In cases where depressive symptoms clearly started first, a correct diagnosis of depression is important, as treating the underlying disorder can also improve secondary anxiety symptoms. Symptoms of depression include low mood, anhedonia, and anergia.
Generalized anxiety disorder is characterized by uncontrollable and irrational worry or anxiety about a wide range of issues and situations, while agoraphobia is an excessive fear of being in a situation where a person cannot freely escape or where help may not be available. Panic disorder is diagnosed when a person has recurrent, severe panic attacks without an obvious precipitant.
In cases where anxiety is secondary to depression, it is important to address the underlying depressive symptoms in order to improve the abnormal anxiety. Symptoms of abnormal anxiety and depression frequently present co-morbidly, and careful history-taking is necessary to determine which is the primary diagnosis. By understanding the relationship between depression and anxiety, clinicians can provide more effective treatment for their patients.
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This question is part of the following fields:
- Psychiatry
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Question 5
Correct
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A mother brings her 8-year-old son to see the general practitioner (GP) as she is very concerned about his school performance. His teacher has reported that he is being highly disruptive in the classroom.
Which of the following sets of behaviours fit best with a diagnosis of attention deficit/hyperactivity disorder (ADHD)?Your Answer: Easily distracted, hyperactivity, interrupts classmates
Explanation:Understanding ADHD: Symptoms and Risk Factors
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. The core features of ADHD include inattention, hyperactivity, and impulsiveness. Individuals with ADHD may be easily distracted, forgetful, fidgety, and have difficulty sustaining attention for prolonged periods. They may also interrupt others, talk excessively, and struggle to wait their turn.
While the exact cause of ADHD is unknown, genetic factors, head injury, and low birthweight are thought to be risk factors. ADHD is more common in men than women. Management of ADHD typically involves counselling and/or medication.
It is important to note that ADHD does not necessarily lead to difficulties in forming friendships or an inability to empathize with peers. Aggression and destruction are also not core features of ADHD. However, individuals with ADHD may struggle with inflexibility and have difficulty finishing tasks. It is important to understand the symptoms and risk factors associated with ADHD in order to provide appropriate support and management.
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This question is part of the following fields:
- Psychiatry
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Question 6
Incorrect
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A 84-year-old woman is admitted to the hospital after falling outside her home. Her carers, who visit three times a day, report that the patient becomes aggressive when prevented from going outside and she also refuses to be accompanied. The patient has no next-of-kin, and she was formally diagnosed with dementia last year. She has a past medical history of hypertension. She is now medically fit for discharge from hospital, but she lacks capacity to make a decision regarding her treatment and her place of residence. It is proposed that an application is made under the Deprivation of Liberty Safeguards (DoLS), in her best interests, to prevent the patient from wandering outside. The ward manager says that this cannot be done, as the patient does not meet all the criteria.
Which of the following is preventing a DoLS from being authorised for this patient?Your Answer: The patient does not have an advance decision about his treatment
Correct Answer: The patient resides in his own home
Explanation:Conditions for Deprivation of Liberty Safeguards (DoLS) Authorisation
DoLS authorisation is a legal process that allows a person to be deprived of their liberty in a care home or hospital for their own safety. However, certain conditions must be met before authorisation can be granted. Firstly, the patient must reside in a care home or hospital, and an application to the Court of Protection must be made if they reside in their own home. Secondly, the patient must lack capacity for decisions regarding treatment. Thirdly, the patient’s lack of an advance decision about their treatment does not prevent DoLS authorisation. Fourthly, the patient must be above 18 years of age. Finally, the patient must have a mental disorder, such as dementia, but it is important to consider if they meet the criteria for detention under the Mental Health Act 1983.
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This question is part of the following fields:
- Psychiatry
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Question 7
Correct
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A 42-year-old man is brought to the Emergency Department by his friends. He holds a senior trading job in an investment bank and has a history of recurrent admissions following cocaine intoxication. They are worried because he recently sent a memo to everyone on the trading floor suggesting that he is now the lead, he has the mental capacity to beat anyone to a higher profit and he should be chairman of the group. In fact, he has been performing poorly and has missed recent performance targets.
Which of the following is the most likely diagnosis?Your Answer: Cocaine-induced delusional disorder
Explanation:Understanding the Psychological Effects of Cocaine Use
Cocaine use can lead to a range of psychological and psychiatric problems, including delusional disorder. This disorder is characterized by grandiose ideas concerning one’s social standing or intellectual ability, which are far in excess of reality. Cocaine-induced hallucinations are also common, particularly of the auditory or tactile variety.
While some may mistake these symptoms for schizophrenia or a manic episode of bipolar disorder, it is important to consider the individual’s history of cocaine use. Cocaine intoxication can cause anxiety, agitation, euphoria, enlarged pupils, and palpitations, while severe intoxication can lead to delirium, hyperactivity, hyperthermia, and psychosis. Cocaine withdrawal, on the other hand, can cause fatigue, agitation, vivid and unpleasant dreams, increased appetite, and psychomotor retardation.
Overall, it is crucial to understand the potential psychological effects of cocaine use and seek appropriate treatment if necessary.
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This question is part of the following fields:
- Psychiatry
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Question 8
Correct
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A 78-year-old, frail elderly man on the geriatric ward is experiencing difficulty sleeping and asks for medication to aid his insomnia. The doctor prescribes a brief course of zopiclone.
What is one of the potential hazards linked to the use of zopiclone in older adults?Your Answer: Increased risk of falls
Explanation:Elderly patients taking zopiclone are at an increased risk of falling due to its mode of action on GABA-containing receptors, which enhances the effects of GABA. This is similar to benzodiazepines. Zopiclone can cause adverse effects such as agitation, constipation, dry mouth, dizziness, and decreased muscle tone. However, diarrhea is not a known side effect. Withdrawal from zopiclone may lead to convulsions, tremors, and hyperventilation.
Understanding Z Drugs and Their Adverse Effects
Z drugs are a class of medications that have similar effects to benzodiazepines, but they differ in their chemical structure. These drugs work by acting on the α2-subunit of the GABA receptor. There are three groups of Z drugs: imidazopyridines, cyclopyrrolones, and pyrazolopyrimidines. Examples of these drugs include zolpidem, zopiclone, and zaleplon.
Despite their effectiveness in treating sleep disorders, Z drugs have adverse effects that are similar to benzodiazepines. One of the most significant risks associated with these drugs is an increased risk of falls in the elderly. Therefore, it is essential to use these medications with caution, especially in older adults. It is also important to follow the prescribed dosage and not to mix them with other medications or alcohol. By understanding the potential risks and benefits of Z drugs, patients can make informed decisions about their use and work with their healthcare providers to manage any adverse effects.
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This question is part of the following fields:
- Psychiatry
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Question 9
Incorrect
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A 36-year-old man with a known history of severe depression has been in hospital for the past year. He was diagnosed with depression at the age of 23 and has been on antidepressants since. He has had multiple self-harm and suicide attempts in the past. For the past year, he has been receiving treatment in hospital and has been making some progress with regard to his mental health. He is not happy to be in hospital, but the doctors thought that it was in his best interests to keep him in hospital for treatment. He has been under a Section which allowed him to be kept in hospital for six months. At the end of the first six months, the doctors applied for a second time for him to be kept for another six months, as they feel he is not yet fit for discharge.
For how long can the relevant Section be renewed for this patient for the third time?Your Answer: Three months
Correct Answer: One year
Explanation:Understanding the Time Limits of Mental Health Detention in the UK
In the UK, mental health detention is governed by specific time limits depending on the type of detention and the purpose of the detention. Here are some of the key time limits to be aware of:
– Section 2: This is the Section used for assessment, and a patient can be kept in hospital for a maximum of 28 days under this Section. It cannot be extended.
– Section 3: This is the Section used for treatment, and a patient can be detained for up to six months initially. The Section can be renewed for another six months, and then for one year at a time. Treatment without consent can be given for the first three months, and then only with the approval of an ‘approved second-opinion doctor’ for the next three months.
– Two years: While a patient can be kept in hospital for up to two years for treatment, Section 3 cannot be renewed for two years at a time. The patient can also be discharged earlier if the doctor thinks the patient is well enough.
– Six months: This is the time for which an initial Section 3 can be applied for and the time for which it can be renewed for a second time. For a third time and onwards, Section 3 can be renewed for one year each time, but the patient can be discharged earlier if doctors think it is not necessary for the patient to be under Section anymore.Understanding these time limits is important for both patients and healthcare professionals involved in mental health detention in the UK.
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This question is part of the following fields:
- Psychiatry
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Question 10
Correct
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A client under your care has been prescribed imipramine for depression. What combination of side-effects is most probable in an individual taking this type of antidepressant?
Your Answer: Blurred vision + dry mouth
Explanation:Tricyclic Antidepressants for Neuropathic Pain
Tricyclic antidepressants (TCAs) were once commonly used for depression, but their side-effects and toxicity in overdose have led to a decrease in their use. However, they are still widely used in the treatment of neuropathic pain, where smaller doses are typically required. TCAs such as low-dose amitriptyline are commonly used for the management of neuropathic pain and the prophylaxis of headache, while lofepramine has a lower incidence of toxicity in overdose. It is important to note that some TCAs, such as amitriptyline and dosulepin, are considered more dangerous in overdose than others.
Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, urinary retention, and lengthening of the QT interval. When choosing a TCA for neuropathic pain, the level of sedation may also be a consideration. Amitriptyline, clomipramine, dosulepin, and trazodone are more sedative, while imipramine, lofepramine, and nortriptyline are less sedative. It is important to work with a healthcare provider to determine the appropriate TCA and dosage for the individual’s specific needs.
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This question is part of the following fields:
- Psychiatry
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Question 11
Correct
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A 32-year-old woman visits her GP for a follow-up on her depression. She is experiencing mild to moderate symptoms of low mood, anhedonia, poor appetite, and poor sleep, despite completing a full course of cognitive behavioural therapy. Her therapist has recommended medication, and the patient is open to this option. What is the appropriate first-line treatment for her depression?
Your Answer: Sertraline
Explanation:Antidepressant Medications: Recommended Use and Precautions
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for moderate to severe depression or mild depression that has not responded to initial interventions. Tricyclic antidepressants, such as amitriptyline and dosulepin, are not recommended as first-line treatment due to their toxicity in overdose. Dosulepin, in particular, has been linked to cardiac conduction defects and other arrhythmias. Monoamine oxidase inhibitors (MAOIs), like phenelzine, may be prescribed by a specialist in refractory cases but are not recommended as first-line treatment. Venlafaxine, a serotonin and noradrenaline reuptake inhibitor, is also not recommended as first-line treatment due to the risk of hypertension, arrhythmias, and potential toxicity in overdose. It is important to consult with a healthcare provider to determine the most appropriate medication for individual cases of depression.
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This question is part of the following fields:
- Psychiatry
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Question 12
Incorrect
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A 29-year-old woman arrives at the Emergency Department in a state of distress. She admits to having lost a significant amount of money through gambling and then taking 4 packets of paracetamol. This is not the first time she has engaged in such behavior. She discloses that her partner of 3 years has been offered a job overseas and is considering accepting it. Despite her initial heartbreak, they had a major argument and she now claims to be indifferent about whether he stays or goes.
What is the most appropriate course of action based on the probable diagnosis?Your Answer: Cognitive behaviour therapy
Correct Answer: Dialectical behaviour therapy
Explanation:Borderline personality disorder (BPD) is characterized by recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation as a way to cope with strong emotions during strained relationships. The defense mechanism of devaluation is evident in the patient’s quick emotional switches, without middle ground. Dialectical behavior therapy is an effective treatment for BPD, while cognitive behavior therapy is more suitable for depression or anxiety disorders. The clinical picture is more consistent with BPD than depression, and antidepressants may not be effective for BPD. Lithium, the mood stabilizer of choice for bipolar disorder, is not appropriate for this acute event, which occurred over the past few hours rather than days.
Personality disorders are a set of personality traits that are maladaptive and interfere with normal functioning in life. It is estimated that around 1 in 20 people have a personality disorder, which are typically categorized into three clusters: Cluster A, which includes Odd or Eccentric disorders such as Paranoid, Schizoid, and Schizotypal; Cluster B, which includes Dramatic, Emotional, or Erratic disorders such as Antisocial, Borderline (Emotionally Unstable), Histrionic, and Narcissistic; and Cluster C, which includes Anxious and Fearful disorders such as Obsessive-Compulsive, Avoidant, and Dependent.
Paranoid individuals exhibit hypersensitivity and an unforgiving attitude when insulted, a reluctance to confide in others, and a preoccupation with conspiratorial beliefs and hidden meanings. Schizoid individuals show indifference to praise and criticism, a preference for solitary activities, and emotional coldness. Schizotypal individuals exhibit odd beliefs and magical thinking, unusual perceptual disturbances, and inappropriate affect. Antisocial individuals fail to conform to social norms, deceive others, and exhibit impulsiveness, irritability, and aggressiveness. Borderline individuals exhibit unstable interpersonal relationships, impulsivity, and affective instability. Histrionic individuals exhibit inappropriate sexual seductiveness, a need to be the center of attention, and self-dramatization. Narcissistic individuals exhibit a grandiose sense of self-importance, lack of empathy, and excessive need for admiration. Obsessive-compulsive individuals are occupied with details, rules, and organization to the point of hampering completion of tasks. Avoidant individuals avoid interpersonal contact due to fears of criticism or rejection, while dependent individuals have difficulty making decisions without excessive reassurance from others.
Personality disorders are difficult to treat, but a number of approaches have been shown to help patients, including psychological therapies such as dialectical behavior therapy and treatment of any coexisting psychiatric conditions.
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This question is part of the following fields:
- Psychiatry
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Question 13
Incorrect
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A 25-year-old woman visits the clinic with her father. He suspects that his daughter may have autism as she spends most of her time in her room playing video games. He mentions that she is emotionally distant and unresponsive when he tries to talk to her about his concerns. She has no close friends and has never been in a romantic relationship. However, she has recently been promoted at work. When asked for her thoughts on the matter, she seems disinterested and just wants to leave. What is the probable diagnosis?
Your Answer: Schizotypal personality disorder
Correct Answer: Schizoid personality disorder
Explanation:The patient in question appears to have schizoid personality disorder, as he displays a lack of interest in social interaction, emotional detachment, and indifference to both positive and negative feedback. This diagnosis is more likely than others such as antisocial personality disorder, autism spectrum disorder, or avoidant personality disorder, as the patient does not exhibit the specific characteristics associated with these disorders.
Personality disorders are a set of personality traits that are maladaptive and interfere with normal functioning in life. It is estimated that around 1 in 20 people have a personality disorder, which are typically categorized into three clusters: Cluster A, which includes Odd or Eccentric disorders such as Paranoid, Schizoid, and Schizotypal; Cluster B, which includes Dramatic, Emotional, or Erratic disorders such as Antisocial, Borderline (Emotionally Unstable), Histrionic, and Narcissistic; and Cluster C, which includes Anxious and Fearful disorders such as Obsessive-Compulsive, Avoidant, and Dependent.
Paranoid individuals exhibit hypersensitivity and an unforgiving attitude when insulted, a reluctance to confide in others, and a preoccupation with conspiratorial beliefs and hidden meanings. Schizoid individuals show indifference to praise and criticism, a preference for solitary activities, and emotional coldness. Schizotypal individuals exhibit odd beliefs and magical thinking, unusual perceptual disturbances, and inappropriate affect. Antisocial individuals fail to conform to social norms, deceive others, and exhibit impulsiveness, irritability, and aggressiveness. Borderline individuals exhibit unstable interpersonal relationships, impulsivity, and affective instability. Histrionic individuals exhibit inappropriate sexual seductiveness, a need to be the center of attention, and self-dramatization. Narcissistic individuals exhibit a grandiose sense of self-importance, lack of empathy, and excessive need for admiration. Obsessive-compulsive individuals are occupied with details, rules, and organization to the point of hampering completion of tasks. Avoidant individuals avoid interpersonal contact due to fears of criticism or rejection, while dependent individuals have difficulty making decisions without excessive reassurance from others.
Personality disorders are difficult to treat, but a number of approaches have been shown to help patients, including psychological therapies such as dialectical behavior therapy and treatment of any coexisting psychiatric conditions.
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This question is part of the following fields:
- Psychiatry
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Question 14
Incorrect
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A 25-year-old female presents to the emergency department with palpitations. Her ECG reveals first-degree heart block, tall P-waves, and flattened T-waves. Upon arterial blood gas analysis, her results are as follows: pH 7.55 (normal range 7.35-7.45), HCO3- 30 mmol/L (normal range 22-26 mmol/L), pCO2 5.8kPa (normal range 4.5-6kPa), p02 11kPa (normal range 10-14kPa), and Chloride 85mmol/L (normal range 95-108mmol/L). What is the underlying cause of her presentation?
Your Answer: Drug abuse
Correct Answer: Bulimia nervosa
Explanation:The palpitations experienced by this patient are likely due to hypokalaemia, as indicated by their ECG. The ABG results reveal a metabolic alkalosis, with low chloride levels suggesting that the cause is likely due to prolonged vomiting resulting in the loss of hydrochloric acid from the stomach. This could also explain the hypokalaemia observed on the ECG. The absence of acute nausea and vomiting suggests that this may be a chronic issue, possibly indicating bulimia nervosa as the underlying condition, unless there is a previous medical history that could account for persistent vomiting.
Bulimia Nervosa: An Eating Disorder Characterized by Binge Eating and Purging
Bulimia nervosa is a type of eating disorder that involves recurrent episodes of binge eating followed by purging behaviors such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. The DSM 5 diagnostic criteria for bulimia nervosa include recurrent episodes of binge eating, a sense of lack of control over eating during the episode, and recurrent inappropriate compensatory behaviors to prevent weight gain. These behaviors occur at least once a week for three months and are accompanied by an undue influence of body shape and weight on self-evaluation.
Management of bulimia nervosa involves referral for specialist care and the use of bulimia-nervosa-focused guided self-help or individual eating-disorder-focused cognitive behavioral therapy (CBT-ED). Children should be offered bulimia-nervosa-focused family therapy (FT-BN). While pharmacological treatments have a limited role, a trial of high-dose fluoxetine is currently licensed for bulimia. It is important to seek appropriate care for bulimia nervosa to prevent the physical and psychological consequences of this eating disorder.
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This question is part of the following fields:
- Psychiatry
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Question 15
Incorrect
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An older woman was discovered collapsed in a stairwell of a parking lot. A card from an outpatient psychiatry department was discovered in her coat pocket, along with a bottle of procyclidine tablets. She was running a fever (38.2°C), conscious but not responding to instructions. Her blood pressure was 160/105 mmHg, and she had significant muscle rigidity. What is the probable diagnosis?
Your Answer: Procyclidine overdose
Correct Answer: Neuroleptic malignant syndrome
Explanation:Neuroleptic Malignant Syndrome and Procyclidine Overdose
Neuroleptic malignant syndrome (NMS) is a serious condition that can occur as a side effect of taking neuroleptic medications. Its symptoms include fever, muscular rigidity, altered mental status, and autonomic dysfunction. These symptoms are typical of NMS and can be life-threatening if not treated promptly.
Procyclidine is a medication used to treat the parkinsonian side-effects of neuroleptics. If found in a patient’s pocket, it implies that they were taking neuroleptics. Signs of procyclidine overdose include agitation, confusion, sleeplessness lasting up to 24 hours or more, and dilated and unreactive pupils. Visual and auditory hallucinations and tachycardia have also been reported.
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This question is part of the following fields:
- Psychiatry
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Question 16
Incorrect
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A 29-year-old man is admitted to a psychiatry ward from the emergency department. He was brought by a concerned family member who was worried by his recent behaviour. He had been engaging in large amounts of shopping, spending nearly every night at the mall and hardly sleeping. When asked if he understands the risks of overspending, he is convinced that nothing can go wrong. He struggles to focus on the topic and begins rambling about buying various different items that are sure to make him happy. A diagnosis of a manic episode is made and he is stabilised on treatment with quetiapine. Subsequently it is decided to initiate lithium to maintain his mood.
When should his serum lithium levels next be monitored?Your Answer: 3 months - 12 hours after last dose
Correct Answer: 1 week - 12 hours after last dose
Explanation:To prevent future manic episodes, this patient with an acute manic episode can be prescribed lithium as a prophylactic mood stabilizer. When starting or changing the dose of lithium, weekly monitoring of lithium levels is necessary, with samples taken 12 hours after the last dose. After treatment is established, monitoring frequency can be reduced to every 3 months, with samples still taken 12 hours after the last dose. Additionally, U&E and TFTs should be monitored every 6 months after starting treatment.
Lithium is a medication used to stabilize mood in individuals with bipolar disorder and as an adjunct in treatment-resistant depression. It has a narrow therapeutic range of 0.4-1.0 mmol/L and is primarily excreted by the kidneys. The mechanism of action is not fully understood, but it is believed to interfere with inositol triphosphate and cAMP formation. Adverse effects may include nausea, vomiting, diarrhea, fine tremors, nephrotoxicity, thyroid enlargement, ECG changes, weight gain, idiopathic intracranial hypertension, leucocytosis, hyperparathyroidism, and hypercalcemia.
Monitoring of patients taking lithium is crucial to prevent adverse effects and ensure therapeutic levels. It is recommended to check lithium levels 12 hours after the last dose and weekly after starting or changing the dose until levels are stable. Once established, lithium levels should be checked every three months. Thyroid and renal function should be monitored every six months. Patients should be provided with an information booklet, alert card, and record book to ensure proper management of their medication. Inadequate monitoring of patients taking lithium is common, and guidelines have been issued to address this issue.
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This question is part of the following fields:
- Psychiatry
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Question 17
Correct
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A 56-year-old man presents to the community mental health team with a history of obsessive-compulsive disorder (OCD). He reports obsessive thoughts about his family members being in danger and admits to calling his wife and daughters 3-4 times an hour to ensure their safety. Despite undergoing cognitive behaviour therapy (CBT) with exposure and response prevention (ERP), he still experiences distressing symptoms. The patient has a medical history of hypertension, hypercholesterolaemia, unstable angina, and pre-diabetes. What would be the most appropriate course of action for managing this man's OCD?
Your Answer: Add sertraline
Explanation:Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions that can cause significant functional impairment and distress. Risk factors include family history, age, pregnancy/postnatal period, and history of abuse, bullying, or neglect. Treatment options include low-intensity psychological treatments, SSRIs, and more intensive CBT (including ERP). Severe cases should be referred to the secondary care mental health team for assessment and may require combined treatment with an SSRI and CBT or clomipramine as an alternative. ERP involves exposing the patient to an anxiety-provoking situation and stopping them from engaging in their usual safety behavior. Treatment with SSRIs should continue for at least 12 months to prevent relapse and allow time for improvement.
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This question is part of the following fields:
- Psychiatry
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Question 18
Correct
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A 28-year-old woman comes to her doctor with a similar complaint of anxiety that has been affecting her sleep and social interactions for several months. She reports feeling restless and agitated but denies any panic attacks. Her medical history is unremarkable. What would be the best initial approach to address her symptoms?
Your Answer: Sertraline
Explanation:The preferred initial pharmacological treatment for generalised anxiety disorder is an SSRI, with sertraline being the recommended choice according to NICE guidance. Tricyclic antidepressants like amitriptyline are considered second- or third-line options, while SNRIs like duloxetine may be used if sertraline is ineffective. Beta-blockers like propranolol are typically used as needed for acute anxiety or panic attacks and are not recommended as monotherapy for chronic anxiety.
Anxiety is a common disorder that can manifest in various ways. According to NICE, the primary feature is excessive worry about multiple events associated with heightened tension. It is crucial to consider potential physical causes when diagnosing anxiety disorders, such as hyperthyroidism, cardiac disease, and medication-induced anxiety. Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants, and caffeine.
NICE recommends a step-wise approach for managing generalised anxiety disorder (GAD). This includes education about GAD and active monitoring, low-intensity psychological interventions, high-intensity psychological interventions or drug treatment, and highly specialist input. Sertraline is the first-line SSRI for drug treatment, and if it is ineffective, an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI) such as duloxetine or venlafaxine may be offered. If the patient cannot tolerate SSRIs or SNRIs, pregabalin may be considered. For patients under 30 years old, NICE recommends warning them of the increased risk of suicidal thinking and self-harm and weekly follow-up for the first month.
The management of panic disorder also follows a stepwise approach, including recognition and diagnosis, treatment in primary care, review and consideration of alternative treatments, review and referral to specialist mental health services, and care in specialist mental health services. NICE recommends either cognitive behavioural therapy or drug treatment in primary care. SSRIs are the first-line drug treatment, and if contraindicated or no response after 12 weeks, imipramine or clomipramine should be offered.
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This question is part of the following fields:
- Psychiatry
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Question 19
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A 55-year-old man visits his GP clinic complaining of chronic constipation that has persisted for several years. He reveals that he has not had a bowel movement in ten days. The patient has a medical history of atrial fibrillation, type II diabetes mellitus, gastro-oesophageal reflux disease, and paranoid schizophrenia. He is currently taking apixaban, clozapine, digoxin, metformin, and lansoprazole. During the physical examination, the doctor notes a hard, non-tender abdomen and fecal impaction upon PR examination. Which of the medications listed above is likely contributing to his long-standing constipation?
Your Answer: Clozapine
Explanation:Constipation/intestinal obstruction is a prevalent adverse effect of clozapine.
Clozapine is known to cause constipation, which can have severe consequences. Research indicates that gastrointestinal side effects, including bowel obstruction and perforation, have a higher mortality rate than agranulocytosis. In contrast, digoxin, metformin, and lansoprazole can all result in diarrhea, while apixaban is not associated with constipation.
Atypical antipsychotics are now recommended as the first-line treatment for patients with schizophrenia, as per the 2005 NICE guidelines. These medications have the advantage of significantly reducing extrapyramidal side-effects. However, they can also cause adverse effects such as weight gain, hyperprolactinaemia, and in the case of clozapine, agranulocytosis. The Medicines and Healthcare products Regulatory Agency has issued warnings about the increased risk of stroke and venous thromboembolism when antipsychotics are used in elderly patients. Examples of atypical antipsychotics include clozapine, olanzapine, risperidone, quetiapine, amisulpride, and aripiprazole.
Clozapine, one of the first atypical antipsychotics, carries a significant risk of agranulocytosis and requires full blood count monitoring during treatment. Therefore, it should only be used in patients who are resistant to other antipsychotic medication. The BNF recommends introducing clozapine if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs, one of which should be a second-generation antipsychotic drug, each for at least 6-8 weeks. Adverse effects of clozapine include agranulocytosis, neutropaenia, reduced seizure threshold, constipation, myocarditis, and hypersalivation. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment.
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This question is part of the following fields:
- Psychiatry
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Question 20
Incorrect
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You are asked to assess a 76-year-old man who was admitted to the ward yesterday with agitation and distressing hallucinations believed to be caused by delirium from a urinary tract infection (UTI). The nursing staff is concerned that he is now exhibiting rigid movements and hand tremors, in addition to being very confused. The patient's wife mentions that he had previously experienced confusion, sleep disturbances, visual hallucinations, and abnormal movements. Which medication is most likely responsible for the patient's decline?
Your Answer: Clonazepam
Correct Answer: Haloperidol
Explanation:Medications for Lewy Body Dementia
Lewy body dementia is a type of dementia that can cause confusion, sleep difficulties, visual hallucinations, and abnormal movements. It is important to choose the right medication for patients with this condition, as some drugs can worsen symptoms. Here are some medications that can be used to treat Lewy body dementia:
1. Clonazepam: This drug can be used to treat rapid eye movement (REM) sleep behavior disorders.
2. Donepezil: This medication is an acetylcholinesterase inhibitor that can help improve symptoms such as hallucinations and confusion.
3. Memantine: This drug is an N-methyl-D-aspartate (NMDA) receptor antagonist that can be used in patients who cannot take acetylcholinesterase inhibitors.
4. Rivastigmine: This medication is another type of acetylcholinesterase inhibitor that can be used to relieve some of the symptoms of Lewy body dementia.
It is important to consult with a healthcare professional before starting any medication for Lewy body dementia.
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This question is part of the following fields:
- Psychiatry
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Question 21
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A 36-year-old woman is admitted to the Emergency Department following taking approximately 18 paracetamol tablets three hours earlier. She had a row with her husband and took the tablets as she was angry and upset. She called her husband after she took the tablets, who rang for an ambulance.
This is the first time she has ever done anything like this, and she regrets the fact that she did it. She is currently studying at university, and only drinks recreationally. She is normally fit and well and has no history of mental health conditions.
Which of the following factors are associated with increased risk of a further suicide attempt in someone who has already made a suicide attempt?Your Answer: Alcohol or drug abuse, history of violence and single, divorced or separated
Explanation:Risk Factors for Repeated Suicide Attempts
Individuals who have previously attempted suicide are at an increased risk of making another attempt. Factors that contribute to this risk include a history of previous attempts, personality disorders, alcohol or drug abuse, previous psychiatric treatment, unemployment, lower social class, criminal record, history of violence, and being between the ages of 25 and 54, as well as being single, divorced, or separated. Rates of further suicide attempts in the year following an attempt are high, ranging from 15 to 25 percent. However, being married or having short stature does not appear to be a significant risk factor for repeated suicide attempts.
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This question is part of the following fields:
- Psychiatry
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Question 22
Correct
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A 26-year-old female smoker comes to your clinic with a complaint of difficulty sleeping for the past 6 months. She often stays awake for hours worrying before finally falling asleep, which is affecting her work concentration. You observe that she seems restless and fidgety during the consultation. Upon reviewing her medical records, you discover that she has recently experienced abdominal pain and palpitations. What is the crucial condition to exclude before diagnosing her with generalized anxiety disorder?
Your Answer: Hyperthyroidism
Explanation:When diagnosing anxiety, it is important to rule out thyroid disease as the symptoms of anxiety and hyperthyroidism can be similar. Hyperthyroidism can both cause and worsen anxiety. While phaeochromocytoma and Wilson’s disease are possible alternative diagnoses, they are not typically considered before diagnosing anxiety. It is worth noting that insomnia is a symptom of anxiety rather than a separate diagnosis.
Anxiety is a common disorder that can manifest in various ways. According to NICE, the primary feature is excessive worry about multiple events associated with heightened tension. It is crucial to consider potential physical causes when diagnosing anxiety disorders, such as hyperthyroidism, cardiac disease, and medication-induced anxiety. Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants, and caffeine.
NICE recommends a step-wise approach for managing generalised anxiety disorder (GAD). This includes education about GAD and active monitoring, low-intensity psychological interventions, high-intensity psychological interventions or drug treatment, and highly specialist input. Sertraline is the first-line SSRI for drug treatment, and if it is ineffective, an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI) such as duloxetine or venlafaxine may be offered. If the patient cannot tolerate SSRIs or SNRIs, pregabalin may be considered. For patients under 30 years old, NICE recommends warning them of the increased risk of suicidal thinking and self-harm and weekly follow-up for the first month.
The management of panic disorder also follows a stepwise approach, including recognition and diagnosis, treatment in primary care, review and consideration of alternative treatments, review and referral to specialist mental health services, and care in specialist mental health services. NICE recommends either cognitive behavioural therapy or drug treatment in primary care. SSRIs are the first-line drug treatment, and if contraindicated or no response after 12 weeks, imipramine or clomipramine should be offered.
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This question is part of the following fields:
- Psychiatry
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Question 23
Correct
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A 14-year-old boy comes to the clinic with complaints of sudden jerking movements of his neck, causing his head to move involuntarily from left to right. He has been experiencing these symptoms for a few years, but lately, he has been feeling embarrassed as he involuntarily utters swear words in social situations. These symptoms worsen when he is under stress. What is the most probable diagnosis for this patient?
Your Answer: Tourette’s syndrome
Explanation:Understanding Tourette’s Syndrome: Symptoms and Treatment Options
Tourette’s syndrome is a neurological disorder that typically presents in childhood or adolescence. It is characterized by the presence of multiple motor tics and one or more vocal tics, which may not occur concurrently. The vocal tics can be throat-clearing, grunting, or other sounds that are not complete words or phrases. In some cases, there may also be associated gestural echopraxia, which can be of an obscene nature.
Schizophrenia, on the other hand, does not typically present with involuntary movements or tics. Conduct disorder is a mental disorder that is diagnosed before or after the age of 10 and is characterized by a persistent pattern of behavior that violates the basic rights of others or goes against age-developmental norms. Malingering is the fabrication of symptoms for some sort of secondary gain, while dissocial personality disorder is characterized by a long-term disregard for others or the violation of others.
Treatment options for Tourette’s syndrome include anti-psychotics such as pimozide, risperidone, and sulpiride, which have been shown to be effective. It is important to seek professional help if you or someone you know is experiencing symptoms of Tourette’s syndrome to receive an accurate diagnosis and appropriate treatment.
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This question is part of the following fields:
- Psychiatry
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Question 24
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A 70-year-old man comes in for his routine psychiatric follow-up appointment. He has a history of schizophrenia that has been difficult to manage, but has been stable for the past 5 years on various antipsychotic medications. He also has type II diabetes. During the appointment, he reports experiencing repetitive, involuntary movements of his lips and tongue, including lip smacking and grimacing. Which medication is the most likely culprit for these symptoms?
Your Answer: Haloperidol
Explanation:Understanding Tardive Dyskinesia and its Association with Antipsychotic Drugs
Tardive dyskinesia is a disorder characterized by involuntary and repetitive movements, including lip puckering, excessive blinking, and pursing of the lips. This condition is commonly associated with the use of typical (older generation) antipsychotics such as haloperidol, prochlorperazine, and flupentixol. However, newer generation (atypical) antipsychotics like olanzapine, quetiapine, risperidone, and clozapine have a lower risk of causing tardive dyskinesia.
If tardive dyskinesia is diagnosed, the causative drug should be discontinued. It is important to note that the dyskinesia may persist for months after drug withdrawal and may even be permanent. Metformin is not linked to tardive dyskinesia.
Risperidone is an atypical antipsychotic used to treat schizophrenia, bipolar disorder, and autism. Current evidence suggests that the risk of developing tardive dyskinesia is lower than with typical antipsychotic use. To prevent tardive dyskinesia in chronic psychoses, it is recommended to use the lowest effective dose for the shortest possible time, while balancing the fact that increased doses are more beneficial to prevent recurrence.
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This question is part of the following fields:
- Psychiatry
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Question 25
Correct
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A 32-year-old Welsh Guard returning from operational duty overseas has been suffering from nightmares and intrusive memories of his military experiences for the past 6 months. He avoids anything that reminds him of his tour of duty and is emotionally detached. He has trouble sleeping, concentrating, and is easily startled by loud noises. Additionally, he has been abusing alcohol. What is the probable diagnosis?
Your Answer: Post-traumatic stress disorder (PTSD)
Explanation:Understanding Different Types of Anxiety Disorders
Post-traumatic stress disorder (PTSD) is characterized by a mix of anxiety and dissociative symptoms that persist for several months. Patients with PTSD often experience unintentional recollection, flashbacks, and nightmares of the traumatic event. They may also exhibit symptoms of chronic hyperarousal, such as sleep disruptions, irritability, and hypervigilance.
Panic disorder with agoraphobia is diagnosed in patients who avoid situations that they believe may trigger a panic attack or where it would be dangerous or embarrassing to have one.
Acute stress disorder is a condition that typically subsides within a month and is most common in patients who use dissociation to separate the events from the associated painful emotions.
Generalized anxiety disorder is characterized by a mental state of dread or fear and somatic manifestations, such as palpitations, churning stomach, and muscle tension. Patients with this disorder often have fears concerning many aspects of their personal security.
Somatization disorder is a condition where patients seek medical attention for cryptic physical symptoms that are difficult to explain. Patients with this disorder complain of problems in at least four different organ systems, usually without clear physical cause. They often deny anxiety or psychic distress, except for distress about their physical condition.
Overall, understanding the different types of anxiety disorders and their symptoms can help with proper diagnosis and treatment.
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This question is part of the following fields:
- Psychiatry
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Question 26
Correct
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A 27-year-old man presents with a 6-month history of depressed mood. He reports feeling fatigued and having suicidal thoughts on a daily basis. His appearance is disheveled and he has made multiple suicide attempts in the past few months. The psychiatrist decides to initiate electroconvulsive therapy (ECT) for his depression, scheduled to begin in a week. The patient is currently taking 100 mg of sertraline daily. What is the appropriate course of action regarding his medication prior to ECT treatment?
Your Answer: Reduce the sertraline daily dose
Explanation:Before commencing ECT treatment, it is important to reduce the dosage of antidepressant medication, but not to stop it completely. The recommended approach is to gradually decrease the dosage to the minimum level. In some cases, an increased dosage of antidepressants may be added towards the end of the ECT course. It is not advisable to increase the dosage or discontinue the medication altogether. Switching to an alternative psychiatric drug, such as another SSRI or lithium, is also not recommended as it can be risky before ECT treatment.
Electroconvulsive therapy (ECT) is a viable treatment option for patients who suffer from severe depression that does not respond to medication, such as catatonia, or those who experience psychotic symptoms. The only absolute contraindication for ECT is when a patient has raised intracranial pressure.
Short-term side effects of ECT include headaches, nausea, short-term memory impairment, memory loss of events prior to the therapy, and cardiac arrhythmia. However, these side effects are typically temporary and resolve quickly.
Long-term side effects of ECT are less common, but some patients have reported impaired memory. It is important to note that the benefits of ECT often outweigh the potential risks, and it can be a life-changing treatment for those who have not found relief from other forms of therapy.
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This question is part of the following fields:
- Psychiatry
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Question 27
Correct
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Which statement about the causation and dynamics of schizophrenia is accurate?
Your Answer: Schizophrenia is commoner in individuals not in stable relationships
Explanation:Schizophrenia Risk Factors
Schizophrenia is a mental disorder that affects a person’s ability to think, feel, and behave clearly. The risk of developing schizophrenia is influenced by various factors, including heavy cannabis use, marital status, socioeconomic status, and genetics.
According to the Swedish conscript study, heavy cannabis users have a sevenfold increase in the risk of developing schizophrenia. However, it is unclear whether cannabis use directly causes schizophrenia or if there are other underlying factors at play.
Marital status also appears to be a factor in schizophrenia risk, with unmarried and divorced individuals being twice as likely to develop the disorder compared to married or widowed individuals. This may be due to the alienating effects of schizophrenia rather than any causal relationship with being single.
Additionally, people with schizophrenia are more likely to be in the lowest socioeconomic groups. While poverty may not directly cause schizophrenia, it may increase the risk of exposure to biological factors or social stressors that could trigger the illness in susceptible individuals.
Finally, genetics also play a significant role in schizophrenia risk, with monozygotic twins having a 50% concordance rate and 10% of offspring being affected. This suggests a strong inheritance component to the disorder.
Overall, while the exact causes of schizophrenia are not fully understood, it is clear that multiple factors contribute to its development.
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This question is part of the following fields:
- Psychiatry
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Question 28
Incorrect
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A 45-year-old patient with a history of rheumatoid arthritis is currently taking sulfasalazine, paracetamol, and ibuprofen for their condition. They have been experiencing low mood and have tried non-pharmaceutical interventions with little success. The patient now reports that their depressive symptoms are worsening, prompting the GP to consider starting them on an antidepressant. Which antidepressant would pose the highest risk of causing a GI bleed in this patient, necessitating the use of a proton pump inhibitor as a precaution?
Your Answer: Selegiline
Correct Answer: Citalopram
Explanation:When prescribing an SSRI such as citalopram for depression, it is important to consider the potential risk of GI bleeding, especially if the patient is already taking an NSAID. This is because SSRIs can deplete platelet serotonin, which can reduce clot formation and increase the risk of bleeding. To mitigate this risk, a PPI should also be prescribed.
TCAs like amitriptyline are also used to treat depression and pain syndromes, but they are not commonly associated with GI bleeds. Haloperidol, a typical antipsychotic, and selegiline, a MAOI, are rarely used for depression and are not typically associated with GI bleeds either.
St John’s Wort, a plant commonly used in alternative medicine for depression, has not been associated with an increased risk of GI bleeding, but it can interfere with other medications and increase the risk of serotonin syndrome when used with other antidepressants.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used as the first-line treatment for depression. Citalopram and fluoxetine are the preferred SSRIs, while sertraline is recommended for patients who have had a myocardial infarction. However, caution should be exercised when prescribing SSRIs to children and adolescents. Gastrointestinal symptoms are the most common side-effect, and patients taking SSRIs are at an increased risk of gastrointestinal bleeding. Patients should also be aware of the possibility of increased anxiety and agitation after starting a SSRI. Fluoxetine and paroxetine have a higher propensity for drug interactions.
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning regarding the use of citalopram due to its association with dose-dependent QT interval prolongation. As a result, citalopram and escitalopram should not be used in patients with congenital long QT syndrome, known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval. The maximum daily dose of citalopram is now 40 mg for adults, 20 mg for patients older than 65 years, and 20 mg for those with hepatic impairment.
When initiating antidepressant therapy, patients should be reviewed by a doctor after 2 weeks. Patients under the age of 25 years or at an increased risk of suicide should be reviewed after 1 week. If a patient responds well to antidepressant therapy, they should continue treatment for at least 6 months after remission to reduce the risk of relapse. When stopping a SSRI, the dose should be gradually reduced over a 4 week period, except for fluoxetine. Paroxetine has a higher incidence of discontinuation symptoms, including mood changes, restlessness, difficulty sleeping, unsteadiness, sweating, gastrointestinal symptoms, and paraesthesia.
When considering the use of SSRIs during pregnancy, the benefits and risks should be weighed. Use during the first trimester may increase the risk of congenital heart defects, while use during the third trimester can result in persistent pulmonary hypertension of the newborn. Paroxetine has an increased risk of congenital malformations, particularly in the first trimester.
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This question is part of the following fields:
- Psychiatry
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Question 29
Correct
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A 25-year-old trans woman visits her primary care physician after experiencing a sexual assault by a coworker at her workplace two weeks ago. She has been suffering from persistent flashbacks, nightmares, and dissociation since the incident, which has affected her sleep and caused her to take a two-week leave from work. What would be the optimal initial treatment for her likely diagnosis, if it were readily accessible?
Your Answer: Trauma-focused cognitive behavioural therapy
Explanation:For individuals experiencing distressing symptoms following a traumatic event, such as the woman in this scenario, trauma-focused cognitive-behavioural therapy (CBT) should be the first-line treatment for acute stress disorders. This type of therapy involves a highly trained therapist exploring the thoughts surrounding the traumatic event and linking them to behaviours or symptoms that may be developing as a result. The goal is to give control back to the individual over their thoughts and behaviours.
Counselling is not appropriate for acute stress disorders, as it involves a counsellor listening and empathising with the individual, but taking less control over the conversation than a therapist would. Counselling may even be harmful, as it may exacerbate negative thoughts by exploring the trauma in an uncontrolled way.
Eye movement desensitisation and reprocessing therapy is not appropriate for acute stress disorders, as it is the first-line treatment for post-traumatic stress disorder, which cannot be diagnosed until 4 weeks after the event. This type of therapy involves reprocessing thoughts of the trauma with the goal of eventually letting them go.
Interpersonal therapy is not appropriate for acute stress disorders, as it is intended to address longer-term, deep-rooted thoughts related to relationships with others.
Mindfulness-based cognitive therapy is not appropriate for acute stress disorders, as there is no evidence that mindfulness alone is enough to deal with severe reactions to trauma.
Acute stress disorder is a condition that occurs within the first four weeks after a person has experienced a traumatic event, such as a life-threatening situation or sexual assault. It is characterized by symptoms such as intrusive thoughts, dissociation, negative mood, avoidance, and arousal. These symptoms can include flashbacks, nightmares, feeling disconnected from reality, and being hypervigilant.
To manage acute stress disorder, trauma-focused cognitive-behavioral therapy (CBT) is typically the first-line treatment. This type of therapy helps individuals process their traumatic experiences and develop coping strategies. In some cases, benzodiazepines may be used to alleviate acute symptoms such as agitation and sleep disturbance. However, caution must be taken when using these medications due to their addictive potential and potential negative impact on adaptation. Overall, early intervention and appropriate treatment can help individuals recover from acute stress disorder and prevent the development of more chronic conditions such as PTSD.
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This question is part of the following fields:
- Psychiatry
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Question 30
Incorrect
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A father is concerned about his 19 year-old daughter, who has recently become more reclusive and spends most days in her bedroom. She has stopped socialising with friends and has dropped out of college. She has also removed all the mirrors in her room as she believes that people are spying on her through the mirrors. The father's sister has had schizophrenia in the past, and he is worried that his daughter is showing very similar symptoms.
Which of the following statements best characterises the aetiology of schizophrenia?Your Answer: In a family with one schizophrenic parent, the risk of schizophrenia in a child is about 25%
Correct Answer: Approximately 20 million people worldwide are reported to have schizophrenia with a prevalence of up to 1%
Explanation:Understanding Schizophrenia: Genetic and Environmental Factors
Schizophrenia is a complex mental illness that affects approximately 20 million people worldwide, with a prevalence of up to 1%. While there is clear evidence of a genetic predisposition to the disease, the heterogeneity of schizophrenia has presented a major challenge to medical research, resulting in a variety of explanatory hypotheses and controversies.
Studies have shown that monozygotic twins have an 85% concordance for schizophrenia, while dizygotic twins have a concordance of 50%. This suggests a significant genetic contribution to the illness, but also implies that non-genetic factors may be necessary for full expression of the disease.
Neurodevelopmental trauma has been linked to an increased risk of schizophrenia, but there is also evidence that family variables can exacerbate the illness. Adoption studies have shown that family environment does not cause schizophrenia, but patients who live in families where they are criticised and treated with hostility by an over-involved parent have higher rates of relapse and greater need for anti-psychotic medication.
Overall, understanding the genetic and environmental factors that contribute to schizophrenia is crucial for developing effective treatments and interventions for those affected by this debilitating illness.
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This question is part of the following fields:
- Psychiatry
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