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  • Question 1 - You are asked to see a new adolescent patient admitted to the ward...

    Incorrect

    • You are asked to see a new adolescent patient admitted to the ward by one of your colleagues. The patient has been diagnosed with acute mania and requires some medication. The patient is keen to discuss the options. The patient asks you which medication is best tolerated. Which of the following medications has been shown to be most acceptable to adolescent patients with acute mania?

      Your Answer: Lithium

      Correct Answer: Olanzapine

      Explanation:

      Antimanic Drugs: Efficacy and Acceptability

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      23.5
      Seconds
  • Question 2 - What are the factors that have been demonstrated to elevate the likelihood of...

    Incorrect

    • What are the factors that have been demonstrated to elevate the likelihood of suicide among prisoners?

      Your Answer: Being older

      Correct Answer: Being on remand

      Explanation:

      Suicide in Prison: High Rates and Risk Factors

      Suicide rates among prisoners are significantly higher than in the general population, with an average rate of 133 per 100,000 population per year in England and Wales in 1999-2000. Remand prisoners had an even higher rate of 339 per 100,000 population per year. Early suicides were more common in drug-dependent prisoners, with 59% occurring within 7 days of reception into prison.

      The most common method of suicide was hanging of self-strangulation, with bedclothes being the most common ligature used. Window bars, beds, and cell fittings such as lights, pipes, cupboards, sinks, toilets, of doors were the main ligature points. 72% of prisoners had at least one known psychiatric diagnosis, with drug dependence being the most common primary diagnosis at 27%. Schizophrenia was diagnosed in 6% of prisoners, and affective disorder in 18%.

      Risk factors for suicide in prisoners include being in a single cell, being male, having a psychiatric illness, having a history of substance misuse, having a history of previous self-harm of attempted suicide, recent suicidal ideation, and being on remand. Surprisingly, being married was found to be a risk factor for suicide in prisoners, in contrast to the general population where it is a protective factor.

      Overall, these findings highlight the urgent need for effective suicide prevention strategies in prisons, particularly for those at higher risk. This may include improved mental health services, better screening and assessment of risk factors, and measures to reduce access to means of suicide such as ligature points.

    • This question is part of the following fields:

      • Forensic Psychiatry
      16.7
      Seconds
  • Question 3 - What is the recommended treatment for alcohol withdrawal in a patient with liver...

    Correct

    • What is the recommended treatment for alcohol withdrawal in a patient with liver impairment?

      Your Answer: Lorazepam

      Explanation:

      Patients with impaired liver function, such as those with liver failure of elderly individuals, may be prescribed oxazepam, temazepam, of lorazepam.

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      9.7
      Seconds
  • Question 4 - A 42-year-old man with a history of heavy alcohol use for the past...

    Correct

    • A 42-year-old man with a history of heavy alcohol use for the past 15 years presents with seizures and worsening difficulty with walking. During a mini-mental state examination, you observe that his score is 20/30, which is two points lower than his previous score from a few months ago. What is the most probable site of the lesion?

      Your Answer: Corpus callosum

      Explanation:

      The passage details the effects of Marchiafava-Bignami disease, a condition resulting from excessive alcohol consumption that leads to the deterioration of the corpus callosum.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      18.5
      Seconds
  • Question 5 - A 55-year-old male is admitted with fatigue, nausea and weight loss. He has...

    Correct

    • A 55-year-old male is admitted with fatigue, nausea and weight loss. He has a history of heavy alcohol use and has experienced delirium tremens in the past. He has abstained from alcohol for the past two days.
      During examination, he appears thin, alert and oriented. He displays signs of chronic liver disease, but there is no evidence of a flapping tremor. His pulse is regular at 88 bpm, his blood pressure is 106/74 mmHg, and his temperature is 37°C.
      What medication would be recommended for preventing acute alcohol withdrawal in this patient?

      Your Answer: Oral lorazepam

      Explanation:

      This patient, who exhibits signs of chronic liver disease due to alcohol consumption, is at high risk of experiencing acute alcohol withdrawal, especially considering her history of delirium tremens. To prevent this, benzodiazepines are appropriate agents, with oral medications like lorazepam and diazepam being recommended. While benzodiazepines can cause hepatic encephalopathy in patients with liver cirrhosis, it is not yet known if this patient has cirrhosis, and the risk of alcohol withdrawal is significant. Therefore, she should be given benzodiazepines and closely monitored for any signs of encephalopathy. In cases of hepatic impairment, benzodiazepines with a shorter half-life, such as lorazepam and oxazepam, are preferred.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      13
      Seconds
  • Question 6 - A 30 year old man presents to his primary care physician with complaints...

    Incorrect

    • A 30 year old man presents to his primary care physician with complaints of insomnia, anxiety, tremors, and confusion. He is an avid bodybuilder and reports that he had been taking a supplement to enhance his muscle growth. He explains that he had been using a clear liquid provided by a friend. What is the most likely cause of his symptoms?

      Your Answer: Mephedrone

      Correct Answer: Gamma Butyrolactone

      Explanation:

      The indications are in line with the effects of discontinuing GBL use, which is frequently utilized by individuals in the bodybuilding community due to its perceived ability to aid in muscle growth.

      New Psychoactive Substances, previously known as ‘legal highs’, are synthetic compounds designed to mimic the effects of traditional illicit drugs. They became popular due to their ability to avoid legislative control, but the introduction of the Psychoactive Substances Act 2016 changed this. There is no standard for clinical classification, but some common legal highs include Mephedrone, Piperazines, GBL, Synthetic cannabinoids, and Benzofuran compounds. These substances have effects similar to ecstasy, amphetamines, and cannabis, and are classified as either Class B of Class C drugs in the UK.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      17.2
      Seconds
  • Question 7 - How does the suicide rate in patients with epilepsy compare to the general...

    Incorrect

    • How does the suicide rate in patients with epilepsy compare to the general population?

      Your Answer: 4 times lower

      Correct Answer: 3 times higher

      Explanation:

      Suicide Risk in Epilepsy

      Several studies have shown that individuals with epilepsy have an increased risk of suicide. A large study published in the Lancet in 2007 found that individuals with epilepsy were three times more likely to commit suicide compared to those without epilepsy. This risk remained high even after excluding those with a history of psychiatric disease and adjusting for socioeconomic factors.

      The highest risk of suicide was found in individuals with epilepsy and comorbid psychiatric disease, with a risk of 13.7 times higher than controls. The risk of suicide was also highest during the first six months after diagnosis, especially in those with a history of comorbid psychiatric disease.

      These findings highlight the importance of addressing mental health concerns in individuals with epilepsy, particularly during the early stages of diagnosis. Healthcare providers should be aware of the increased risk of suicide in this population and provide appropriate support and resources to prevent suicide.

    • This question is part of the following fields:

      • General Adult Psychiatry
      6.3
      Seconds
  • Question 8 - Which statement about Brief psychodynamic therapy is false? ...

    Correct

    • Which statement about Brief psychodynamic therapy is false?

      Your Answer: Transference is not considered important

      Explanation:

      Brief Psychodynamic Psychotherapy: A Time-Limited Treatment

      Brief psychodynamic psychotherapy is a type of therapy that is based on psychodynamic principles and is designed to be completed within a limited time frame, typically 10-12 sessions. This therapy is particularly effective when there is a specific focus of problem that the patient is dealing with. However, it is important that the patient is highly motivated and able to think in feeling terms for the therapy to be successful.

      There are different subtypes of brief psychodynamic psychotherapy, and some factors are considered contraindications for this type of therapy. These include serious suicide attempts, substance abuse, and marked acting out. Overall, brief psychodynamic psychotherapy can be a useful tool for addressing specific issues and helping patients achieve their therapeutic goals within a limited time frame.

    • This question is part of the following fields:

      • Psychotherapy
      18.3
      Seconds
  • Question 9 - As per Rapoport, what is the principle of permissiveness in therapeutic communities? ...

    Correct

    • As per Rapoport, what is the principle of permissiveness in therapeutic communities?

      Your Answer: To follow rules and respect boundaries

      Explanation:

      Rapoport’s four principles of therapeutic communities include permissiveness, democratisation, communalism, and reality confrontation. Permissiveness allows members to express themselves freely while respecting the community’s rules and boundaries. This principle encourages members to investigate and discuss their behavior to gain insight. However, permissiveness should not negatively affect other members of exclude them. Communalism involves communication, task-sharing, and interdependence, promoting belonging and primary bond development. Reality confrontation helps members find their place among others. Democratisation involves participation in decision-making and voting.

    • This question is part of the following fields:

      • Psychotherapy
      21
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  • Question 10 - A 45-year-old individual with a long-standing history of bipolar disorder has been an...

    Correct

    • A 45-year-old individual with a long-standing history of bipolar disorder has been an inpatient on an acute admission ward for four months detained under section 2 of the Mental Health Act. Their manic episodes have subsided to their chronic baseline level. Periods of escorted leave have been associated with substance misuse and impulsive behavior including shoplifting and suspected vandalism. What would be the most suitable course of action for their treatment plan?

      Your Answer: Transfer to rehabilitation unit

      Explanation:

      Given the patient’s improved psychotic symptoms, an extended stay in an acute ward would not be beneficial. However, due to ongoing substance misuse and challenging behaviors, discharge from the hospital is not yet possible. While an addictions admission of transfer to a forensic ward is not necessary, a rehabilitation psychiatry ward would be the most appropriate next step. This would provide the patient with the necessary support to address their substance misuse and challenging behaviors, while also promoting their skills and independence for a successful return to community living.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      134.5
      Seconds
  • Question 11 - Which of the following is most likely to result in a positive drug...

    Incorrect

    • Which of the following is most likely to result in a positive drug urinalysis for benzodiazepines?

      Your Answer: Lorazepam

      Correct Answer: Diazepam

      Explanation:

      Urine drug screens typically aim to identify nordiazepam of oxazepam, which are metabolites of diazepam. However, benzodiazepines such as alprazolam, lorazepam, and clonazepam, which are commonly prescribed and abused, do not produce these metabolites and may not be detected by many urine drug immunoassays.

      Drug Screening

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      17.1
      Seconds
  • Question 12 - Who were ineligible to participate in the voting process during the 2015 UK...

    Incorrect

    • Who were ineligible to participate in the voting process during the 2015 UK parliamentary election?

      Your Answer: Detained inpatients

      Correct Answer: Prisoners serving a custodial sentence

      Explanation:

      Individuals who are serving a custodial sentence were excluded from voting in the 2015 UK general election. However, patients undergoing treatment for mental illness have the right to vote, except for those who have been detained by the courts due to a criminal conviction. People with disabilities that may affect their ability to vote, such as those with intellectual disabilities, are still eligible to vote and should be provided with extra assistance to help them exercise their right to vote.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      21
      Seconds
  • Question 13 - What signs of symptoms would indicate a diagnosis of conduct disorder instead of...

    Incorrect

    • What signs of symptoms would indicate a diagnosis of conduct disorder instead of oppositional defiant disorder?

      Your Answer: Losing temper

      Correct Answer: Often lies to obtain goods of favours of to avoid obligations

      Explanation:

      Disruptive Behaviour of Dissocial Disorders

      Conduct disorders are the most common reason for referral of young children to mental health services. These disorders are characterized by a repetitive and persistent pattern of antisocial, aggressive, of defiant conduct that goes beyond ordinary childish mischief of adolescent rebelliousness. Oppositional defiant disorder (ODD) shares some negative attributes but in a more limited fashion.

      ICD-11 terms the disorder as ‘Conduct-dissocial disorder’, while DSM-5 recognizes three separate conditions related to emotional/behavioral problems seen in younger people: conduct disorder, oppositional defiant disorder, and intermittent explosive disorder. Conduct disorder is about poorly controlled behavior, intermittent explosive disorder is about poorly controlled emotions, and ODD is in between. Conduct disorders are further divided into childhood onset (before 10 years) and adolescent onset (10 years of older).

      The behavior pattern of conduct disorders must be persistent and recurrent, including multiple incidents of aggression towards people of animals, destruction of property, deceitfulness of theft, and serious violations of rules. The pattern of behavior must result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      Oppositional defiant disorder represents a less severe form of conduct disorder, where there is an absence of more severe dissocial of aggressive acts. The behavior pattern of ODD includes persistent difficulty getting along with others, provocative, spiteful, of vindictive behavior, and extreme irritability of anger.

      The prevalence of conduct disorders increases throughout childhood and is more common in boys than girls. The most frequent comorbid problem seen with conduct disorder is hyperactivity. The conversion rate from childhood conduct disorder to adult antisocial personality disorder varies from 40 to 70% depending on the study.

      NICE recommends group parent-based training programs of parent and child training programs for children with complex needs for ages 3-11, child-focused programs for ages 9-14, and multimodal interventions with a family focus for ages 11-17. Medication is not recommended in routine practice, but risperidone can be used where other approaches fail and they are seriously aggressive.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      48
      Seconds
  • Question 14 - What alternative treatment options are available for schizophrenia if clozapine proves to be...

    Incorrect

    • What alternative treatment options are available for schizophrenia if clozapine proves to be ineffective?

      Your Answer: Haloperidol combined with pimozide

      Correct Answer: Olanzapine and allopurinol

      Explanation:

      It is important to be aware of the Maudsley Guidelines, which provide over 30 different recommendations for patients with schizophrenia who are resistant to clozapine. While a thorough understanding of these guidelines is not necessary, it is important to have knowledge of alternative treatments for clozapine-resistant schizophrenia, rather than just augmentation strategies.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      24.5
      Seconds
  • Question 15 - Which of the following is not a side-effect of methylphenidate? ...

    Correct

    • Which of the following is not a side-effect of methylphenidate?

      Your Answer: Tinnitus

      Explanation:

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      10.2
      Seconds
  • Question 16 - Which statement accurately describes IPT? ...

    Incorrect

    • Which statement accurately describes IPT?

      Your Answer: Client problems are formulated into one of 5 interpersonal problem areas

      Correct Answer: It focuses mainly on current rather than past relationships

      Explanation:

      Cognitive Analytic Therapy (CAT) was developed by Anthony Ryle.

      Interpersonal Therapy: A Structured Approach to Addressing Social Functioning Problems

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
      20.8
      Seconds
  • Question 17 - An economic analysis conducted in 2011 on the Rapid Assessment Interface and Discharge...

    Correct

    • An economic analysis conducted in 2011 on the Rapid Assessment Interface and Discharge (RAID) psychiatric liaison service at City Hospital in Birmingham revealed what benefit-to-cost ratio?

      Your Answer: 4

      Explanation:

      The Rapid Assessment Interface and Discharge (RAID) psychiatric liaison service at Birmingham’s City Hospital was evaluated by the London School of Economics, which found that the benefit:cost ratio was over 4:1. The evaluation showed that the service resulted in savings of £3.55 million per year in general hospital bed use, at a cost of £0.8 million.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      30.5
      Seconds
  • Question 18 - What is a known cause of Stevens-Johnson Syndrome? ...

    Correct

    • What is a known cause of Stevens-Johnson Syndrome?

      Your Answer: Carbamazepine

      Explanation:

      Stevens-Johnson syndrome is a rare but serious condition that affects the skin and mucous membranes. It is often caused by a reaction to medication of infection and can start with flu-like symptoms. The condition is characterized by a painful rash that spreads and blisters, leading to the shedding of the top layer of affected skin. Hospitalization is usually required as it is a medical emergency. Medications that have been known to cause Stevens-Johnson syndrome include lamotrigine, phenobarbital, sertraline, and certain types of NSAIDs such as meloxicam, piroxicam, and tenoxicam.

      Antiepileptic drugs (AEDs) are commonly used for the treatment of epilepsy, but many of them also have mood stabilizing properties and are used for the prophylaxis and treatment of bipolar disorder. However, some AEDs carry product warnings for serious side effects such as hepatic failure, pancreatitis, thrombocytopenia, and skin reactions. Additionally, some AEDs have been associated with an increased risk of suicidal behavior and ideation.

      Behavioral side-effects associated with AEDs include depression, aberrant behaviors, and the development of worsening of irritability, impulsivity, anger, hostility, and aggression. Aggression can occur before, after, of in between seizures. Some AEDs are considered to carry a higher risk of aggression, including levetiracetam, perampanel, and topiramate. However, data on the specific risk of aggression for other AEDs is lacking of mixed. It is important for healthcare providers to carefully consider the potential risks and benefits of AEDs when prescribing them for patients with epilepsy of bipolar disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
      4
      Seconds
  • Question 19 - What is the recommended treatment for a stroke patient experiencing pathological crying? ...

    Incorrect

    • What is the recommended treatment for a stroke patient experiencing pathological crying?

      Your Answer: Clozapine

      Correct Answer: Amitriptyline

      Explanation:

      Pathological Crying

      Pathological crying, also known as pseudobulbar affect, is a condition characterized by sudden outbursts of crying of laughing in response to minor stimuli without any changes in mood. This condition can occur in response to nonspecific and inconsequential stimuli, and lacks a clear association with the prevailing mood state. Pathological crying can result from various neurological conditions, including strokes and multiple sclerosis.

      When it comes to treating pathological crying post-stroke, citalopram is often the recommended treatment due to its efficacy in open label studies. The Maudsley Guidelines suggest that TCAs of SSRIs may be effective for MS, while valproic acid and the combination of dextromethorphan and low dose quinidine have also shown efficacy.

      Understanding the neuroanatomy of pathological laughing and crying is important for diagnosing and treating this condition. Further research is needed to better understand the underlying mechanisms and develop more effective treatments.

    • This question is part of the following fields:

      • Old Age Psychiatry
      10.2
      Seconds
  • Question 20 - What is a personality disorder screening tool that focuses on identifying dimensional aspects...

    Incorrect

    • What is a personality disorder screening tool that focuses on identifying dimensional aspects of personality rather than using a categorical approach?

      Your Answer: IPDS

      Correct Answer: FFMRF

      Explanation:

      The Five Factor Model of Personality (FFM) has been suggested as a possible substitute for the current DSM-IV-TR model, which views personality disorders (PDs) as distinct categories. Douglas B. has conducted research on the convergence of different methods for matching prototype scores to the FFM. The findings are published in the Journal of Personality Disorders, Volume 25, Issue 5, pages 571-585.

      There are several screening tools available for personality disorder, including SAPAS, FFMRF, IPDE, PDQ-R, IPDS, and IIP-PD. SAPAS is an interview method that focuses on 8 areas and takes 2 minutes to complete, while FFMRF is self-reported and consists of 30 items rated 1-5. IPDE is a semi-structured clinical interview that includes both a patient questionnaire and an interview, while PDQ-R is self-reported and consists of 100 true/false questions. IPDS is an interview method that consists of 11 criteria and takes less than 5 minutes, while IIP-PD is self-reported and contains 127 items rated 0-4. A score of 3 of more on SAPAS warrants further assessment.

    • This question is part of the following fields:

      • Forensic Psychiatry
      17.2
      Seconds
  • Question 21 - A researcher wants to compare the mean age of two groups of participants...

    Correct

    • A researcher wants to compare the mean age of two groups of participants who were randomly assigned to either a standard exercise program of a standard exercise program + new supplement. The data collected is parametric and continuous. What is the most appropriate statistical test to use?

      Your Answer: Unpaired t test

      Explanation:

      The two sample unpaired t test is utilized to examine whether the null hypothesis that the two populations related to the two random samples are equivalent is true of not. When dealing with continuous data that is believed to conform to the normal distribution, a t test is suitable, making it appropriate for comparing weight loss between two groups. In contrast, a paired t test is used when the data is dependent, meaning there is a direct correlation between the values in the two samples. This could include the same subject being measured before and after a process change of at different times.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      48.1
      Seconds
  • Question 22 - Which mental health issue has the strongest correlation with homicide rates? ...

    Correct

    • Which mental health issue has the strongest correlation with homicide rates?

      Your Answer: Substance misuse

      Explanation:

      When substance misuse is considered, the majority of harmful actions towards others are not attributed primarily to mental illness. Additionally, individuals with mental illness of intellectual disability are at a higher risk of being subjected to violence rather than being the ones who commit violent acts.

      Homicide is classified into three categories in England and Wales: murder, manslaughter, and infanticide. Murder requires intent to kill of cause grievous bodily harm, while manslaughter can be voluntary of involuntary. Mental disorder is significantly associated with homicide, particularly in people diagnosed with schizophrenia and personality disorder. Homicide rates by people with a mental disorder are based on calculations of those with disposals such as ‘diminished responsibility’ and ‘not guilty by reason of insanity’. The age-standardised rate for homicide in people with schizophrenia is estimated to be around 0.1 / 100,000, which translates to about 20-30 mental disorder homicides each year in England and Wales. However, a significant proportion of these cases tend to have a secondary diagnosis of alcohol / drug dependence. Individuals with schizophrenia commit 5-6% of homicides in England.

    • This question is part of the following fields:

      • Forensic Psychiatry
      6.9
      Seconds
  • Question 23 - Which epilepsy medication can alleviate concerns about weight gain and may even lead...

    Correct

    • Which epilepsy medication can alleviate concerns about weight gain and may even lead to weight loss for a patient with epilepsy?

      Your Answer: Topiramate

      Explanation:

      Topiramate is a medication used for epilepsy and bipolar affective disorder. It works by inhibiting voltage gated sodium channels and increasing GABA levels. Unlike most psychotropic drugs, it is associated with weight loss.

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.4
      Seconds
  • Question 24 - A case-control study was conducted to determine if exposure to passive smoking during...

    Correct

    • A case-control study was conducted to determine if exposure to passive smoking during childhood increases the risk of nicotine dependence. Two groups were recruited: 200 patients with nicotine dependence and 200 controls without nicotine dependence. Among the patients, 40 reported exposure to parental smoking during childhood, while among the controls, 20 reported such exposure. The odds ratio of developing nicotine dependence after being exposed to passive smoking is:

      Your Answer: 2.25

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      111.8
      Seconds
  • Question 25 - You are seeing a 67-year-old man with a history of cardiovascular disease who...

    Correct

    • You are seeing a 67-year-old man with a history of cardiovascular disease who is experiencing symptoms of depression. He had a heart attack six months ago.
      Which antidepressant would be the safest and most appropriate choice for this patient?

      Your Answer: Sertraline

      Explanation:

      The most appropriate treatment for chronic heart disease (CHD) is SSRIs, with sertraline being the preferred option for post-MI patients due to its safety. However, venlafaxine should be used cautiously in patients with established cardiac disease that may increase the risk of ventricular arrhythmias. Tricyclic antidepressants, such as Amitriptyline, should be avoided in CHD patients as they are considered cardiotoxic and contraindicated in those who have had a recent MI. While citalopram is generally used post-MI, its dose-dependent QT interval prolongation should be taken into consideration. Mirtazapine can be used as an alternative in CHD patients who cannot tolerate SSRIs, but it may not be the most appropriate treatment option.

    • This question is part of the following fields:

      • Old Age Psychiatry
      23.2
      Seconds
  • Question 26 - Considering the recovery model, which of the following is an example of a...

    Incorrect

    • Considering the recovery model, which of the following is an example of a user-based recovery definition?

      Your Answer: Being involved in work

      Correct Answer: Overcoming the effects of being a patient

      Explanation:

      The recovery model raises questions about how to define recovery from a mental health problem. Mental health services tend to define recovery based on measures such as symptom remission, hospitalization, independence, and involvement in work of school. However, people with mental health problems define recovery differently, placing importance on factors such as overcoming the effects of being a patient, establishing a fulfilling life and positive identity, and discovering how to live well with enduring symptoms.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      48.9
      Seconds
  • Question 27 - Which of the following is related to Sigmund Freud's idea of 'dream work'?...

    Correct

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

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

      Explanation:

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

    • This question is part of the following fields:

      • Psychotherapy
      7.3
      Seconds
  • Question 28 - What is the appropriate denominator to use when computing the sample variance? ...

    Correct

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

      Your Answer: n-1

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      12.4
      Seconds
  • Question 29 - Which of the following is not considered one of the functions of Dialectical...

    Incorrect

    • Which of the following is not considered one of the functions of Dialectical Behavioural Therapy?

      Your Answer: Enhance behavioural capabilities

      Correct Answer: Enhance insight through dream analysis

      Explanation:

      DBT is a specialized version of CBT that is designed to address the unique needs of individuals with borderline personality disorder, incorporating mindfulness techniques into the treatment approach.

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

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

    • This question is part of the following fields:

      • Psychotherapy
      20.9
      Seconds
  • Question 30 - Freud coined a term to describe the unconscious desire of a boy to...

    Correct

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

      Your Answer: Oedipus complex

      Explanation:

      Understanding the Oedipus Complex

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

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

    • This question is part of the following fields:

      • Psychotherapy
      10.3
      Seconds
  • Question 31 - A 10 year old boy has been referred by his GP due to...

    Correct

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

      Your Answer: Atomoxetine

      Explanation:

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

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      37.6
      Seconds
  • Question 32 - What hormonal imbalance is observed in individuals with anorexia nervosa? ...

    Incorrect

    • What hormonal imbalance is observed in individuals with anorexia nervosa?

      Your Answer: Increased testosterone

      Correct Answer: Raised growth hormone levels

      Explanation:

      Extensive research has been conducted on the endocrine alterations linked to anorexia nervosa, revealing compelling evidence of hypothalamic dysfunction. These changes are all secondary and can be reversed through weight gain. Additional changes associated with anorexia nervosa include decreased levels of gonadotropins (FSH and LH), normal of elevated cortisol levels, reduced sex hormones, and imbalanced thyroid hormones characterized by low T3, high reverse T3, and an elevated T4:T3 ratio.

    • This question is part of the following fields:

      • General Adult Psychiatry
      37.7
      Seconds
  • Question 33 - What statement is the most accurate regarding school refusal? ...

    Correct

    • What statement is the most accurate regarding school refusal?

      Your Answer: Associated with moving to a new school.

      Explanation:

      School refusal typically occurs when children are transitioning between schools, particularly from primary to secondary school, which usually happens between the ages of 10 and 13. It affects both boys and girls equally. The primary cause of school refusal is social anxiety, which arises from having to navigate new situations such as making friends on the playground and adapting to new teachers. It is important to note that school refusal is not related to a child’s academic performance.

      Understanding School Refusal

      School refusal is a common problem that affects 1-5% of children, with similar rates in both boys and girls. Although it can occur at any age, it is more common in children aged five, six, 10, and 11 years. Unlike truancy, school refusal is not a formal diagnosis and is characterized by severe distress about attending school, often manifesting as temper tantrums and somatic symptoms. Parents are generally aware of the absence, and there is no antisocial behavior present. Children with school refusal often have a desire and willingness to do school work at home, whereas those who are truant show little interest in school work in any setting.

      The onset of school refusal symptoms is usually gradual and may occur after a holiday of illness. Stressful events at home of school, of with peers, may also cause school refusal. Presenting symptoms include fearfulness, panic symptoms, crying episodes, temper tantrums, threats of self-harm, and somatic symptoms that present in the morning and improve if the child is allowed to stay home.

      Behavioural approaches, primarily exposure-based treatments, are used to treat school refusal. However, it is important to note that school refusal is not a diagnosis but a presenting problem that may be linked to other diagnoses such as separation anxiety disorder, generalized anxiety disorder, depression, oppositional defiant disorder, learning disorders, and pervasive developmental disabilities such as Asperger’s disorder, autism, and mental retardation.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      9.9
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  • Question 34 - What is the recommended approach by NICE for managing distress in patients with...

    Correct

    • What is the recommended approach by NICE for managing distress in patients with delirium?

      Your Answer: Haloperidol

      Explanation:

      Delirium Management

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      5.5
      Seconds
  • Question 35 - Typically, how much time elapses before delirium tremens (DTs) occur after a person...

    Correct

    • Typically, how much time elapses before delirium tremens (DTs) occur after a person stops drinking completely?

      Your Answer: 3-5 days

      Explanation:

      The onset of DTs typically happens between three to five days after stopping drinking. However, tremulousness of withdrawal convulsions (also known as rum fits) can occur during a drinking binge of shortly after stopping drinking. Alcoholic hallucinosis, on the other hand, can develop over a period of days of weeks and is characterized by auditory hallucinations. Unlike DTs, it is typically accompanied by less severe agitation and mental confusion.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      13
      Seconds
  • Question 36 - What is the primary treatment option for a 10 year old child diagnosed...

    Incorrect

    • What is the primary treatment option for a 10 year old child diagnosed with Tourette's syndrome?

      Your Answer: Haloperidol

      Correct Answer: Clonidine

      Explanation:

      Tourette’s Syndrome: Understanding the Disorder and Management Options

      Tourette’s syndrome is a type of tic disorder characterized by multiple motor tics and one of more vocal tics. Tics are sudden, involuntary movements of vocalizations that serve no apparent purpose and can be suppressed for varying periods of time. Unlike stereotyped repetitive movements seen in other disorders, tics lack rhythmicity. Manneristic motor activities tend to be more complex and variable than tics, while obsessive-compulsive acts have a defined purpose.

      Tourette’s syndrome typically manifests in childhood, with a mean age of onset of six to seven years. Tics tend to peak in severity between nine and 11 years of age and may be exacerbated by external factors such as stress, inactivity, and fatigue. The estimated prevalence of Tourette’s syndrome is 1% of children, and it is more common in boys than girls. A family history of tics is also common.

      Management of Tourette’s syndrome may involve pharmacological options of behavioral programs. Clonidine is recommended as first-line medication, with antipsychotics as a second-line option due to their side effect profile. Selective serotonin reuptake inhibitors (SSRIs) have not been found to be effective in suppressing tics. However, most people with tics never require medication, and behavioral programs appear to work equally as well.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      7.7
      Seconds
  • Question 37 - What conclusion was drawn from the STAR*D trial? ...

    Correct

    • What conclusion was drawn from the STAR*D trial?

      Your Answer: 1 in 3 participants reached remission on citalopram

      Explanation:

      STAR*D Study

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      14.3
      Seconds
  • Question 38 - In the management of acute mania in adult patients, NICE recommends which of...

    Incorrect

    • In the management of acute mania in adult patients, NICE recommends which of the following?

      Your Answer: Aripiprazole

      Correct Answer: Risperidone

      Explanation:

      Bipolar Disorder: Diagnosis and Management

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      10.4
      Seconds
  • Question 39 - A masters student had noticed that nearly all of her patients with arthritis...

    Incorrect

    • A masters student had noticed that nearly all of her patients with arthritis were over the age of 50. She was keen to investigate this further to see if there was an association.
      She selected 100 patients with arthritis and 100 controls. of the 100 patients with arthritis, 90 were over the age of 50. of the 100 controls, only 40 were over the age of 50.
      What is the odds ratio?

      Your Answer: 2.95

      Correct Answer: 3.77

      Explanation:

      The odds of being married are 3.77 times higher in individuals with panic disorder compared to controls.

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      321.3
      Seconds
  • Question 40 - What is the accuracy of the standardised mortality ratio for individuals with schizophrenia?...

    Incorrect

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

      Your Answer: It is higher in males

      Correct Answer: It falls with age

      Explanation:

      Schizophrenia and Mortality

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      88.6
      Seconds
  • Question 41 - Which cluster B personality disorder is most prevalent among prisoners aged 50 and...

    Correct

    • Which cluster B personality disorder is most prevalent among prisoners aged 50 and above in prisons located in England and Wales?

      Your Answer: Antisocial

      Explanation:

      Prisoner Mental Health: Focus on Older Adults

      Limited research exists on the mental health of older adults (60 years and above) in prison. However, a study conducted in 2001 in England and Wales revealed high rates of depressive disorder and personality disorder among this population. More than half (53%) of the sample had a psychiatric diagnosis, with approximately 30% diagnosed with depression and another 30% with personality disorder (including 8% with antisocial personality disorder). Only 1% of the sample had dementia. Further research is needed to better understand and address the mental health needs of older adults in prison.

    • This question is part of the following fields:

      • Forensic Psychiatry
      11.4
      Seconds
  • Question 42 - In which conditions has Cotard's syndrome been reported? ...

    Incorrect

    • In which conditions has Cotard's syndrome been reported?

      Your Answer: Schizophrenia

      Correct Answer: All of the above

      Explanation:

      Cotard’s syndrome is a delusion where an individual believes they do not exist of have lost their blood, internal organs, of soul. It is commonly seen in depression, schizophrenia, and bipolar disorder, and can also occur after trauma. The condition is more prevalent in females and the elderly.

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.5
      Seconds
  • Question 43 - What is a true statement about Lesch-Nyhan syndrome? ...

    Incorrect

    • What is a true statement about Lesch-Nyhan syndrome?

      Your Answer: Those affected tend to have moderate to severe intellectual disability

      Correct Answer: The condition is inherited in an X-linked recessive pattern

      Explanation:

      Lesch-Nyhan Syndrome: A Rare Genetic Disorder

      Lesch-Nyhan syndrome is a rare genetic disorder that causes the overproduction and accumulation of uric acid in the body, leading to various health problems such as gouty arthritis, kidney stones, and subcutaneous tophi. The condition primarily affects males and is caused by mutations in the HPRT gene located on the X-chromosome.

      People with Lesch-Nyhan syndrome typically experience motor disability, including severe dystonia, hypotonia, and choreoathetosis, which can make it difficult of impossible for them to walk of sit without assistance. They may also exhibit self-injurious behavior, such as biting and head-banging, which is the most common and distinctive behavioral problem associated with the condition. Intellectual disability is common, but severe cognitive impairment is rare.

      The absence of the HPRT enzyme, which is responsible for recycling purine bases, leads to the accumulation of uric acid and affects the development of specific neural pathways in the brain, particularly the mesotelencephalic dopamine pathways. This disruption is likely responsible for the motor disability and behavioral peculiarities associated with the condition.

      Treatment for self-injurious behavior typically involves the use of protective restraints applied to the limbs, trunk, of head to prevent self-hitting of self-biting. Dental extraction may be necessary in cases of lip of tongue biting. Behavior modification methods that involve extinction may also be used, but neuroleptics may be required during particularly stressful of difficult behavior periods. However, these medications should only be used transiently due to their sedative effects and potential side-effects.

    • This question is part of the following fields:

      • Learning Disability
      14.3
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  • Question 44 - When conducting a literature review, it is advisable to do the following: ...

    Correct

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

      Your Answer: Include grey literature

      Explanation:

      When conducting a literature review, it is important to broaden your search beyond traditional academic sources. This means including grey literature, such as reports, conference proceedings, and government documents. Additionally, it is crucial to consider both primary and secondary sources of evidence, as they can provide different perspectives and insights on your research topic. To ensure a comprehensive review, it is recommended to use multiple databases and search engines, rather than relying on a single source.

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      9.6
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  • Question 45 - Which of the options below does not demonstrate selection bias? ...

    Correct

    • Which of the options below does not demonstrate selection bias?

      Your Answer: Recall bias

      Explanation:

      Types of Bias in Statistics

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      14
      Seconds
  • Question 46 - What is an example of a neurovegetative symptom? ...

    Correct

    • What is an example of a neurovegetative symptom?

      Your Answer: Insomnia

      Explanation:

      Symptoms related to inadequate performance of the autonomic nervous system, such as difficulties with sleep, exhaustion, and reduced energy levels, are referred to as neurovegetative symptoms.

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      8.6
      Seconds
  • Question 47 - What is the weekly unit intake of a patient who consumes 3 litres...

    Incorrect

    • What is the weekly unit intake of a patient who consumes 3 litres of 12% ABV wine per day?

      Your Answer: 36

      Correct Answer: 252

      Explanation:

      The weekly total is 252 units.

      Alcohol Conversion

      When converting alcohol volume to units, use the equation: Alcohol (units) = Alcohol volume (litres) x Alcohol by volume. For example, if you have 2 liters of cider with 6% alcohol, it is equal to 12 units. Remember to always use this equation to accurately convert alcohol volume to units.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      22
      Seconds
  • Question 48 - What value of NNT indicates the most positive result for an intervention? ...

    Correct

    • What value of NNT indicates the most positive result for an intervention?

      Your Answer: NNT = 1

      Explanation:

      An NNT of 1 indicates that every patient who receives the treatment experiences a positive outcome, while no patient in the control group experiences the same outcome. This represents an ideal outcome.

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      14.2
      Seconds
  • Question 49 - Which statement about multiple sclerosis is incorrect? ...

    Correct

    • Which statement about multiple sclerosis is incorrect?

      Your Answer: It is more common in males

      Explanation:

      Psychiatric Consequences of Multiple Sclerosis

      Multiple sclerosis (MS) is a neurological disorder that affects individuals between the ages of 20 and 40. It is characterized by multiple demyelinating lesions in the optic nerves, cerebellum, brainstem, and spinal cord. MS presents with diverse neurological signs, including optic neuritis, internuclear ophthalmoplegia, and ocular motor cranial neuropathy.

      Depression is the most common psychiatric condition seen in MS, with a lifetime prevalence of 25-50%. The symptoms of depression in people with MS tend to be different from those without MS. The preferred diagnostic indicators for depression in MS include pervasive mood change, diurnal mood variation, suicidal ideation, functional change not related to physical disability, and pessimistic of negative patterns of thinking. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for depression in patients with MS.

      Suicide is common in MS, with recognized risk factors including male gender, young age at onset of illness, current of previous history of depression, social isolation, and substance misuse. Mania is more common in people with MS, and mood stabilizers are recommended for treatment. Pathological laughing and crying, defined as uncontrollable laughing and/of crying without the associated affect, occurs in approximately 10% of cases of MS. Emotional lability, defined as an excessive emotional response to a minor stimulus, is also common in MS and can be treated with amitriptyline and SSRIs.

      The majority of cases of neuropsychiatric side effects from corticosteroids fit an affective profile of mania and/of depression. Psychotic symptoms, particularly hallucinations, are present in up to half of these cases. Glatiramer acetate has not been associated with neuropsychiatric side-effects. The data regarding the risk of mood symptoms related to interferon use is conflicting.

      In conclusion, MS has significant psychiatric consequences, including depression, suicide, mania, pathological laughing and crying, emotional lability, and neuropsychiatric side effects from treatment. Early recognition and treatment of these psychiatric symptoms are essential for improving the quality of life of individuals with MS.

    • This question is part of the following fields:

      • General Adult Psychiatry
      2263.5
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  • Question 50 - What is the correct approach to treating Wernicke's encephalopathy? ...

    Correct

    • What is the correct approach to treating Wernicke's encephalopathy?

      Your Answer: Parenteral thiamine is suggested rather than an oral route

      Explanation:

      To ensure prompt treatment, thiamine 200 mg should be administered three times daily before any carbohydrate intake, preferably through intravenous administration. It is recommended to avoid delaying treatment by relying solely on imaging for diagnosis. Intravenous administration is preferred over oral administration, as there is a risk of anaphylaxis with intranasal administration. Therefore, intranasal administration should only be considered if facilities are available to manage potential anaphylactic reactions.

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      11
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  • Question 51 - According to Gottesman (1982), what is the risk of a child developing schizophrenia...

    Correct

    • According to Gottesman (1982), what is the risk of a child developing schizophrenia if they have an affected parent?

      Your Answer: 13%

      Explanation:

      Schizophrenia: Understanding the Risk Factors

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 52 - What is the most frequent symptom observed in individuals with Huntington's disease? ...

    Correct

    • What is the most frequent symptom observed in individuals with Huntington's disease?

      Your Answer: Lack of initiative

      Explanation:

      Huntington’s disease is more likely to cause a lack of initiative than a depressed mood.

      Psychiatric and Behavioural Symptoms of Huntington’s Disease

      Huntington’s disease is a condition that affects individuals with a triad of symptoms, including motor, cognitive, and psychiatric symptoms. While the symptoms typically begin in the third and fourth decades of life, individuals with a high number of CAG repeats may experience symptoms before the age of 20, known as juvenile Huntington’s disease.

      The psychiatric symptoms of Huntington’s disease can include depression, apathy, dementia, psychosis, anxiety, mania, sexual dysfunction, and even suicide. These symptoms can significantly impact an individual’s quality of life and require appropriate treatment. Advances in psychiatric treatment have been made to address these symptoms and improve the overall well-being of individuals with Huntington’s disease.

    • This question is part of the following fields:

      • Old Age Psychiatry
      4.9
      Seconds
  • Question 53 - Which topic is Penrose's law related to? ...

    Incorrect

    • Which topic is Penrose's law related to?

      Your Answer: Fitness to plead

      Correct Answer: Transinstitutionalisation

      Explanation:

      Penrose’s Law: Increasing Mental Hospital Beds Can Reduce Crime Rates

      In 1939, Lionel Penrose conducted a cross-sectional study across 18 European countries, including the Nordic region. His research revealed a significant inverse relationship between the number of mental hospital beds and the number of prisoners. Additionally, he found a strong negative correlation between the number of mental hospital beds and the number of deaths attributed to murder. Based on his findings, Penrose argued that increasing the number of mental institution beds could potentially reduce serious crimes and imprisonment rates. This theory, known as Penrose’s Law, suggests that providing adequate mental health care can have a positive impact on society’s overall safety and well-being.

    • This question is part of the following fields:

      • Forensic Psychiatry
      8.1
      Seconds
  • Question 54 - Which of the following sedatives is not recommended by the Maudsley Guidelines for...

    Incorrect

    • Which of the following sedatives is not recommended by the Maudsley Guidelines for people with hepatic impairment?

      Your Answer: Temazepam

      Correct Answer: Nitrazepam

      Explanation:

      Sedatives and Liver Disease

      Sedatives are commonly used for their calming effects, but many of them are metabolized in the liver. Therefore, caution must be taken when administering sedatives to patients with liver disease. The Maudsley Guidelines recommend using low doses of the following sedatives in patients with hepatic impairment: lorazepam, oxazepam, temazepam, and zopiclone. It is important to note that zopiclone should also be used with caution and at low doses in this population. Proper management of sedative use in patients with liver disease can help prevent further damage to the liver and improve overall patient outcomes.

    • This question is part of the following fields:

      • General Adult Psychiatry
      8.9
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  • Question 55 - What is the probability that a person who tests negative on the new...

    Correct

    • What is the probability that a person who tests negative on the new Mephedrone screening test does not actually use Mephedrone?

      Your Answer: 172/177

      Explanation:

      Negative predictive value = 172 / 177

      Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and post-test odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating post-test probabilities.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      35.6
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  • Question 56 - A 16 year old boy presents with moderate depression. What would be the...

    Correct

    • A 16 year old boy presents with moderate depression. What would be the most suitable initial treatment option?

      Your Answer: Individual CBT

      Explanation:

      Depression in Young People: NICE Guidelines

      The NICE Guidelines for depression in young people are limited to those between the ages of 5-18. For mild depression without significant comorbid problems of active suicidal ideas of plans, watchful waiting is recommended, along with digital CBT, group CBT, group IPT, of group non-directive supportive therapy. For moderate to severe depression, family-based IPT, family therapy, psychodynamic psychotherapy, individual CBT, and fluoxetine may be used for 5-11 year olds, while individual CBT and fluoxetine may be used for 12-18 year olds. Antidepressant medication should not be used for initial treatment of mild depression, and should only be used in combination with concurrent psychological therapy for moderate to severe depression. Fluoxetine is the only antidepressant for which clinical trial evidence shows that the benefits outweigh the risks, and should be used as the first-line treatment. Paroxetine, venlafaxine, tricyclic antidepressants, and St John’s wort should not be used for the treatment of depression in children and young people. Second generation antipsychotics may be used for depression with psychotic symptoms, and ECT should only be considered for those with very severe depression and life-threatening symptoms.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 57 - A trainee who appeared to have extraordinary potential as a psychotherapist, experienced continued...

    Correct

    • A trainee who appeared to have extraordinary potential as a psychotherapist, experienced continued strong irritation in the early part of her treatment with a 25-year-old male patient. She reacted to the patient in a controlled, muted manner.

      The patient was an angry, obsessional young man suffering from many borderline features. He negated the therapist's attempts to help him understand how his conflicts might be contributing to his ongoing problems with women, and he usually negated the therapist's observations about what he might be feeling.

      Through exploration within supervision, it emerged that unresolved anxieties from within the trainee about not being good enough, about fearing that she could not take care of others sufficiently, and about fears of her supervisor's evaluation of her were clearly implicated in her irritation and her muted reaction to the patient.

      Which of the following best describes the trainee’s behaviour towards the patient?:

      Your Answer: Countertransference

      Explanation:

      Transference and Countertransference

      Transference is the unconscious transfer of feelings, attitudes, thoughts, desires, fantasies, of behaviors from past significant relationships to a current interpersonal relationship. It is often observed in therapy, and the therapist interprets its meaning and source to help the patient understand how their past experiences affect their current relationships. Factors that increase transference include anxiety, frequent contact with a key worker, and borderline personality disorder. Effective management of transference involves recognizing the importance of the relationship to the patient, maintaining professional boundaries, interpreting the transference, and being a reliable therapist.

      Countertransference, on the other hand, refers to the therapist’s emotional, cognitive, of behavioral response to the patient, triggered by some characteristic of the patient but ultimately resulting from unresolved conflicts within the therapist. There are different conceptions of countertransference, including the classical definition, the totalistic conception, the complementary conception, and the relational perspective. However, a working definition suggests that countertransference is a response to the patient triggered by unresolved conflicts within the therapist. Effective management of countertransference involves understanding the patient’s interpersonal style of relating and framing therapeutic interventions accordingly.

    • This question is part of the following fields:

      • Psychotherapy
      90.8
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  • Question 58 - What is the main focus of a therapist during cognitive analytic therapy in...

    Correct

    • What is the main focus of a therapist during cognitive analytic therapy in terms of identifying certain aspects?

      Your Answer: Reciprocal role procedures

      Explanation:

      Jungian analytical psychology involves the study of archetypes. Interpersonal therapy is used to identify interpersonal problems, while CBT focuses on identifying negative automatic thoughts. CAT, on the other hand, aims to identify reciprocal role procedures (RRP’s).

      Understanding Cognitive Analytic Therapy

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

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

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
      16
      Seconds
  • Question 59 - A study examining potential cases of neuroleptic malignant syndrome reports on several physical...

    Incorrect

    • A study examining potential cases of neuroleptic malignant syndrome reports on several physical parameters, including patient temperature in Celsius.

      This is an example of which of the following variables?:

      Your Answer: Ratio

      Correct Answer: Interval

      Explanation:

      Types of Variables

      There are different types of variables in statistics. Binary of dichotomous variables have only two values, such as gender. Categorical variables can be grouped into two or more categories, such as eye color of ethnicity. Continuous variables can be further classified into interval and ratio variables. They can be placed anywhere on a scale and have arithmetic properties. Ratio variables have a value of 0 that indicates the absence of the variable, such as temperature in Kelvin. On the other hand, interval variables, like temperature in Celsius of Fahrenheit, do not have a true zero point. Lastly, ordinal variables allow for ranking but do not allow for arithmetic comparisons between values. Examples of ordinal variables include education level and income bracket.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      16.3
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  • Question 60 - What are the common symptoms of Lennox-Gastaut syndrome? ...

    Incorrect

    • What are the common symptoms of Lennox-Gastaut syndrome?

      Your Answer: Depression

      Correct Answer: Seizures

      Explanation:

      Understanding Lennox-Gastaut Syndrome

      Lennox-Gastaut syndrome (LGS) is a type of epilepsy that typically manifests between the ages of two and six. This condition is marked by frequent seizures and various types of seizures. In addition, individuals with LGS may experience developmental delays, as well as psychological and behavioral issues. Understanding this syndrome is crucial for effective management and treatment.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 61 - A client successfully completed a detoxification regime for her alcohol dependence 4 weeks...

    Incorrect

    • A client successfully completed a detoxification regime for her alcohol dependence 4 weeks ago and has still not consumed alcohol. According to the stages of change model, which of the following stages is she currently at?

      Your Answer: Maintenance

      Correct Answer: Action

      Explanation:

      Stages of Change Model

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      12.2
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  • Question 62 - A 42-year-old woman presents to your clinic with complaints of increasing forgetfulness over...

    Incorrect

    • A 42-year-old woman presents to your clinic with complaints of increasing forgetfulness over the past year. She has trouble recalling the names of close family members and has gotten lost in familiar places. Her husband reports that she has left the stove on multiple times and has difficulty managing household tasks. She has no significant medical history and is not taking any prescribed medications. Her mother had similar symptoms in her 50s. What is the most probable genetic association?

      Your Answer: Mutation in gene coding alpha synuclein

      Correct Answer: Mutation in presenilin 1

      Explanation:

      The individual in the image is displaying symptoms consistent with early onset Alzheimer’s disease, which can affect individuals in their 40s. This form of the disease is often inherited in an autosomal dominant pattern, and mutations in the presenilin 1 and 2 genes have been linked to its development.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 63 - What is the most appropriate option for augmentation in cases of schizophrenia that...

    Correct

    • What is the most appropriate option for augmentation in cases of schizophrenia that are resistant to clozapine?

      Your Answer: Amisulpride

      Explanation:

      Amisulpride is the only option with documented evidence supporting its effectiveness as a clozapine augmentation treatment.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      42.1
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  • Question 64 - What risk factor for autism spectrum disorder has consistently appeared in research studies?...

    Incorrect

    • What risk factor for autism spectrum disorder has consistently appeared in research studies?

      Your Answer: Maternal smoking

      Correct Answer: Low birth weight

      Explanation:

      According to current evidence, there is no connection between autism spectrum disorder (ASD) risk and various environmental factors such as vaccination, maternal smoking, thimerosal exposure, and assisted reproductive technologies (Modabbernia, 2017).

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      57.3
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  • Question 65 - Which statistical test is appropriate for analyzing normally distributed data that is measured?...

    Correct

    • Which statistical test is appropriate for analyzing normally distributed data that is measured?

      Your Answer: Independent t-test

      Explanation:

      The t-test is appropriate for analyzing data that meets parametric assumptions, while other tests are more suitable for non-parametric data.

      Choosing the right statistical test can be challenging, but understanding the basic principles can help. Different tests have different assumptions, and using the wrong one can lead to inaccurate results. To identify the appropriate test, a flow chart can be used based on three main factors: the type of dependent variable, the type of data, and whether the groups/samples are independent of dependent. It is important to know which tests are parametric and non-parametric, as well as their alternatives. For example, the chi-squared test is used to assess differences in categorical variables and is non-parametric, while Pearson’s correlation coefficient measures linear correlation between two variables and is parametric. T-tests are used to compare means between two groups, and ANOVA is used to compare means between more than two groups. Non-parametric equivalents to ANOVA include the Kruskal-Wallis analysis of ranks, the Median test, Friedman’s two-way analysis of variance, and Cochran Q test. Understanding these tests and their assumptions can help researchers choose the appropriate statistical test for their data.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      34.6
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  • Question 66 - Which antipsychotic is not advised by NICE for managing acute mania? ...

    Incorrect

    • Which antipsychotic is not advised by NICE for managing acute mania?

      Your Answer: Haloperidol

      Correct Answer: Amisulpride

      Explanation:

      Bipolar Disorder: Diagnosis and Management

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      9
      Seconds
  • Question 67 - What is the truth about neonaticide in the UK? ...

    Incorrect

    • What is the truth about neonaticide in the UK?

      Your Answer: Boys are unlikely to be victims

      Correct Answer: Neonaticide mothers tend to be be younger than mothers who kill older infants

      Explanation:

      Mothers who commit neonaticide, which is the killing of a newborn within 24 hours, are typically younger than those who kill their older infants. While both boys and girls are equally at risk of neonaticide, boys are more likely to be victims of infant homicide.

      Infant Homicide

      Homicide is a significant contributor to infant mortality, with infants under 1 year of age being more likely to be victims of homicide than older children of the general population. Neonaticide, the killing of a baby within 24 hours of delivery, is different from the homicide of infants older than a day. Neonaticide is usually committed by the mother, who is often young, single, and living with her parents. The pregnancy is often unintentional and concealed, and the motivation to kill is usually because the child was unwanted. In contrast, the homicide of infants older than a day is more likely to be committed by a parent, with boys at greater risk than girls. Risk factors for the homicide of infants older than a day include younger age, family history of violence, violence in current relationships of the perpetrator, evidence of past abuse of neglect of children, and personality disorder and/of depression.

    • This question is part of the following fields:

      • Forensic Psychiatry
      29.9
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  • Question 68 - What is the primary benefit of conducting non-inferiority trials in the evaluation of...

    Incorrect

    • What is the primary benefit of conducting non-inferiority trials in the evaluation of a new medication?

      Your Answer: Useful for conditions where there is no proven drug treatment

      Correct Answer: Small sample size is required

      Explanation:

      Study Designs for New Drugs: Options and Considerations

      When launching a new drug, there are various study design options available. One common approach is a placebo-controlled trial, which can provide strong evidence but may be deemed unethical if established treatments are available. Additionally, it does not allow for a comparison with standard treatments. Therefore, statisticians must decide whether the trial aims to demonstrate superiority, equivalence, of non-inferiority to an existing treatment.

      Superiority trials may seem like the obvious choice, but they require a large sample size to show a significant benefit over an existing treatment. Equivalence trials define an equivalence margin on a specified outcome, and if the confidence interval of the difference between the two drugs falls within this margin, the drugs are assumed to have a similar effect. Non-inferiority trials are similar to equivalence trials, but only the lower confidence interval needs to fall within the equivalence margin. These trials require smaller sample sizes, and once a drug has been shown to be non-inferior, larger studies may be conducted to demonstrate superiority.

      It is important to note that drug companies may not necessarily aim to show superiority over an existing product. If they can demonstrate that their product is equivalent of even non-inferior, they may compete on price of convenience. Overall, the choice of study design depends on various factors, including ethical considerations, sample size, and the desired outcome.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      27.7
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  • Question 69 - What is accurate about the immediate management of self-harm in adolescents? ...

    Incorrect

    • What is accurate about the immediate management of self-harm in adolescents?

      Your Answer: Skin closure strips should be offered as first-line in the treatment and management of superficial uncomplicated injuries of 5 cm of less in length

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

      Explanation:

      Flumazenil is commonly used, but it lacks official licensing. Naloxone administration is determined by clinical symptoms rather than drug potency and duration of action. Tissue adhesive is recommended as the primary treatment option. Activated charcoal is most effective when given within an hour of ingestion (of up to two hours at most), especially in cases of tricyclic overdose, which can slow gastric emptying.

      Self-harm is a common issue among young people, particularly girls, with rates appearing to have risen over the past decade. It is most likely to occur between the ages of 12 and 15 years and is associated with a range of psychiatric problems. Short-term management involves a psychosocial assessment and consideration of activated charcoal for drug overdose. Longer-term management may involve psychological interventions, but drug treatment should not be offered as a specific intervention to reduce self-harm. Risk assessment tools should not be used to predict future suicide of repetition of self-harm, but certain factors such as male gender, substance misuse, and parental mental disorder may be associated with a higher risk of completed suicide. It is important to seek professional help if you of someone you know is engaging in self-harm.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      36.9
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  • Question 70 - Globally, which demographic has the highest incidence of completed suicides? ...

    Incorrect

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

      Your Answer: 50 to 69 years

      Correct Answer: 70 and over

      Explanation:

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      4.7
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  • Question 71 - What standardized mortality ratio indicates a lower mortality rate in a sample group...

    Incorrect

    • What standardized mortality ratio indicates a lower mortality rate in a sample group compared to a reference group?

      Your Answer: -10

      Correct Answer: 0.5

      Explanation:

      A negative SMR is not possible. An SMR less than 1.0 suggests that there were fewer deaths than expected in the study population, while an SMR of 1.0 indicates that the observed and expected deaths were equal. An SMR greater than 1.0 indicates that there were excess deaths in the study population.

      Calculation of Standardised Mortality Ratio (SMR)

      To calculate the SMR, age and sex-specific death rates in the standard population are obtained. An estimate for the number of people in each category for both the standard and study populations is needed. The number of expected deaths in each age-sex group of the study population is calculated by multiplying the age-sex-specific rates in the standard population by the number of people in each category of the study population. The sum of all age- and sex-specific expected deaths gives the expected number of deaths for the whole study population. The observed number of deaths is then divided by the expected number of deaths to obtain the SMR.

      The SMR can be standardised using the direct of indirect method. The direct method is used when the age-sex-specific rates for the study population and the age-sex-structure of the standard population are known. The indirect method is used when the age-specific rates for the study population are unknown of not available. This method uses the observed number of deaths in the study population and compares it to the number of deaths that would be expected if the age distribution was the same as that of the standard population.

      The SMR can be interpreted as follows: an SMR less than 1.0 indicates fewer than expected deaths in the study population, an SMR of 1.0 indicates the number of observed deaths equals the number of expected deaths in the study population, and an SMR greater than 1.0 indicates more than expected deaths in the study population (excess deaths). It is sometimes expressed after multiplying by 100.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 72 - What is the closest estimate of the lifetime prevalence of schizophrenia in England?...

    Incorrect

    • What is the closest estimate of the lifetime prevalence of schizophrenia in England?

      Your Answer: 0.10%

      Correct Answer: 0.60%

      Explanation:

      Schizophrenia Epidemiology

      Prevalence:
      – In England, the estimated annual prevalence for psychotic disorders (mostly schizophrenia) is around 0.4%.
      – Internationally, the estimated annual prevalence for psychotic disorders is around 0.33%.
      – The estimated lifetime prevalence for psychotic disorders in England is approximately 0.63% at age 43, consistent with the typically reported 1% prevalence over the life course.
      – Internationally, the estimated lifetime prevalence for psychotic disorders is around 0.48%.

      Incidence:
      – In England, the pooled incidence rate for non-affective psychosis (mostly schizophrenia) is estimated to be 15.2 per 100,000 years.
      – Internationally, the incidence of schizophrenia is about 0.20/1000/year.

      Gender:
      – The male to female ratio is 1:1.

      Course and Prognosis:
      – Long-term follow-up studies suggest that after 5 years of illness, one quarter of people with schizophrenia recover completely, and for most people, the condition gradually improves over their lifetime.
      – Schizophrenia has a worse prognosis with onset in childhood of adolescence than with onset in adult life.
      – Younger age of onset predicts a worse outcome.
      – Failure to comply with treatment is a strong predictor of relapse.
      – Over a 2-year period, one-third of patients with schizophrenia showed a benign course, and two-thirds either relapsed of failed to recover.
      – People with schizophrenia have a 2-3 fold increased risk of premature death.

      Winter Births:
      – Winter births are associated with an increased risk of schizophrenia.

      Urbanicity:
      – There is a higher incidence of schizophrenia associated with urbanicity.

      Migration:
      – There is a higher incidence of schizophrenia associated with migration.

      Class:
      – There is a higher prevalence of schizophrenia among lower socioeconomic classes.

      Learning Disability:
      – Prevalence rates for schizophrenia in people with learning disabilities are approximately three times greater than for the general population.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 73 - In the initial phases of Parkinson's disease, what type of hallucinations are more...

    Incorrect

    • In the initial phases of Parkinson's disease, what type of hallucinations are more commonly observed?

      Your Answer: Pareidolic illusions

      Correct Answer: Passage hallucinations

      Explanation:

      Parkinson’s Disease: Presentation, Aetiology, Medical Treatment, and Psychiatric Aspects

      Parkinson’s disease is a degenerative disease of the brain that is characterised by motor symptoms such as rigidity, bradykinesia, and tremor. It has a long prodromal phase and early symptoms generally present asymmetrically. The tremor associated with Parkinson’s disease is classically described as ‘pill rolling’. The principle abnormality is the degeneration of dopaminergic neurons in the pars compacta of the substantia nigra, which leads to an accumulation of alpha-synuclein in these abnormal dopaminergic cells. The majority of cases of Parkinson’s disease are idiopathic, but single gene mutations occur in a minority of cases. Pesticide, herbicide, and heavy metal exposures are linked to an increased risk of Parkinson’s disease in some epidemiologic studies, whereas smoking and caffeine use are associated with decreased risks.

      Treatment for Parkinson’s disease predominantly focuses on symptomatic relief with drugs aiming to either restore the level of dopamine in the striatum of to act on striatal postsynaptic dopamine receptors. However, as dopamine is not the only neurotransmitter involved in Parkinson’s disease, many other drugs are also being used to target specific symptoms, such as depression of dementia. Psychiatric symptoms are common in Parkinson’s disease and range from mild to severe. Factors associated with severe symptoms include age, sleep disturbance, dementia, and disease severity. Hallucinations are common in Parkinson’s disease and tend to be visual but can be auditory of tactile. In the majority of patients, psychotic symptoms are thought to be secondary to dopaminergic medication rather than due to the Parkinson’s disease itself. Anticholinergics and dopamine agonists seem to be associated with a higher risk of inducing psychosis than levodopa of catechol-O-methyltransferase inhibitors. Medications used for psychotic symptoms may worsen movement problems. Risperidone and the typicals should be avoided completely. Low dose quetiapine is the best tolerated. Clozapine is the most effective antipsychotic drug for treating psychosis in Parkinson’s disease but its use in clinical practice is limited by the need for monitoring and the additional physical risks.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 74 - The patient inquires about the potential memory impairment caused by ECT. Which specific...

    Incorrect

    • The patient inquires about the potential memory impairment caused by ECT. Which specific type of memory is impacted by this procedure?

      Your Answer: Retrograde only

      Correct Answer: Retrograde and anterograde

      Explanation:

      Electroconvulsive therapy (ECT) is known to cause retrograde amnesia, which is the most persistent cognitive side effect (Lisanby, 2000). Patients often experience memory gaps for events that occurred around the time of ECT, and sometimes even for events that happened months of years prior. While retrograde amnesia typically improves within a few months after treatment, some patients may not fully recover and may have permanent memory loss for events close to the time of treatment. Additionally, anterograde amnesia may also be a possible side effect.

      ECT (Treatment) – Summary of Effectiveness and Recommendations

      ECT (Electroconvulsive Therapy) is a treatment that induces a therapeutic seizure through the application of electrical current under general anesthesia and muscle relaxation. It is prescribed as a course and is usually administered twice weekly for 6 to 12 treatments. ECT is the most effective short-term treatment for major depression, with remission rates of around 60-80% when used as first-line treatment in a severe depressive episode. However, without maintenance treatment, the relapse rate is extremely high (over 80%) in the 6 months after successful ECT.

      Cognitive effects are the main limitation to the wider use of ECT, particularly acute confusion shortly after the treatment, retrograde amnesia, and some losses in autobiographical memory longer term. The current state of evidence does not allow the general use of ECT in the management of schizophrenia. Bilateral ECT is more effective than unilateral ECT but may cause more cognitive impairment. With unilateral ECT, a higher stimulus dose is associated with greater efficacy but also increased cognitive impairment compared with a lower stimulus dose.

      NICE (National Institute for Health and Care Excellence) recommends that ECT is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/of when the condition is considered to be potentially life-threatening. ECT is recommended for individuals with severe depression (that is life-threatening and when a rapid response is required, of when other treatments have failed), moderate depression (consider it if their depression has not responded to multiple drug treatments and psychological treatment), catatonia, and a prolonged of severe manic episode.

      The RCPsych (Royal College of Psychiatrists) position on ECT recommends it as a first-line treatment for individuals with high suicidal risk, severe psychomotor retardation and associated problems of compromised eating and drinking and/of physical deterioration, treatment-resistant depression that has responded to ECT in a previous episode of illness, pregnant individuals with severe depression, of severe mixed affective states, mania of catatonia and whose physical health of that of the fetus is at serious risk, and those who prefer this form of treatment. ECT is recommended as a second-line treatment for individuals with treatment-resistant depression, severe side-effects from medication, and persistent of life-threatening symptoms in severe of prolonged mania. ECT is indicated in some circumstances for individuals with bipolar depression, postnatal psychosis, treatment-resistant schizophrenia, treatment-resistant catatonia, and frequent relapses and recurrences of depression (maintenance).

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      11
      Seconds
  • Question 75 - At what age do male offenders in the UK typically reach their highest...

    Incorrect

    • At what age do male offenders in the UK typically reach their highest rate of criminal activity?

      Your Answer: 22-23

      Correct Answer: 17-18

      Explanation:

      Offending in the UK: Gender and Age Differences

      The peak age for offending in the UK is different for girls and boys, with girls peaking at 14 years and boys at 17-18 years. Half of the more serious indictable crimes are committed by individuals under the age of 21. As individuals mature, crime rates generally decrease, except for a small peak in women aged 40-50 around menopause.

      In the UK, males convicted of crimes outnumber females by a ratio of 5 to 1. Females are less frequently reported for crimes, especially by male police officers, yet they are up to three times more likely to be imprisoned for their first offense than males.

      Female offenders tend to come from more damaged backgrounds and exhibit more psychological and behavioral disturbances than males who have committed the same offense. This is reflected in the fact that females in prison tend to be more behaviorally and psychiatrically disturbed than their male counterparts.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 76 - What is a true statement about flumazenil? ...

    Correct

    • What is a true statement about flumazenil?

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

      Explanation:

      Flumazenil is not authorized for treating benzodiazepine overdose in the UK, despite its widespread use. It works by competitively inhibiting the benzodiazepine binding site on the GABAA receptor, reversing the effects of benzodiazepines. Due to its brief half-life of approximately 10 minutes, it is important to note that multiple doses may be required in cases of benzodiazepine overdose.

      Self-Harm and its Management

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      3
      Seconds
  • Question 77 - Anterior deficits on the SPECT scan are linked to what condition? ...

    Correct

    • Anterior deficits on the SPECT scan are linked to what condition?

      Your Answer: Frontotemporal dementia

      Explanation:

      Anterior deficits in frontotemporal dementia.

      Dementia is a condition that can be diagnosed and supported with the use of neuroimaging techniques. In Alzheimer’s disease, MRI and CT scans are used to assess volume changes in specific areas of the brain, such as the mesial temporal lobe and temporoparietal cortex. SPECT and PET scans can also show functional changes, such as hypoperfusion and glucose hypometabolism. Vascular dementia can be detected with CT and MRI scans that show atrophy, infarcts, and white matter lesions, while SPECT scans reveal a patchy multifocal pattern of hypoperfusion. Lewy body dementia tends to show nonspecific and subtle changes on structural imaging, but SPECT and PET scans can reveal posterior deficits and reduced D2 receptor density. Frontotemporal dementia is characterized by frontal lobe atrophy, which can be seen on CT and MRI scans, while SPECT scans show anterior perfusion deficits. NICE recommends the use of MRI for early diagnosis and detection of subcortical vascular changes, SPECT for differentiating between Alzheimer’s disease, vascular dementia, and frontotemporal dementia, and DaTscan for establishing a diagnosis of dementia with Lewy bodies.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 78 - What is the most distinctive feature of pellagra? ...

    Correct

    • What is the most distinctive feature of pellagra?

      Your Answer: Dermatitis

      Explanation:

      Pellagra: A Vitamin B3 Deficiency Disease

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 79 - A 35 year old male is seen in clinic with depression. He has...

    Correct

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

      Your Answer: 2 weeks

      Explanation:

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 80 - A 65-year-old patient develops tardive dyskinesia while taking zuclopenthixol. What is the most...

    Incorrect

    • A 65-year-old patient develops tardive dyskinesia while taking zuclopenthixol. What is the most suitable course of action in this scenario?

      Your Answer: Reduce the dose and continue

      Correct Answer: Switch to olanzapine

      Explanation:

      The practice of reducing the dosage of antipsychotics is outdated and no longer recommended, as per Cochrane’s 2006 findings. Instead, a more effective approach is to switch to an antipsychotic medication that has a lower risk of causing the condition.

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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SESSION STATS - PERFORMANCE PER SPECIALTY

General Adult Psychiatry (9/20) 45%
Forensic Psychiatry (2/7) 29%
Substance Misuse/Addictions (6/10) 60%
Psychotherapy (6/8) 75%
Organisation And Delivery Of Psychiatric Services (2/5) 40%
Child And Adolescent Psychiatry (4/9) 44%
Old Age Psychiatry (4/8) 50%
Research Methods, Statistics, Critical Review And Evidence-Based Practice (8/12) 67%
Learning Disability (0/1) 0%
Passmed