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Question 1
Correct
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At what IQ level is someone considered to have a profound intellectual disability?
Your Answer: <20
Explanation:Classification of Intellectual Disability
Intellectual disability affects approximately 2% of the general population, with an estimated 828,000 adults aged 18 of older affected in England alone. Those with an IQ below 70 are considered to have an intellectual disability, with the average IQ being 100. The severity of intellectual disability is categorized based on IQ scores, with mild intellectual disability being the most common (85% of cases) and profound intellectual disability being the least common (1-2% of cases). People with intellectual disability may require varying levels of support in their daily lives, depending on their individual needs. It is important to use the preferred term ‘people with intellectual disability’ when referring to individuals with this condition.
Level IQ Range Mild IQ 52–69 Moderate IQ 36–51 Severe IQ 20–35 Profound IQ 19 or below -
This question is part of the following fields:
- Learning Disability
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Question 2
Incorrect
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What is the estimated percentage of prisoners aged 60 and above in England and Wales who have been diagnosed with a personality disorder?
Your Answer:
Correct Answer: 30%
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.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 3
Incorrect
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You are asked by the neurologists to see a teenager who has been involved in a serious road traffic accident. They have sustained significant damage to their frontal lobe. What symptoms would you anticipate in this patient?
Your Answer:
Correct Answer: Contralateral hemiplegia
Explanation:Cerebral Dysfunction: Lobe-Specific Features
When the brain experiences dysfunction, it can manifest in various ways depending on the affected lobe. In the frontal lobe, dysfunction can lead to contralateral hemiplegia, impaired problem solving, disinhibition, lack of initiative, Broca’s aphasia, and agraphia (dominant). The temporal lobe dysfunction can result in Wernicke’s aphasia (dominant), homonymous upper quadrantanopia, and auditory agnosia (non-dominant). On the other hand, the non-dominant parietal lobe dysfunction can lead to anosognosia, dressing apraxia, spatial neglect, and constructional apraxia. Meanwhile, the dominant parietal lobe dysfunction can result in Gerstmann’s syndrome. Lastly, occipital lobe dysfunction can lead to visual agnosia, visual illusions, and contralateral homonymous hemianopia.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 4
Incorrect
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According to Maudsley Guidelines, what is the recommended maximum length of time for prescribing benzodiazepines for anxiety?
Your Answer:
Correct Answer: 4 weeks
Explanation:Benzodiazepines and Addiction
Benzodiazepines are known to be addictive and should only be prescribed as a hypnotic or anxiolytic for a maximum of 4 weeks. Withdrawal symptoms can be physical of psychological, including stiffness, weakness, GI disturbance, paraesthesia, flu-like symptoms, visual disturbance, anxiety, insomnia, nightmares, depersonalisation, decreased memory and concentration, delusions, and hallucinations. Patients who wish to withdraw from short-acting benzodiazepines should first be converted to diazepam, which has a longer half-life and produces less severe withdrawal. The table provides approximate equivalent doses for different benzodiazepines. These guidelines are from the Maudsley Guidelines 10th Edition.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 5
Incorrect
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What is a true statement about the National Comorbidity Survey?
Your Answer:
Correct Answer: It was conducted using the Composite International Diagnostic Interview
Explanation:Epidemiological surveys and prevalence estimates have been conducted to determine the prevalence of various mental health conditions. The Epidemiological Catchment Area (ECA) study was conducted in the mid-1980s using the Diagnostic Interview Schedule (DIS) based on DSM-III criteria. The National Comorbidity Survey (NCS) used the Composite International Diagnostic Interview (CIDI) and was conducted in the 1990s and repeated in 2001. The Adult Psychiatric Morbidity Survey (APMS) used the Clinical Interview Schedule (CIS-R) and was conducted in England every 7 years since 1993. The WHO World Mental Health (WMH) Survey Initiative used the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) and was conducted in close to 30 countries from 2001 onwards.
The main findings of these studies show that major depression has a prevalence of 4-10% worldwide, with 6.7% in the past 12 months and 16.6% lifetime prevalence. Generalised anxiety disorder (GAD) has a 3.1% 12-month prevalence and 5.7% lifetime prevalence. Panic disorder has a 2.7% 12-month prevalence and 4.7% lifetime prevalence. Specific phobia has an 8.7% 12-month prevalence and 12.5% lifetime prevalence. Social anxiety disorder has a 6.8% 12-month prevalence and 12.1% lifetime prevalence. Agoraphobia without panic disorder has a 0.8% 12-month prevalence and 1.4% lifetime prevalence. Obsessive-compulsive disorder (OCD) has a 1.0% 12-month prevalence and 1.6% lifetime prevalence. Post-traumatic stress disorder (PTSD) has a 1.3-3.6% 12-month prevalence and 6.8% lifetime prevalence. Schizophrenia has a 0.33% 12-month prevalence and 0.48% lifetime prevalence. Bipolar I disorder has a 1.5% 12-month prevalence and 2.1% lifetime prevalence. Bulimia nervosa has a 0.63% lifetime prevalence, anorexia nervosa has a 0.16% lifetime prevalence, and binge eating disorder has a 1.53% lifetime prevalence.
These prevalence estimates provide important information for policymakers, healthcare providers, and researchers to better understand the burden of mental health conditions and to develop effective prevention and treatment strategies.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 6
Incorrect
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What percentage of values fall within a range of 3 standard deviations above and below the mean?
Your Answer:
Correct Answer: 99.70%
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 7
Incorrect
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What does NICE recommend as the most effective method for reducing harm related to alcohol consumption?
Your Answer:
Correct Answer: Making alcohol less affordable
Explanation:Reducing Alcohol-Related Harm
According to NICE (2010), the most effective and targeted approach to reducing heavy drinking and alcohol-related harm is through implementing a minimum alcohol price. Additionally, limiting the availability of alcohol by reducing the number of outlets selling it in a specific area and restricting the days and hours when it can be sold is another effective strategy.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 8
Incorrect
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What is the most accurate approximation of the occurrence rate of puerperal psychosis?
Your Answer:
Correct Answer: 2 in 1000
Explanation:Puerperal Psychosis: Incidence, Risk Factors, and Treatment
Postpartum psychosis is a subtype of bipolar disorder with an incidence of 1-2 in 1000 pregnancies. It typically occurs rapidly between day 2 and day 14 following delivery, with almost all cases occurring within 8 weeks of delivery. Risk factors for puerperal psychosis include a past history of puerperal psychosis, pre-existing psychotic illness (especially affective psychosis) requiring hospital admission, and a family history of affective psychosis in first of second degree relatives. However, factors such as twin pregnancy, breastfeeding, single parenthood, and stillbirth have not been shown to be associated with an increased risk. Treatment for puerperal psychosis is similar to that for psychosis in general, but special consideration must be given to potential issues if the mother is breastfeeding.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 9
Incorrect
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What does the term necrophilia refer to in regards to an abnormal sexual preference?
Your Answer:
Correct Answer: Corpses
Explanation:Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).
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This question is part of the following fields:
- Forensic Psychiatry
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Question 10
Incorrect
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What steps should be taken to rule out other possible causes before diagnosing a child with encopresis?
Your Answer:
Correct Answer: Hirschsprung's disease
Explanation:Elimination Disorders
Elimination disorders refer to conditions that affect a child’s ability to control their bladder of bowel movements. Enuresis, of lack of control over the bladder, typically occurs between the ages of 1-3, while control over the bowel usually occurs before that of the bladder for most toddlers. Toilet training can be influenced by various factors, including intellectual capacity, cultural determinants, and psychological interactions between the child and their parents.
Enuresis is characterized by involuntary voiding of urine, by day and/of by night, which is abnormal in relation to the individual’s age and is not a result of any physical abnormality. It is not normally diagnosed before age 5 and may be primary (the child never having achieved continence) of secondary. Treatment options include reassurance, enuresis alarms, and medication.
Encopresis refers to repeated stool evacuation in inappropriate places in children over the age of four. The behavior can be either involuntary of intentional and may be due to unsuccessful toilet training (primary encopresis) of occur after a period of normal bowel control (secondary encopresis). Treatment generally involves bowel clearance, prevention of impaction, and behavioral therapy.
Before a diagnosis of encopresis is made, organic causes must be excluded. Hirschsprung’s disease is a condition that results from an absence of parasympathetic ganglion cells in the rectum, colon, and sometimes the small intestine. It leads to a colonic obstruction and is diagnosed in at least half of all cases in the first year of life. It is twice as common in boys than in girls.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 11
Incorrect
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What is the recommended minimum dose of olanzapine for a patient experiencing a relapse of schizophrenia?
Your Answer:
Correct Answer: 7.5 mg
Explanation:Antipsychotics: Minimum Effective Doses
The Maudsley Guidelines provide a table of minimum effective oral doses for antipsychotics in schizophrenia. The following doses are recommended for first episode and relapse (multi-episode) cases:
– Chlorpromazine: 200mg (first episode) and 300mg (relapse)
– Haloperidol: 2mg (first episode) and 4mg (relapse)
– Sulpiride: 400mg (first episode) and 800mg (relapse)
– Trifluoperazine: 10mg (first episode) and 15mg (relapse)
– Amisulpride: 300mg (first episode) and 400mg (relapse)
– Aripiprazole: 10mg (first episode and relapse)
– Olanzapine: 5mg (first episode) and 7.5mg (relapse)
– Quetiapine: 150mg (first episode) and 300mg (relapse)
– Risperidone: 2mg (first episode) and 4mg (relapse)The minimum effective doses may vary depending on individual patient factors and response to treatment. It is important to consult with a healthcare professional before making any changes to medication dosages.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 12
Incorrect
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Which statement accurately describes Prader-Willi syndrome?
Your Answer:
Correct Answer: Affected individuals typically have small gonads
Explanation:Genomic Imprinting and its Role in Psychiatric Disorders
Genomic imprinting is a phenomenon where a piece of DNA behaves differently depending on whether it is inherited from the mother of the father. This is because DNA sequences are marked of imprinted in the ovaries and testes, which affects their expression. In psychiatry, two classic examples of genomic imprinting disorders are Prader-Willi and Angelman syndrome.
Prader-Willi syndrome is caused by a deletion of chromosome 15q when inherited from the father. This disorder is characterized by hypotonia, short stature, polyphagia, obesity, small gonads, and mild mental retardation. On the other hand, Angelman syndrome, also known as Happy Puppet syndrome, is caused by a deletion of 15q when inherited from the mother. This disorder is characterized by an unusually happy demeanor, developmental delay, seizures, sleep disturbance, and jerky hand movements.
Overall, genomic imprinting plays a crucial role in the development of psychiatric disorders. Understanding the mechanisms behind genomic imprinting can help in the diagnosis and treatment of these disorders.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 13
Incorrect
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What is necessary for a study to confidently assert causation?
Your Answer:
Correct Answer: Good internal validity
Explanation:In order to make assertions about causation, strong internal validity is necessary.
Validity in statistics refers to how accurately something measures what it claims to measure. There are two main types of validity: internal and external. Internal validity refers to the confidence we have in the cause and effect relationship in a study, while external validity refers to the degree to which the conclusions of a study can be applied to other people, places, and times. There are various threats to both internal and external validity, such as sampling, measurement instrument obtrusiveness, and reactive effects of setting. Additionally, there are several subtypes of validity, including face validity, content validity, criterion validity, and construct validity. Each subtype has its own specific focus and methods for testing validity.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 14
Incorrect
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What evidence indicates the presence of obsessive compulsive personality disorder?
Your Answer:
Correct Answer: Inability to discard worn out objects with no sentimental value
Explanation:It is important to note that there is a significant difference between obsessive compulsive disorder and obsessive compulsive personality disorder.
Personality Disorder (Obsessive Compulsive)
Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control, which can hinder flexibility and efficiency. This pattern typically emerges in early adulthood and can be present in various contexts. The estimated prevalence ranges from 2.1% to 7.9%, with males being diagnosed twice as often as females.
The DSM-5 diagnosis requires the presence of four of more of the following criteria: preoccupation with details, rules, lists, order, organization, of agenda to the point that the key part of the activity is lost; perfectionism that hampers completing tasks; extreme dedication to work and efficiency to the elimination of spare time activities; meticulous, scrupulous, and rigid about etiquettes of morality, ethics, of values; inability to dispose of worn-out of insignificant things even when they have no sentimental meaning; unwillingness to delegate tasks of work with others except if they surrender to exactly their way of doing things; miserly spending style towards self and others; and rigidity and stubbornness.
The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder, which can be further specified as “mild,” “moderate,” of “severe.” The anankastic trait domain is characterized by a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behavior and controlling situations to ensure conformity to these standards. Common manifestations of anankastic include perfectionism and emotional and behavioral constraint.
Differential diagnosis includes OCD, hoarding disorder, narcissistic personality disorder, antisocial personality disorder, and schizoid personality disorder. OCD is distinguished by the presence of true obsessions and compulsions, while hoarding disorder should be considered when hoarding is extreme. Narcissistic personality disorder individuals are more likely to believe that they have achieved perfection, while those with obsessive-compulsive personality disorder are usually self-critical. Antisocial personality disorder individuals lack generosity but will indulge themselves, while those with obsessive-compulsive personality disorder adopt a miserly spending style toward both self and others. Schizoid personality disorder is characterized by a fundamental lack of capacity for intimacy, while in obsessive-compulsive personality disorder, this stems from discomfort with emotions and excessive devotion to work.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 15
Incorrect
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A new medication is being developed to treat hypertension in elderly patients. Several different drugs are being considered for their efficacy in reducing blood pressure. Which study design would require the largest number of participants to achieve a significant outcome?
Your Answer:
Correct Answer: Superiority trial
Explanation:Since a superiority trial involves comparing a new drug with an already existing treatment that can also reduce HbA1c levels, a substantial sample size is necessary to establish a significant distinction.
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 16
Incorrect
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Which topic is Penrose's law related to?
Your Answer:
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.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 17
Incorrect
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Which statistical test is best suited for analyzing the difference in blood pressure between the two groups of patients who were given either the established of new anti-hypertensive medication in a randomized controlled trial with a crossover design?
Your Answer:
Correct Answer: Paired t-test
Explanation:The appropriate statistical test to analyze the research question of the difference between two related groups with a dependent variable of change in BP (ratio) and parametric data is a paired t-test.
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 18
Incorrect
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What is the state of mental health among prisoners in the UK?
Your Answer:
Correct Answer: Rates of suicidal attempts are higher in remand compared to sentenced prisoners
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 19
Incorrect
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What is the minimum duration of symptoms required for a diagnosis of schizophrenia according to the ICD-11?
Your Answer:
Correct Answer: 1 month
Explanation:– Schizophrenia and other primary psychotic disorders are characterized by impairments in reality testing and alterations in behavior.
– Schizophrenia is a chronic mental health disorder with symptoms including delusions, hallucinations, disorganized speech of behavior, and impaired cognitive ability.
– The essential features of schizophrenia include persistent delusions, persistent hallucinations, disorganized thinking, experiences of influence, passivity of control, negative symptoms, grossly disorganized behavior, and psychomotor disturbances.
– Schizoaffective disorder is diagnosed when all diagnostic requirements for schizophrenia are met concurrently with mood symptoms that meet the diagnostic requirements of a moderate or severe depressive episode, a manic episode, of a mixed episode.
– Schizotypal disorder is an enduring pattern of unusual speech, perceptions, beliefs, and behaviors that are not of sufficient intensity of duration to meet the diagnostic requirements of schizophrenia, schizoaffective disorder, of delusional disorder.
– Acute and transient psychotic disorder is characterized by an acute onset of psychotic symptoms, which can include delusions, hallucinations, disorganized thinking, of experiences of influence, passivity of control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks.
– Delusional disorder is diagnosed when there is a presence of a delusion of set of related delusions, typically persisting for at least 3 months and often much longer, in the absence of a depressive, manic, of mixed episode. -
This question is part of the following fields:
- General Adult Psychiatry
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Question 20
Incorrect
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What is a true statement about fitness to plead?
Your Answer:
Correct Answer: If a person is found unfit to plead, there is usually a trial of the facts.
Explanation:When a person is deemed unfit to plead, typically a trial of the facts follows. Unfitness to plead is determined at the time of trial, rather than at the time of the offense, and can be caused by physical illness.
Fitness to Plead: Criteria and Process
Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 21
Incorrect
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What condition would make it inappropriate to use the Student's t-test for conducting a significance test?
Your Answer:
Correct Answer: Using it with data that is not normally distributed
Explanation:T-tests are appropriate for parametric data, which means that the data should conform to a normal distribution.
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 22
Incorrect
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A teenager is referred for a review following a stressful life event associated with a deterioration in their mental health.
How can we distinguish between post traumatic stress disorder and an acute stress reaction in this case?Your Answer:
Correct Answer: The duration of the symptoms
Explanation:The primary distinction between PTSD and an acute stress reaction lies in the length of time that symptoms persist. If symptoms have not significantly diminished within a month, the diagnosis shifts to PTSD; prior to that point, it is classified as an acute stress reaction.
Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 23
Incorrect
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How can somatoform disorder be best defined?
Your Answer:
Correct Answer: Da Costa's syndrome
Explanation:Psychalgia refers to pain that has a psychological origin.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 24
Incorrect
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How should a patient with anorexia nervosa and a BMI of 14 be managed appropriately?
Your Answer:
Correct Answer: Unsupervised use of toilet facilities
Explanation:The MARSIPAN group has provided specific recommendations for managing the physical health issues of patients with anorexia nervosa. These recommendations vary depending on the patient’s BMI, with different management plans suggested for those with a BMI below 15 and those with a BMI below 13. For patients with a BMI below 15, the group suggests allowing unsupervised use of the toilet, but advises that fluid balance monitoring may be necessary. The other options mentioned in the question are relevant for patients with a BMI below 13. The MARSIPAN guidelines were published in October 2010 as the College Report CR162 by the Royal College of Psychiatrists and Royal College of Physicians in London.
Anorexia is a serious mental health condition that can have severe physical complications. These complications can affect various systems in the body, including the cardiac, skeletal, hematologic, reproductive, metabolic, gastrointestinal, CNS, and dermatological systems. Some of the recognized physical complications of anorexia nervosa include bradycardia, hypotension, osteoporosis, anemia, amenorrhea, hypothyroidism, delayed gastric emptying, cerebral atrophy, and lanugo.
The Royal College of Psychiatrists has issued advice on managing sick patients with anorexia nervosa, recommending hospital admission for those with high-risk items. These items include a BMI of less than 13, a pulse rate of less than 40 bpm, a SUSS test score of less than 2, a sodium level of less than 130 mmol/L, a potassium level of less than 3 mmol/L, a serum glucose level of less than 3 mmol/L, and a QTc interval of more than 450 ms. The SUSS test involves assessing the patient’s ability to sit up and squat without using their hands. A rating of 0 indicates complete inability to rise, while a rating of 3 indicates the ability to rise without difficulty. Proper management and treatment of anorexia nervosa are crucial to prevent of manage these physical complications.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 25
Incorrect
-
What is the most dependable risk factor that has been demonstrated for autism spectrum disorder?
Your Answer:
Correct Answer: Valproate use during pregnancy
Explanation:Autism Spectrum Disorder (ASD) is a lifelong disorder characterized by deficits in communication and social understanding, as well as restrictive and repetitive behaviors. The distinction between autism and Asperger’s has been abandoned, and they are now grouped together under the ASD category. Intellectual ability is difficult to assess in people with ASD, with an estimated 33% having an intellectual disability. ASD was first described in Europe and the United States using different terms, with Leo Kanner and Hans Asperger being the pioneers. Diagnosis is based on persistent deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior. The worldwide population prevalence is about 1%, with comorbidity being common. Heritability is estimated at around 90%, and both genetic and environmental factors seem to cause ASD. Currently, there are no validated pharmacological treatments that alleviate core ASD symptoms, but second-generation antipsychotics are the first-line pharmacological treatment for children and adolescents with ASD and associated irritability.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 26
Incorrect
-
What is the typical age when males begin to experience puberty?
Your Answer:
Correct Answer: Age 12
Explanation:Boys typically begin puberty around the age of 12, while girls typically begin around the age of 11.
Puberty
Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 27
Incorrect
-
What is the recommendation of NICE guidelines regarding the use of a certain treatment for depression?
Your Answer:
Correct Answer: Dosulepin
Explanation:NICE recommends against the use of dosulepin due to the higher risk of cardiac complications and overdose toxicity, which outweigh any potential benefits in terms of tolerability compared to other antidepressants.
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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 28
Incorrect
-
What statistical test would be appropriate to compare the mean blood pressure measurements of a group of individuals before and after exercise?
Your Answer:
Correct Answer: Paired t-test
Explanation: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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 29
Incorrect
-
What is the estimated percentage of male prisoners who have been sentenced in England and Wales and are believed to have antisocial personality disorder?
Your Answer:
Correct Answer: 50%
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 30
Incorrect
-
Which of the following terms is used to describe a behavior that supports of encourages someone's addiction?
Your Answer:
Correct Answer: The mother of a man addicted to heroin goes to buy drugs on his behalf as he is too scared to leave the house
Explanation:Codependency and Enabling Behaviors in Addiction
Codependency is a term used to describe a situation where a person becomes emotionally and psychologically dependent on the behavior of an addict. This goes beyond a normal caring role and can lead to a maladaptive and destructive dynamic. The codependent person may unintentionally encourage the addiction and perpetuate it to protect their role. This is significant because codependent people may engage in enabling behaviors, which involve helping of encouraging an addict to continue using drugs, either directly of indirectly. For example, a spouse giving money to an addict to buy drugs is an enabling behavior. It is important to recognize and address codependency and enabling behaviors in addiction to promote healthy relationships and recovery.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 31
Incorrect
-
In what way can the study on depression be deemed as having limited applicability to the average patient population?
Your Answer:
Correct Answer: External validity
Explanation:When a study has good external validity, its findings can be applied to other populations with confidence.
Validity in statistics refers to how accurately something measures what it claims to measure. There are two main types of validity: internal and external. Internal validity refers to the confidence we have in the cause and effect relationship in a study, while external validity refers to the degree to which the conclusions of a study can be applied to other people, places, and times. There are various threats to both internal and external validity, such as sampling, measurement instrument obtrusiveness, and reactive effects of setting. Additionally, there are several subtypes of validity, including face validity, content validity, criterion validity, and construct validity. Each subtype has its own specific focus and methods for testing validity.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 32
Incorrect
-
A 25-year-old man is referred for an opinion having been persuaded to see his GP by his girlfriend. He explains that he struggles to concentrate at work and has been criticised for being disorganised. His girlfriend tells you that her boyfriend never seems to listen and always seems distracted. A further inquiry into his personal history reveals that he was often in trouble at school for interrupting and fidgeting and that one teacher called him the 'Red Devil'. Which of the following would be the most appropriate option based on the above description?:
Your Answer:
Correct Answer: Methylphenidate
Explanation:Based on the description, it appears that the individual may have adult ADHD.
ADHD Diagnosis and Management in Adults
ADHD is a behavioural syndrome characterised by symptoms of inattention, hyperactivity, and impulsivity. The DSM-5 and ICD-11 provide diagnostic criteria for ADHD, with the DSM-5 recognising three subtypes of the condition: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
Treatment for ADHD in adults includes medication and non-pharmacological interventions. NICE recommends offering medication to adults with ADHD if their symptoms are still causing significant impairment after environmental modifications have been implemented and reviewed. Methylphenidate of lisdexamfetamine are first-line medications, with atomoxetine offered for those who cannot tolerate the former two. Additional medication options may be considered with advice from a tertiary ADHD service.
NICE advises against elimination diets, dietary fatty acid supplementation, and the use of the ‘few foods diet’ for ADHD. Prior to initiating medication, referral to cardiology is recommended if there is a suggestion of cardiac pathology. If a person with ADHD develops mania of psychosis, ADHD treatment should be stopped until the episode has resolved. If a person taking stimulants develops tics, medication options may be adjusted.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 33
Incorrect
-
What is a skin alteration that can be observed in individuals with anorexia nervosa?
Your Answer:
Correct Answer: All of the above
Explanation:Skin Changes in Anorexia Nervosa
Anorexia nervosa is an eating disorder characterized by a distorted body image and an intense fear of gaining weight. In addition to the physical effects of malnutrition, anorexia can also cause various skin changes. These changes include xerosis of dry skin, cheilitis of inflammation of the lips, gingivitis of inflammation of the gums, hypertrichiosis of excess hair growth in areas that do not normally have hair, hyperpigmentation, Russell’s sign of scarring on knuckles and back of hand, carotenoderma of yellow/orange skin color, acne, nail changes, acrocyanosis of persistent blue, cyanotic discoloration of the digits, and seborrheic dermatitis. These skin changes can be a sign of underlying malnutrition and should be addressed as part of the treatment plan for anorexia nervosa.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 34
Incorrect
-
What is the primary purpose of funnel plots?
Your Answer:
Correct Answer: Demonstrate the existence of publication bias in meta-analyses
Explanation:Stats Publication Bias
Publication bias refers to the tendency for studies with positive findings to be published more than studies with negative findings, leading to incomplete data sets in meta-analyses and erroneous conclusions. Graphical methods such as funnel plots, Galbraith plots, ordered forest plots, and normal quantile plots can be used to detect publication bias. Funnel plots are the most commonly used and offer an easy visual way to ensure that published literature is evenly weighted. The x-axis represents the effect size, and the y-axis represents the study size. A symmetrical, inverted funnel shape indicates that publication bias is unlikely, while an asymmetrical funnel indicates a relationship between treatment effect and study size, indicating either publication bias of small study effects.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 35
Incorrect
-
What is the closest estimate of the prevalence of ADHD in adults worldwide according to the DSM-IV definition?
Your Answer:
Correct Answer: 3.50%
Explanation:ADHD is a prevalent disorder worldwide, with a prevalence of 7% in those under 18 and 3.5% in those over 18. It is more common in males, with a male to female ratio of 2:1 in children and 1.6:1 in adults. While some improvement in symptoms is seen over time, the majority of those diagnosed in childhood continue to struggle with residual symptoms and impairments through at least young adulthood, with an estimated persistence rate of 50%.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 36
Incorrect
-
NICE recommends a certain treatment for young people with OCD (excluding depression).
Your Answer:
Correct Answer: Sertraline
Explanation:According to NICE guidelines from 2006, when prescribing an SSRI to children and young people with OCD, a licensed medication such as sertraline of fluvoxamine should be used. However, if the patient has significant comorbid depression, fluoxetine should be used due to current regulatory requirements.
OCD and BDD are two mental health disorders that can affect children. OCD is characterized by obsessions and compulsions, while BDD is characterized by a preoccupation with an imagined defect in one’s appearance. Both disorders can cause significant distress and impairment in daily functioning.
For mild cases of OCD, guided self-help may be considered along with support and information for the family of caregivers. For moderate to severe cases of OCD, cognitive-behavioral therapy (CBT) that involves the family of caregivers and is adapted to suit the child’s developmental age is recommended. For all children and young people with BDD, CBT (including exposure and response prevention) is recommended.
If a child declines psychological treatment, a selective serotonin reuptake inhibitor (SSRI) may be prescribed. However, a licensed medication (sertraline of fluvoxamine) should be used for children and young people with OCD, while fluoxetine should be used for those with BDD. If an SSRI is ineffective of not tolerated, another SSRI of clomipramine may be tried. Tricyclic antidepressants other than clomipramine should not be used to treat OCD of BDD in children and young people. Other antidepressants (MAOIs, SNRIs) and antipsychotics should not be used alone in the routine treatment of OCD of BDD in children of young people, but may be considered as an augmentation strategy.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 37
Incorrect
-
What is a known factor that can lead to psychosis?
Your Answer:
Correct Answer: Huntington's disease
Explanation: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.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 38
Incorrect
-
What is the approximate occurrence rate of functional psychosis among male remand prisoners in England and Wales?
Your Answer:
Correct Answer: 10%
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 39
Incorrect
-
Which treatment option is not advised by NICE for individuals with anorexia nervosa?
Your Answer:
Correct Answer: Anorexia adapted rational emotive therapy
Explanation:Eating Disorders: NICE Guidelines
Anorexia:
For adults with anorexia nervosa, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED), Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), of specialist supportive clinical management (SSCM). If these are not acceptable, contraindicated, of ineffective, consider eating-disorder-focused focal psychodynamic therapy (FPT). For children and young people, consider anorexia-nervosa-focused family therapy (FT-AN) of individual CBT-ED. Do not offer medication as the sole treatment.Bulimia:
For adults, the first step is an evidence-based self-help programme. If this is not effective, consider individual CBT-ED. For children and young people, offer bulimia-nervosa-focused family therapy (FT-BN) of individual CBT-ED. Do not offer medication as the sole treatment.Binge Eating Disorder:
The first step is a guided self-help programme. If this is not effective, offer group of individual CBT-ED. For children and young people, offer the same treatments recommended for adults. Do not offer medication as the sole treatment.Advice for those with eating disorders:
Encourage people with an eating disorder who are vomiting to avoid brushing teeth immediately after vomiting, rinse with non-acid mouthwash, and avoid highly acidic foods and drinks. Advise against misusing laxatives of diuretics and excessive exercise.Additional points:
Do not offer physical therapy as part of treatment. Consider bone mineral density scans after 1 year of underweight in children and young people, of 2 years in adults. Do not routinely offer oral of transdermal oestrogen therapy to treat low bone mineral density in children of young people with anorexia nervosa. Consider transdermal 17-β-estradiol of bisphosphonates for women with anorexia nervosa.Note: These guidelines are taken from NICE guidelines 2017.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 40
Incorrect
-
A research project has a significance level of 0.05, and the obtained p-value is 0.0125. What is the probability of committing a Type I error?
Your Answer:
Correct Answer: Jan-80
Explanation:An observed p-value of 0.0125 means that there is a 1.25% chance of obtaining the observed result by chance, assuming the null hypothesis is true. This also means that the Type I error rate (the probability of falsely rejecting the null hypothesis) is 1/80 of 1.25%. In comparison, a p-value of 0.05 indicates a 5% chance of obtaining the observed result by chance, of a Type I error rate of 1/20.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 41
Incorrect
-
Which of the following is an example of selection bias?
Your Answer:
Correct Answer: Berkson's 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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 42
Incorrect
-
Which of the following options is NOT a suitable initial treatment for an adult diagnosed with obsessive-compulsive disorder?
Your Answer:
Correct Answer: Mirtazapine
Explanation:SSRIs are recommended for the treatment of OCD in adults.
Maudsley Guidelines
First choice: SSRI of clomipramine (SSRI preferred due to tolerability issues with clomipramine)
Second line:
– SSRI + antipsychotic
– Citalopram + clomipramine
– Acetylcysteine + (SSRI of clomipramine)
– Lamotrigine + SSRI
– Topiramate + SSRI -
This question is part of the following fields:
- General Adult Psychiatry
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Question 43
Incorrect
-
What is the recommended duration of antidepressant treatment for children diagnosed with OCD according to NICE guidelines?
Your Answer:
Correct Answer: 6 months following remission
Explanation:For children and young individuals diagnosed with OCD of BDD, medication should be gradually discontinued if they have achieved remission, meaning their symptoms are no longer clinically significant and they are functioning normally, and this has been maintained for a minimum of 6 months. For adults, the recommended duration of remission before medication withdrawal is 12 months.
OCD and BDD are two mental health disorders that can affect children. OCD is characterized by obsessions and compulsions, while BDD is characterized by a preoccupation with an imagined defect in one’s appearance. Both disorders can cause significant distress and impairment in daily functioning.
For mild cases of OCD, guided self-help may be considered along with support and information for the family of caregivers. For moderate to severe cases of OCD, cognitive-behavioral therapy (CBT) that involves the family of caregivers and is adapted to suit the child’s developmental age is recommended. For all children and young people with BDD, CBT (including exposure and response prevention) is recommended.
If a child declines psychological treatment, a selective serotonin reuptake inhibitor (SSRI) may be prescribed. However, a licensed medication (sertraline of fluvoxamine) should be used for children and young people with OCD, while fluoxetine should be used for those with BDD. If an SSRI is ineffective of not tolerated, another SSRI of clomipramine may be tried. Tricyclic antidepressants other than clomipramine should not be used to treat OCD of BDD in children and young people. Other antidepressants (MAOIs, SNRIs) and antipsychotics should not be used alone in the routine treatment of OCD of BDD in children of young people, but may be considered as an augmentation strategy.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 44
Incorrect
-
Sara is referred to you by her GP. Sara had a road traffic accident 3 months ago and is suffering with symptoms of PTSD. She is struggling to sleep and is experiencing problems in her relationship. She also reports thoughts of self-harm since the incident and last week took an overdose of tablets.
All of the following would be appropriate to offer, except:Your Answer:
Correct Answer: Supported trauma-focused computerised CBT
Explanation:Computer-based CBT should not be provided in situations where there is a potential for self-harm.
Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 45
Incorrect
-
A teenager presents to A&E with acute mania, it is their first episode. You decide to admit them to the ward and contact the consultant on call for advice. The consultant asks you your opinion on drug treatment. Which of the following has been shown to be most effective in the treatment of acute mania?
Your Answer:
Correct Answer: Haloperidol
Explanation:Haloperidol has been demonstrated to be the most efficacious treatment, despite not being the most well-tolerated due to its side effects.
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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 46
Incorrect
-
What are the endocrine changes observed in individuals with Anorexia nervosa?
Your Answer:
Correct Answer: Increased cortisol levels
Explanation:Eating Disorders: Lab Findings and Medical Complications
Eating disorders can lead to a range of medical complications, including renal failure, peripheral edema, sinus bradycardia, QT-prolongation, pericardial effusion, and slowed GI motility. Other complications include constipation, cathartic colon, esophageal esophagitis, hair loss, and dental erosion. Blood abnormalities are also common in patients with eating disorders, including hyponatremia, hypokalemia, hypophosphatemia, and hypoglycemia. Additionally, patients may experience leucopenia, anemia, low albumin, elevated liver enzymes, and vitamin deficiencies. These complications can cause significant morbidity and mortality in patients with eating disorders. It is important for healthcare providers to monitor patients for these complications and provide appropriate treatment.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 47
Incorrect
-
A teenager is referred to you regarding his concern about the appearance of his nose. He complains that it is extremely large and has approached several surgeons in an attempt to get a reduction. Objectively you think his nose is an average size. Which of the following conditions would you suspect?
Your Answer:
Correct Answer: Body dysmorphic disorder
Explanation:Body Dysmorphic Disorder is a condition where individuals are preoccupied with one of more perceived flaws in their appearance, which may not be noticeable to others. They may feel excessively self-conscious and believe that others are judging them based on these flaws. This can lead to repetitive behaviors such as examining the perceived flaw, attempting to hide of alter it, of avoiding social situations that trigger distress. In contrast, Body Integrity Dysphoria is a rare condition where individuals experience discomfort of negative feelings about a specific body part, often leading to a desire to amputate of remove it, rather than improve its appearance.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 48
Incorrect
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What is the most commonly perceived area of the body affected in individuals with body dysmorphic disorder?
Your Answer:
Correct Answer: Skin
Explanation:Maudsley Guidelines
First choice: SSRI of clomipramine (SSRI preferred due to tolerability issues with clomipramine)
Second line:
– SSRI + antipsychotic
– Citalopram + clomipramine
– Acetylcysteine + (SSRI of clomipramine)
– Lamotrigine + SSRI
– Topiramate + SSRI -
This question is part of the following fields:
- General Adult Psychiatry
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Question 49
Incorrect
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Which of the options below is not necessary to meet the Pritchard criteria for determining fitness to plead?
Your Answer:
Correct Answer: A defendant is able to recall the events surrounding the alleged offence
Explanation:Although amnesia is not rare in criminal cases, it does not automatically make a person incapable of entering a plea. To be able to make an informed decision about their plea, a defendant must comprehend the evidence presented and the charges against them.
Fitness to Plead: Criteria and Process
Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 50
Incorrect
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Which of the following factors does not increase the risk of self-injury in individuals with learning disabilities?
Your Answer:
Correct Answer: Polypharmacy
Explanation:Medication for Self-Mutilating Behaviour in People with Learning Disability
Self-injurious behaviour is a common issue among people with learning disability, and several risk factors have been identified, including younger age, lower developmental ability, autistic symptoms, and sensory impairment. According to R Collacott’s study published in the British Journal of Psychiatry in 1998, these factors increase the likelihood of self-injury in this population.
Currently, lithium is the only medication that is licensed for the treatment of self-mutilating behaviour in people with learning disability. Other medications may be prescribed off-label, but their effectiveness and safety in this population are not well-established. Therefore, healthcare professionals should carefully consider the risks and benefits of medication use and closely monitor their patients for any adverse effects.
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This question is part of the following fields:
- Learning Disability
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Question 51
Incorrect
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A 16-year-old patient presents with daily auditory hallucinations, delusional beliefs, and avolition that have been ongoing for five weeks. The patient had a two-month history of anxiety and increased social isolation prior to the onset of these symptoms.
What is the most suitable ICD-11 diagnosis for this patient?Your Answer:
Correct Answer: Schizophrenia
Explanation:The symptoms of hallucinations and delusions that have been present for five weeks meet the diagnostic criteria for schizophrenia according to the ICD-11. It should be noted that schizophreniform disorder is not recognized as a diagnosis in the ICD-11, but rather in the DSM-5. In the DSM-5, schizophreniform disorder is considered an intermediate diagnosis between brief psychotic disorder (similar to acute and transient psychotic disorder in the ICD-11) and schizophrenia.
– Schizophrenia and other primary psychotic disorders are characterized by impairments in reality testing and alterations in behavior.
– Schizophrenia is a chronic mental health disorder with symptoms including delusions, hallucinations, disorganized speech of behavior, and impaired cognitive ability.
– The essential features of schizophrenia include persistent delusions, persistent hallucinations, disorganized thinking, experiences of influence, passivity of control, negative symptoms, grossly disorganized behavior, and psychomotor disturbances.
– Schizoaffective disorder is diagnosed when all diagnostic requirements for schizophrenia are met concurrently with mood symptoms that meet the diagnostic requirements of a moderate or severe depressive episode, a manic episode, of a mixed episode.
– Schizotypal disorder is an enduring pattern of unusual speech, perceptions, beliefs, and behaviors that are not of sufficient intensity of duration to meet the diagnostic requirements of schizophrenia, schizoaffective disorder, of delusional disorder.
– Acute and transient psychotic disorder is characterized by an acute onset of psychotic symptoms, which can include delusions, hallucinations, disorganized thinking, of experiences of influence, passivity of control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks.
– Delusional disorder is diagnosed when there is a presence of a delusion of set of related delusions, typically persisting for at least 3 months and often much longer, in the absence of a depressive, manic, of mixed episode. -
This question is part of the following fields:
- General Adult Psychiatry
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Question 52
Incorrect
-
What is the recommended antidepressant for an individual with epilepsy who experiences symptoms of depression?
Your Answer:
Correct Answer: Mirtazapine
Explanation:Psychotropics and Seizure Threshold in People with Epilepsy
People with epilepsy are at an increased risk for various mental health conditions, including depression, anxiety, psychosis, and suicide. It is important to note that the link between epilepsy and mental illness is bidirectional, as patients with mental health conditions also have an increased risk of developing new-onset epilepsy. Psychotropic drugs are often necessary for people with epilepsy, but they can reduce the seizure threshold and increase the risk of seizures. The following tables provide guidance on the seizure risk associated with different classes of antidepressants, antipsychotics, and ADHD medications. It is important to use caution and carefully consider the risks and benefits of these medications when treating people with epilepsy.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 53
Incorrect
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You are part of a team creating a community program for adolescents with Conduct Disorder, aimed at reducing their likelihood of re-offending. The program will offer both individual and group-based psychological interventions.
Which psychological treatment would be most suitable to provide?Your Answer:
Correct Answer: Mentalisation based therapy
Explanation:Mentalisation based therapy (MBT) has shown effectiveness in treating patients with Personality Disorders by helping them understand their own and others’ actions based on intentional mental states such as desires, feelings, and beliefs. While psychoanalytically oriented, it is fully manualised and may be a helpful underlying theory for the service. However, individual psychoanalytic therapy may not be the first line of treatment due to its long delivery time and patient tolerance issues. Individual behavioural therapy and accredited group programmes are easier to run but may not address the complexities of this client group. Other evidence-based psychological treatments for personality disorders include CBT, DBT, schema therapy, CAT, transference-focused psychotherapy, and therapeutic communities (non-forensic).
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This question is part of the following fields:
- Psychotherapy
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Question 54
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 55
Incorrect
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The research team is studying the effectiveness of a new treatment for a certain medical condition. They have found that the brand name medication Y and its generic version Y1 have similar efficacy. They approach you for guidance on what type of analysis to conduct next. What would you suggest?
Your Answer:
Correct Answer: Cost minimisation analysis
Explanation:Cost minimisation analysis is employed to compare net costs when the observed effects of health care interventions are similar. To conduct this analysis, it is necessary to have clinical evidence that demonstrates the differences in health effects between alternatives are negligible of insignificant. This approach is commonly used by institutions like the National Institute for Health and Care Excellence (NICE).
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 56
Incorrect
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Which medication is most likely to reduce the effectiveness of the oral contraceptive pill?
Your Answer:
Correct Answer: Carbamazepine
Explanation:Mood stabilisers and contraception: Some anticonvulsants/mood stabilisers can interfere with contraception, such as carbamazepine, phenytoin, and topiramate. However, others like valproate, lamotrigine, gabapentin, and lithium do not tend to cause this problem and are preferred for women using contraception. It is important to note that valproate should only be used in girls and women of childbearing potential if other treatments are ineffective of not tolerated, as judged by an experienced specialist. Additionally, valproate is contraindicated in girls and women of childbearing potential unless the conditions of the valproate pregnancy prevention programme (‘prevent’) are met.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 57
Incorrect
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A 56-year-old man who recently retired and lives in a residential home reports seeing ghosts. He has decreased vision in both eyes and a slit lamp exam shows cataracts in both eyes. There is no evidence of any secondary gain related to his complaints. What is the most probable diagnosis?
Your Answer:
Correct Answer: Charles Bonnet syndrome
Explanation:Charles Bonnet syndrome (CBS) is a condition where mentally healthy individuals experience vivid and recurring visual hallucinations, also known as fictive visual percepts. These hallucinations are typically small in size, known as lilliputian hallucinations. CBS is commonly found in individuals who have visual impairments due to old age of damage to the eyes of optic pathways. However, not all individuals with such deficits develop CBS. In some cases, CBS may be triggered by a combination of central vision loss due to conditions like macular degeneration and peripheral vision loss from glaucoma. In this context, bilateral lenticular opacities refer to cataracts. For more information on CBS, please refer to the Royal National Institute of Blind People (RNIB).
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This question is part of the following fields:
- Old Age Psychiatry
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Question 58
Incorrect
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A woman with schizophrenia and alcohol misuse is admitted to hospital following a fall. On day three of the admission she becomes confused and agitated. Which of the following should not be prescribed?
Your Answer:
Correct Answer: IV glucose
Explanation:It is possible that the man is experiencing alcohol withdrawal, which often causes fluid imbalances that need to be addressed. However, administering intravenous glucose is not recommended as it could lead to Wernicke’s encephalopathy. While beta blockers have been found to be helpful in treating alcohol withdrawal, this is not a widely used method. A resource for further information on this topic is the article Alcohol Withdrawal Syndrome by Bayard M. in the March 15, 2004 issue of American Family Physician.
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.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 59
Incorrect
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What category does country of origin fall under in terms of data classification?
Your Answer:
Correct Answer: Nominal
Explanation:Scales of Measurement in Statistics
In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.
Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.
Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.
Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 60
Incorrect
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Who is credited with introducing the idea of the 'good enough mother'?
Your Answer:
Correct Answer: Winnicott
Explanation:Winnicott: An Overview
Donald Winnicott, a British paediatrician and psychotherapist, is known for his contributions to the field of child development and psychoanalysis. He introduced several concepts that are still relevant today.
Good Enough Mother: Winnicott emphasised the importance of being a good enough mother rather than a perfect one. He believed that children needed someone who would attend to them but not immediately so that they could learn to tolerate frustration.
Holding Environment: This refers to the psychic and physical space between the mother and infant that ensures the mother is there for the child when needed but allows them to explore independently when ready.
Transitional Object: Winnicott talked about the two separate realities for a child, the ‘me’ and the ‘not me’. The transitional object is one that represents another (e.g. Mother) and is regarded as the first ‘not me’ possession.
False Self: Winnicott described the situation of ‘not good-enough mothering’ as one in which the mother (consciously of unconsciously) is unable to respond adequately to her infant’s spontaneous behaviour (true self), but tends to impose her own wishes and desires (e.g. for an ‘ideal’ child). This may lead the infant to an adaptation on the basis of ’compliance’ (false self) and later, in adulthood, to the loss of a sense of personal autonomy and integrity.
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This question is part of the following fields:
- Psychotherapy
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Question 61
Incorrect
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What is the likelihood of women with bipolar disorder experiencing a relapse during the postpartum period?
Your Answer:
Correct Answer: 40%
Explanation:Bipolar Disorder in Women of Childbearing Potential
Prophylaxis is recommended for women with bipolar disorder, as postpartum relapse rates are high. Women without prophylactic pharmacotherapy during pregnancy have a postpartum relapse rate of 66%, compared to 23% for women with prophylaxis. Antipsychotics are recommended for pregnant women with bipolar disorder, according to NICE Guidelines (CG192) and the Maudsley. Women taking valproate, lithium, carbamazepine, of lamotrigine should discontinue treatment and start an antipsychotic, especially if taking valproate. If a woman with bipolar disorder is taking lithium and becomes pregnant, she should gradually stop lithium over a 4 week period and start an antipsychotic. If this is not possible, lithium levels must be taken regularly, and the dose adjusted accordingly. For acute mania, an antipsychotic should be considered. For mild depressive symptoms, self-help approaches, brief psychological interventions, and antidepressant medication can be considered. For moderate to severe depressive symptoms, psychological treatment (CBT) for moderate depression and combined medication and structured psychological interventions for severe depression should be considered.
Reference: Wesseloo, R., Kamperman, A. M., Munk-Olsen, T., Pop, V. J., Kushner, S. A., & Bergink, V. (2016). Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. The American Journal of Psychiatry, 173(2), 117-127.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 62
Incorrect
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How would you describe the behavior of a child who complains of stomach pains when taken to school but appears fine and eager to learn and play when allowed to stay at home?
Your Answer:
Correct Answer: School refusal
Explanation: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.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 63
Incorrect
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What type of bias could arise from using only one psychiatrist to diagnose all participants in a study?
Your Answer:
Correct Answer: Information bias
Explanation:The scenario described above highlights the issue of information bias, which can arise due to errors in measuring, collecting, of interpreting data related to the exposure of disease. Specifically, interviewer/observer bias is a type of information bias that can occur when a single psychiatrist has a tendency to either over of under diagnose a condition, potentially skewing the study results.
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 64
Incorrect
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What conclusion did the POTS study draw about treating OCD in children?
Your Answer:
Correct Answer: Children with OCD should begin treatment with the combination of CBT plus an SSRI of CBT alone
Explanation:The recommended treatment for children and adolescents with OCD is either a combination of CBT and a selective serotonin reuptake inhibitor of CBT alone, according to the study’s findings.
POTS Study: Combination of CBT and Sertraline Best for Treating Pediatric OCD
The Pediatric OCD Treatment Study (POTS I) was the first randomized trial in pediatric OCD to compare the efficacy of sertraline, OCD-specific cognitive behavioral treatment (CBT), their combination, and a placebo control condition in treating children and adolescents with clinically significant OCD. The study took place in the United States and involved 112 participants who were randomly assigned to receive CBT alone, sertraline alone, combined CBT and sertraline, of a placebo for 12 weeks.
The study found that all three active treatments (CBT alone, sertraline alone, and combined treatment) were significantly more effective than the placebo. The combined treatment was found to be the most effective, with a remission rate of 53.6%, followed by CBT alone (39.3%) and sertraline alone (21.4%). The study also found that combined treatment was less susceptible to setting-specific variations than CBT and sertraline alone.
The study concluded that children and adolescents with OCD should begin treatment with the combination of CBT plus a selective serotonin reuptake inhibitor of CBT alone. The three active treatments were found to be acceptable and well-tolerated, with no evidence of treatment-emergent harm to self of others.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 65
Incorrect
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What does testamentary capacity refer to?
Your Answer:
Correct Answer: Ability to make a will
Explanation:The term used to refer to the individual who creates a will is the testator, which is why the ability to create a will is known as testamentary capacity (derived from the Latin word testator).
Testamentary Capacity
Testamentary capacity is a crucial aspect of common law that pertains to a person’s legal and mental ability to create a will. To meet the requirements for testamentary capacity, there are four key factors that a testator must be aware of at the time of making the will. These include knowing the extent and value of their property, identifying the natural beneficiaries, understanding the disposition they are making, and having a plan for how the property will be distributed.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 66
Incorrect
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What is the best course of action for a pregnant patient who regularly attends clinic for moderate to severe depression and is taking paroxetine, but is unwilling to consider psychological options?
Your Answer:
Correct Answer: Continue the paroxetine
Explanation:If the patient’s depression history was only mild to moderate, NICE would suggest considering stopping paroxetine and using facilitated self-help. However, since the patient’s depression history is more severe, it would not be wise to discontinue antidepressant treatment. The Maudsley recommends continuing with the same antidepressant if it is effective, except for MAOIs, to prevent relapse. Although some studies have linked paroxetine to cardiac malformations, other studies have not replicated this finding and have implicated other SSRIs. While paroxetine may increase the likelihood of neonatal withdrawal effects compared to alternatives with a longer half-life, these effects are typically mild and self-limiting.
Paroxetine Use During Pregnancy: Is it Safe?
Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 67
Incorrect
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Which of the following is most commonly linked to altruistic homicide?
Your Answer:
Correct Answer: Depression
Explanation:Offending by the Mentally Disordered
The prevalence of epilepsy is higher among prisoners than in the general population, but this does not necessarily mean that they are more likely to be serving a custodial sentence for violence. Matricide, the killing of one’s mother, is often associated with schizophrenia, although not always. Othello’s syndrome, a delusional jealousy that usually affects men in their 40s after about 10 years of marriage, can be difficult to treat with antipsychotic medication and may require separation from the spouse. Depressive disorder is more commonly associated with suicide, but in some cases, it can lead to homicide, particularly in the morning and involving family members.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 68
Incorrect
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In psychodynamic theory, what are the two defences that are thought to be the basis of phobias?
Your Answer:
Correct Answer: Repression and displacement
Explanation:Defense Mechanisms in Specific Conditions
Certain psychiatric conditions are characterized by specific defense mechanisms. These mechanisms are used by individuals to protect themselves from anxiety and other negative emotions. The following conditions and the associated defenses tend to come up on membership exams.
Phobias are characterized by intense and irrational fears of specific objects of situations. The defense mechanisms commonly used in phobias are repression and displacement. Repression involves pushing the anxiety-provoking thoughts of memories out of conscious awareness. Displacement involves redirecting the anxiety onto a less threatening object of situation.
Obsessive-compulsive disorder (OCD) is characterized by intrusive and repetitive thoughts (obsessions) and/of repetitive behaviors (compulsions). The defense mechanisms commonly used in OCD are isolation, undoing, and reaction formation. Isolation involves separating the anxiety-provoking thought from the associated emotion. Undoing involves performing a ritual of action to undo the anxiety-provoking thought. Reaction formation involves expressing the opposite emotion of the anxiety-provoking thought.
Borderline personality disorder (BPD) is characterized by unstable moods, relationships, and self-image. The defense mechanisms commonly used in BPD are projection and splitting. Projection involves attributing one’s own unacceptable thoughts of feelings onto another person. Splitting involves seeing people of situations as either all good of all bad.
Narcissistic personality disorder (NPD) is characterized by a grandiose sense of self-importance, a need for admiration, and a lack of empathy. The defense mechanisms commonly used in NPD are projection and splitting, similar to BPD.
Agoraphobia is characterized by a fear of being in situations where escape may be difficult of embarrassing. The defense mechanism commonly used in agoraphobia is displacement, which involves redirecting the anxiety onto a less threatening object of situation.
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This question is part of the following fields:
- Psychotherapy
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Question 69
Incorrect
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You are seeing a 70-year-old woman and her husband in a memory clinic. She reports subjective memory difficulties, but her daily functioning is not affected. Her MMSE score is 28/30, with a loss of two points on recall. Her husband asks you about the likelihood of her developing dementia within the next year. What advice do you give them?
Your Answer:
Correct Answer: 10%
Explanation:Mild cognitive impairment (MCI) is a diagnosis that encompasses a diverse group of individuals, some of whom may be in the early stages of dementia. To diagnose MCI, there must be a reported concern about changes in cognitive functioning, impairment in one of more cognitive domains, preservation of functional abilities, and a score above the cut-off for dementia on cognitive tests. While some patients with MCI may return to normal cognition, approximately 10% of patients progress to dementia per year, with 85% of cases being Alzheimer’s and 15% being vascular dementia. The exact number of patients with MCI who will develop dementia is difficult to determine due to challenges in long-term follow-up.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 70
Incorrect
-
What is the recommended initial treatment for PTSD according to NICE?
Your Answer:
Correct Answer: Trauma focussed CBT
Explanation:According to NICE guidelines in 2018, trauma focussed CBT is the recommended first-line therapy for PTSD, while drug treatment is not considered as the initial option.
Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 71
Incorrect
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What is the most common negative effect experienced with deep brain stimulation (DBS)?
Your Answer:
Correct Answer: Ataxic gait
Explanation:DBS can lead to various complications, such as intracranial bleeding (which occurs in around 2.0-2.5% of implants), dislocation, lead fracture, and infection. Additionally, stimulation-induced adverse side effects may include paraesthesia, tonic muscle contractions, dyskinesia, and gait ataxia. While less common, some individuals may experience side effects such as aggression, mirthful laughter, depression, penile erection, of mania.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 72
Incorrect
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What type of data is required to compute the relative risk of odds ratio?
Your Answer:
Correct Answer: Dichotomous
Explanation:When outcomes are binary (such as dead of alive), there are various ways to report them, including proportions, percentages, risk, odds, risk ratios, odds ratios, number needed to treat, likelihood ratios, sensitivity, specificity, and pre-test and post-test probability. However, for non-binary data types, different methods of reporting are required.
Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 73
Incorrect
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Which of the following has a maximum licensed dose of 1200 mg/day?
Your Answer:
Correct Answer: Amisulpride
Explanation:Antipsychotics (Maximum Doses)
It is important to be aware of the maximum doses for commonly used antipsychotics. The following are the maximum doses for various antipsychotics:
– Clozapine (oral): 900 mg/day
– Haloperidol (oral): 20 mg/day
– Olanzapine (oral): 20 mg/day
– Quetiapine (oral): 750mg/day (for schizophrenia) and 800 mg/day (for bipolar disorder)
– Risperidone (oral): 16 mg/day
– Amisulpride (oral): 1200 mg/day
– Aripiprazole (oral): 30 mg/day
– Flupentixol (depot): 400 mg/week
– Zuclopenthixol (depot): 600 mg/week
– Haloperidol (depot): 300 mg every 4 weeksIt is important to keep these maximum doses in mind when prescribing antipsychotics to patients.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 74
Incorrect
-
What is a true statement about paedophilic disorder as defined by the DSM-5?
Your Answer:
Correct Answer: The individual must be at least 5 years older than the child of interest to qualify for a diagnosis
Explanation:There is a correlation between adult males with paedophilia and a history of childhood sexual abuse, but it is uncertain whether this relationship indicates that childhood sexual abuse causes adult paedophilia.
Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).
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This question is part of the following fields:
- Forensic Psychiatry
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Question 75
Incorrect
-
What distinguishing characteristic indicates the presence of reactive attachment disorder as opposed to disinhibited social engagement disorder?
Your Answer:
Correct Answer: Failure to seek comfort when distressed
Explanation:Both reactive attachment disorder and disinhibited social engagement disorder share a common feature of having an atypical relationship with caregivers, which makes it difficult to distinguish between the two. However, children with reactive attachment disorder tend to exhibit more inhibited behavior similar to those with autism spectrum disorder, while children with disinhibited social engagement disorder tend to display more disinhibited behavior similar to those with attention deficit hyperactivity disorder.
Disorders resulting from inadequate caregiving during childhood are recognised by both the DSM-5 and the ICD-11, with two distinct forms of disorder identified: Reactive attachment disorder and Disinhibited social engagement disorder. Reactive attachment disorder is characterised by social withdrawal and aberrant attachment behaviour, while Disinhibited social engagement disorder is characterised by socially disinhibited behaviour. Diagnosis of these disorders involves a history of grossly insufficient care, and symptoms must be evident before the age of 5. Treatment options include video feedback programs for preschool aged children and parental training with group play sessions for primary school aged children. Pharmacological interventions are not recommended in the absence of coexisting mental health problems.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 76
Incorrect
-
What antidepressant is not advised by NICE for treating PTSD in adults?
Your Answer:
Correct Answer: Amitriptyline
Explanation:According to NICE 2018 guidelines, the recommended treatment options for PTSD are either SSRI of venlafaxine.
Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 77
Incorrect
-
In which situations might lower doses of clozapine be necessary?
Your Answer:
Correct Answer: Female patients
Explanation:Clozapine is an effective antipsychotic drug used in the management of treatment-resistant schizophrenia (TRS). It was reintroduced in the 1990s with mandatory blood monitoring due to the risk of agranulocyte
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This question is part of the following fields:
- General Adult Psychiatry
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Question 78
Incorrect
-
What hierarchical language does NLM utilize to enhance search strategies and index articles?
Your Answer:
Correct Answer: MeSH
Explanation:NLM’s hierarchical vocabulary, known as MeSH (Medical Subject Heading), is utilized for the purpose of indexing articles in PubMed.
Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.
When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.
There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 79
Incorrect
-
What is the highest approved dosage of olanzapine?
Your Answer:
Correct Answer: 20 mg/day
Explanation:Antipsychotics (Maximum Doses)
It is important to be aware of the maximum doses for commonly used antipsychotics. The following are the maximum doses for various antipsychotics:
– Clozapine (oral): 900 mg/day
– Haloperidol (oral): 20 mg/day
– Olanzapine (oral): 20 mg/day
– Quetiapine (oral): 750mg/day (for schizophrenia) and 800 mg/day (for bipolar disorder)
– Risperidone (oral): 16 mg/day
– Amisulpride (oral): 1200 mg/day
– Aripiprazole (oral): 30 mg/day
– Flupentixol (depot): 400 mg/week
– Zuclopenthixol (depot): 600 mg/week
– Haloperidol (depot): 300 mg every 4 weeksIt is important to keep these maximum doses in mind when prescribing antipsychotics to patients.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 80
Incorrect
-
What approach did William Tuke employ at the York Retreat?
Your Answer:
Correct Answer: Moral therapy
Explanation:Tuke, a member of the Quaker community, introduced a novel method of psychiatric care at the Retreat in York. Previously, patients were treated as non-human creatures and were subjected to inhumane conditions, spending their days in chains. Tuke’s approach, known as ‘moral therapy’, aimed to treat patients with greater compassion, reducing the use of restraints and encouraging them to take accountability for their behavior.
Fonagy and Bateman – Mentalisation-Based Treatment
Mentalisation-Based Treatment (MBT) was developed by Peter Fonagy and Anthony Bateman in the 1990s. It is a psychodynamic therapy that focuses on improving the patient’s ability to mentalise, which is the capacity to understand one’s own and others’ mental states. MBT is primarily used to treat borderline personality disorder, but it has also been used to treat other mental health conditions.
Fonagy and Bateman work on MBT was influenced by their research on attachment theory and the importance of early relationships in shaping mentalisation abilities. They believed that individuals with borderline personality disorder have difficulties with mentalisation due to early attachment disruptions, and that MBT could help them develop more stable and secure relationships.
MBT is typically delivered in a group of individual format, and it involves a combination of psychoeducation, cognitive-behavioral techniques, and psychodynamic interventions. The therapist helps the patient to identify and reflect on their thoughts, feelings, and behaviors, and to understand how these are influenced by their past experiences and relationships. The therapist also helps the patient to develop more adaptive coping strategies and to improve their interpersonal skills.
Overall, Fonagy and Bateman work on MBT has contributed to the development of psychodynamic therapies that are more focused on specific treatment goals and evidence-based practices.
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This question is part of the following fields:
- Psychotherapy
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Question 81
Incorrect
-
What is the classification of dysthymic disorder according to the ICD-11?
Your Answer:
Correct Answer: Brief periods of normal mood may occur, but these cannot exceed two months to be consistent with a diagnosis
Explanation:Dysthymia is a type of mood disorder characterized by persistent low-grade depressive symptoms that last for at least two years. Although there may be brief periods without symptoms, there has never been a prolonged period of two months of more without symptoms since the onset of the disorder. While treatment for dysthymia can be effective, the results may be modest and short-lived, and the course of the disorder can be challenging. Dysthymia often begins in childhood of adolescence and is associated with a higher likelihood of substance misuse and co-occurring personality disorders, particularly when onset occurs before the age of 21. Co-occurring disorders are common in individuals with dysthymia.
Depression is diagnosed using different criteria in the ICD-11 and DSM-5. The ICD-11 recognizes single depressive episodes, recurrent depressive disorder, dysthymic disorder, and mixed depressive and anxiety disorder. The DSM-5 recognizes disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder, and premenstrual dysphoric disorder.
For a diagnosis of a single depressive episode, the ICD-11 requires the presence of at least five characteristic symptoms occurring most of the day, nearly every day during a period lasting at least 2 weeks. The DSM-5 requires the presence of at least five symptoms during the same 2-week period, with at least one of the symptoms being either depressed mood of loss of interest of pleasure.
Recurrent depressive disorder is characterized by a history of at least two depressive episodes separated by at least several months without significant mood disturbance, according to the ICD-11. The DSM-5 requires at least two episodes with an interval of at least 2 consecutive months between separate episodes in which criteria are not met for a major depressive episode.
Dysthymic disorder is diagnosed when a person experiences persistent depressed mood lasting 2 years of more, according to the ICD-11. The DSM-5 requires depressed mood for most of the day, for more days than not, for at least 2 years, along with the presence of two or more additional symptoms.
Mixed depressive and anxiety disorder is recognized as a separate code in the ICD-11, while the DSM-5 uses the ‘with anxious distress’ qualifier. The ICD-11 requires the presence of both depressive and anxiety symptoms for most of the time during a period of 2 weeks of more, while the DSM-5 requires the presence of both depressive and anxious symptoms during the same 2-week period.
Overall, the criteria for diagnosing depression vary between the ICD-11 and DSM-5, but both require the presence of characteristic symptoms that cause significant distress of impairment in functioning.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 82
Incorrect
-
What should people with insomnia avoid doing?
Your Answer:
Correct Answer: Get regular exercise in the evening
Explanation:Insomnia Treatment: Sleep Hygiene
Before resorting to medication, it is important to try sleep hygiene approaches to treat insomnia. These approaches include increasing daily exercise (but not in the evening), avoiding large meals in the evening, ensuring exposure to natural light during the day, reducing of stopping daytime napping, reducing alcohol and stimulant (caffeine and nicotine) intake, associating the bed with sleep (not using it for TV, radio, of reading), using anxiety management and relaxation techniques, and developing a regular routine of rising and retiring at the same time each day (regardless of the amount of sleep taken). By implementing these strategies, individuals can improve their sleep quality and quantity without the use of medication.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 83
Incorrect
-
According to NICE guidelines, which option is linked to the least amount of risk in case of an overdose?
Your Answer:
Correct Answer: Lofepramine
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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 84
Incorrect
-
Which of the following symptoms is uncommon in cases of alcohol withdrawal?
Your Answer:
Correct Answer: Persistent hallucinations
Explanation:It is uncommon for individuals experiencing alcohol withdrawal to have transient hallucinations, as they are not a typical symptom.
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.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 85
Incorrect
-
What is a true statement about frontotemporal lobar degeneration?
Your Answer:
Correct Answer: In semantic dementia, speech is characteristically fluent
Explanation:Frontotemporal Lobar Degeneration
Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.
The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).
As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.
In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 86
Incorrect
-
What is the estimated percentage of children with conduct disorders who are believed to fulfill the diagnostic criteria for antisocial personality disorder in adulthood?
Your Answer:
Correct Answer: 50%
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.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 87
Incorrect
-
What is the first-line treatment recommended by NICE for pre-school children with attention deficit hyperactivity disorder?
Your Answer:
Correct Answer: Parental training programmes
Explanation:ADHD (Diagnosis and Management in Children)
ADHD is a behavioural syndrome characterised by symptoms of inattention, hyperactivity, and impulsivity. The DSM-5 and ICD-11 provide diagnostic criteria for the condition, with both recognising three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
Treatment for children under 5 involves offering an ADHD-focused group parent-training programme as a first-line option. Medication should only be considered after obtaining advice from a specialist ADHD service. For children and young people aged 5-18, advice and support should be given, along with an ADHD-focused group parent-training programme. Medication should only be offered if ADHD symptoms persist after environmental modifications have been implemented and reviewed. Cognitive behavioural therapy may also be considered for those who have benefited from medication but still experience significant impairment.
NICE advises against elimination diets, dietary fatty acid supplementation, and the use of the ‘few foods diet’. Methylphenidate of lisdexamfetamine is the first-line medication option, with dexamphetamine considered for those who respond to lisdexamfetamine but cannot tolerate the longer effect profile. Atomoxetine of guanfacine may be offered for those who cannot tolerate methylphenidate of lisdexamfetamine. Clonidine and atypical antipsychotics should only be used with advice from a tertiary ADHD service.
Drug holidays may be considered for children and young people who have not met the expected height for their age due to medication. However, NICE advises that withdrawal from treatment is associated with a risk of symptom exacerbation.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 88
Incorrect
-
What is the focus of assessment in interpersonal psychotherapy?
Your Answer:
Correct Answer: Current relationships
Explanation:Interpersonal Therapy: A Structured Approach to Addressing Social Functioning Problems
Interpersonal therapy (IPT) is a structured form of psychotherapy that is often used to treat depression. It is based on the belief that social functioning problems have a significant impact on psychological problems. IPT is a time-limited therapy that typically runs for 10-16 one hour sessions. The therapy is organized into three phases, with the first phase involving data collection and formulation. The remaining sessions explore the formulation in more detail.
IPT focuses on four areas of social functioning problems: grief, role transitions, interpersonal deficits, and interpersonal disputes. The therapy aims to intervene at the level of social functioning, rather than focusing on personality. The therapy has been found to be effective in treating depression, particularly in patients with severe depression. However, it may be less effective in treating people with depression and comorbid personality disorders.
The evidence base for IPT is most developed for eating disorders, and the intervention is recommended in NICE guidelines for eating disorders. Overall, IPT is a structured approach to addressing social functioning problems that can be effective in treating depression and other psychological problems.
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This question is part of the following fields:
- Psychotherapy
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Question 89
Incorrect
-
What is the most frequently observed symptom of post-traumatic stress disorder among individuals with learning disabilities?
Your Answer:
Correct Answer: Aggression
Explanation:Post Traumatic Stress Disorder in People with Learning Difficulties
Post traumatic stress disorder (PTSD) can present differently in people with learning difficulties compared to those without. While nightmares, jumpiness, and sleep disturbance are common in the general population, aggression and behavioral disturbance are more common in those with learning disabilities. Other symptoms may include disruptive of defiant behavior, self-harm, agitation, distractibility, and depressed mood.
The most common cause of PTSD in people with learning difficulties is abuse. Treatment for PTSD in this population is similar to that for those without learning difficulties, including trauma-focused cognitive behavioral therapy of eye movement desensitization and reprocessing (EMDR) with selective serotonin reuptake inhibitors (SSRIs) of venlafaxine as an alternative of combined. However, the therapy must be tailored to the individual’s ability to understand and communicate.
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This question is part of the following fields:
- Learning Disability
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Question 90
Incorrect
-
Regarding symptoms of withdrawal associated with prolonged alcohol consumption, which of the following statements is accurate?
Your Answer:
Correct Answer: Carbamazepine is as effective as benzodiazepines in the acute treatment of the symptoms of alcohol withdrawal
Explanation:A study has found that starting with a dose of 800 mg of Carbamazepine per day is just as effective as using Oxazepam for treating acute alcohol withdrawal. However, Phenytoin has been shown to be ineffective in treating seizures related to alcohol withdrawal. The symptoms of alcohol withdrawal are caused by a decrease in neurotransmission through type A gamma-aminobutyric pathways and an increase in neurotransmission through N-methyl-D-aspartate pathways. For more information, refer to the article Management of Drug and Alcohol Withdrawal by Kosten TR and O’Connor PG in the New England Journal of Medicine.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 91
Incorrect
-
What is another term used to refer to Neyman bias?
Your Answer:
Correct Answer: Prevalence/incidence bias
Explanation:Neyman bias arises when a research study is examining a condition that is marked by either undetected cases of cases that result in early deaths, leading to the exclusion of such cases from the analysis.
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 92
Incorrect
-
What is the most prevalent personality disorder among women incarcerated in England and Wales?
Your Answer:
Correct Answer: Antisocial
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 93
Incorrect
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What environmental factor increases the risk of violence in hospitalized patients?
Your Answer:
Correct Answer: High use of temporary staff
Explanation:Risk Factors for Violence in In-Patient Settings
In-patient settings can be prone to violence, and there are several risk factors that contribute to this issue. According to Davison (2005), patient-related risk factors include being young, having a history of violence, being compulsorily admitted, having comorbid substance misuse, and being in the acute phase of the illness. Environmental risk factors include a lack of structured activity, high use of temporary staff, low levels of staff-patient interaction, poor staffing levels, poorly defined staffing roles, unpredictable ward programmes, lack of privacy, overcrowding, poor physical facilities, and the availability of weapons. It is important for healthcare providers to be aware of these risk factors and take steps to mitigate them to ensure the safety of both patients and staff.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 94
Incorrect
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Which statement is false regarding an individual's ability to plead fitness?
Your Answer:
Correct Answer: Someone is unfit to plead if they cannot recall the alleged crime
Explanation:Fitness to Plead: Criteria and Process
Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 95
Incorrect
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Which of the following exceeds the weekly alcohol limit recommended for women, which is no more than 21 units per week?
Your Answer:
Correct Answer: 12 × 500 ml bottles of 4% ABV 'alcopop'
Explanation:– ABV indicates the number of units of alcohol per litre of a liquid.
– The total number of alcoholic units in any given amount of liquid may be calculated by multiplying the volume of liquid (ml) by the ABV and dividing by 1000.
– A 1L bottle of 20% ABV port contains 20 units of alcohol.
– 6 large (250 ml) glasses of 12% ABV wine contain 18 units of alcohol.
– 12 330ml bottles of 5% ABV lager contain 20 units of alcohol.
– 12 500 ml bottles of 4% ABV ‘alcopop’ contain 24 units of alcohol.
– 20 standard (25 ml) measures of 40% ABV whiskey contain 20 units of alcohol. -
This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 96
Incorrect
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What is the most suitable medication for a pregnant woman experiencing symptoms of a mixed affective state?
Your Answer:
Correct Answer: Haloperidol
Explanation:Due to the patient’s pregnancy, mood stabilisers cannot be used as a traditional treatment for their mixed affective state, which presents symptoms of both mania and depression. Instead, an antipsychotic is the preferred course of action.
Bipolar Disorder in Women of Childbearing Potential
Prophylaxis is recommended for women with bipolar disorder, as postpartum relapse rates are high. Women without prophylactic pharmacotherapy during pregnancy have a postpartum relapse rate of 66%, compared to 23% for women with prophylaxis. Antipsychotics are recommended for pregnant women with bipolar disorder, according to NICE Guidelines (CG192) and the Maudsley. Women taking valproate, lithium, carbamazepine, of lamotrigine should discontinue treatment and start an antipsychotic, especially if taking valproate. If a woman with bipolar disorder is taking lithium and becomes pregnant, she should gradually stop lithium over a 4 week period and start an antipsychotic. If this is not possible, lithium levels must be taken regularly, and the dose adjusted accordingly. For acute mania, an antipsychotic should be considered. For mild depressive symptoms, self-help approaches, brief psychological interventions, and antidepressant medication can be considered. For moderate to severe depressive symptoms, psychological treatment (CBT) for moderate depression and combined medication and structured psychological interventions for severe depression should be considered.
Reference: Wesseloo, R., Kamperman, A. M., Munk-Olsen, T., Pop, V. J., Kushner, S. A., & Bergink, V. (2016). Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. The American Journal of Psychiatry, 173(2), 117-127.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 97
Incorrect
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What is the most appropriate option for augmentation in cases of schizophrenia that are resistant to clozapine?
Your Answer:
Correct 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
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This question is part of the following fields:
- General Adult Psychiatry
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Question 98
Incorrect
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What is a common characteristic of Ganser's syndrome?
Your Answer:
Correct Answer: Pseudohallucinations
Explanation:Confabulation is the creation of false memories while being fully aware, often due to an organic amnesia. Ganser’s syndrome is a disputed diagnosis that includes symptoms such as approximate answers, clouded consciousness, somatic conversion, pseudohallucinations, and amnesia for the time when the symptoms were present. It is commonly observed in incarcerated individuals awaiting trial and may be seen as a simulation of a psychotic disorder. Some experts argue that it is a type of malingering, and it is classified as a dissociative disorder.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 99
Incorrect
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A 35 year old male is seen in clinic with depression. He has no past psychiatric history and has never self-harmed. He denies suicidal ideation. He is commenced on citalopram. After what period of time do NICE guidelines suggest he is reviewed?
Your Answer:
Correct Answer: 2 weeks
Explanation:Depression Treatment Guidelines by NICE
The National Institute for Health and Care Excellence (NICE) provides guidelines for the treatment of depression. The following are some general recommendations:
– Selective serotonin reuptake inhibitors (SSRIs) are preferred when prescribing antidepressants.
– Antidepressants are not the first-line treatment for mild depression.
– After remission, continue antidepressant treatment for at least six months.
– Continue treatment for at least two years if at high risk of relapse of have a history of severe or prolonged episodes of inadequate response.
– Use a stepped care approach to depression treatment, starting at the appropriate level based on the severity of depression.The stepped care approach involves the following steps:
– Step 1: Assessment, support, psychoeducation, active monitoring, and referral for further assessment and interventions.
– Step 2: Low-intensity psychosocial interventions, psychological interventions, medication, and referral for further assessment and interventions.
– Step 3: Medication, high-intensity psychological interventions, combined treatments, collaborative care, and referral for further assessment and interventions.
– Step 4: Medication, high-intensity psychological interventions, electroconvulsive therapy, crisis service, combined treatments, multiprofessional and inpatient care.Individual guided self-help programs based on cognitive-behavioral therapy (CBT) principles should be supported by a trained practitioner and last 9 to 12 weeks. Physical activity programs should consist of three sessions per week of moderate duration over 10 to 14 weeks.
NICE advises against using antidepressants routinely to treat persistent subthreshold depressive symptoms of mild depression. However, they may be considered for people with a past history of moderate or severe depression, initial presentation of subthreshold depressive symptoms that have been present for a long period, of subthreshold depressive symptoms of mild depression that persist after other interventions.
NICE recommends a combination of antidepressant medication and a high-intensity psychological intervention (CBT of interpersonal therapy) for people with moderate of severe depression. Augmentation of antidepressants with lithium, antipsychotics, of other antidepressants may be appropriate, but benzodiazepines, buspirone, carbamazepine, lamotrigine, of valproate should not be routinely used.
When considering different antidepressants, venlafaxine is associated with a greater risk of death from overdose compared to other equally effective antidepressants. Tricyclic antidepressants (TCAs) except for lofepramine are associated with the greatest risk in overdose. Higher doses of venlafaxine may exacerbate cardiac arrhythmias, and venlafaxine and duloxetine may exacerbate hypertension. TCAs may cause postural hypotension and arrhythmias, and mianserin requires hematological monitoring in elderly people.
The review frequency depends on the age and suicide risk of the patient. If the patient is over 30 and has no suicide risk, see them after two weeks and then at intervals of 2-4 weeks for the first three months. If the patient is under 30 and has a suicide risk, see them after one week.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 100
Incorrect
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What is a true statement about Kleine-Levin syndrome?
Your Answer:
Correct Answer: It is associated with hyperphagia
Explanation:Kleine-Levin Syndrome: A Mysterious Condition
Kleine-Levin syndrome is a peculiar disorder that typically affects adolescent boys. It is characterized by an excessive need for sleep and an insatiable appetite when awake. The condition is also associated with emotional and behavioral issues such as irritability and aggression.
The onset of symptoms is sudden and can last for several days to weeks before disappearing. This is followed by a period of normalcy, only to be followed by another episode. This pattern can continue for years, but the severity of symptoms tends to decrease over time. During the periods between episodes, those affected appear to be perfectly healthy with no signs of physical of behavioral dysfunction. The media has dubbed this condition as Sleeping Beauty syndrome.
Despite extensive research, the cause of Kleine-Levin syndrome remains unknown. However, the prognosis is generally positive, with most individuals making a full recovery.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 101
Incorrect
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What is the recommended initial treatment for a child with mild learning difficulties who has obsessive-compulsive disorder?
Your Answer:
Correct Answer: Cognitive behavioural therapy
Explanation:The treatment recommendations for OCD are similar for both adults and young people, regardless of whether they have a learning difficulty of not. The first line of treatment is psychological therapy, such as self-help of CBT with ERP. If this is not effective, an SSRI can be used. It is important to note that having a learning difficulty should not prevent someone from accessing psychological therapy. While severe disabilities may limit access, tailored forms of CBT can still be effective for those with less severe forms of learning difficulties.
OCD and BDD are two mental health disorders that can affect children. OCD is characterized by obsessions and compulsions, while BDD is characterized by a preoccupation with an imagined defect in one’s appearance. Both disorders can cause significant distress and impairment in daily functioning.
For mild cases of OCD, guided self-help may be considered along with support and information for the family of caregivers. For moderate to severe cases of OCD, cognitive-behavioral therapy (CBT) that involves the family of caregivers and is adapted to suit the child’s developmental age is recommended. For all children and young people with BDD, CBT (including exposure and response prevention) is recommended.
If a child declines psychological treatment, a selective serotonin reuptake inhibitor (SSRI) may be prescribed. However, a licensed medication (sertraline of fluvoxamine) should be used for children and young people with OCD, while fluoxetine should be used for those with BDD. If an SSRI is ineffective of not tolerated, another SSRI of clomipramine may be tried. Tricyclic antidepressants other than clomipramine should not be used to treat OCD of BDD in children and young people. Other antidepressants (MAOIs, SNRIs) and antipsychotics should not be used alone in the routine treatment of OCD of BDD in children of young people, but may be considered as an augmentation strategy.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 102
Incorrect
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What drug is classified as a class C substance in the United Kingdom?
Your Answer:
Correct Answer: Anabolic steroids
Explanation:While there is no specific law against possessing steroids, it is considered unlawful to produce, distribute, of import/export steroids with the intention of supplying them without proper licensing. Those found guilty of such actions may face a maximum sentence of 14 years imprisonment and/of a substantial monetary penalty.
Drug Misuse (Law and Scheduling)
The Misuse of Drugs Act (1971) regulates the possession and supply of drugs, classifying them into three categories: A, B, and C. The maximum penalty for possession varies depending on the class of drug, with Class A drugs carrying a maximum sentence of 7 years.
The Misuse of Drugs Regulations 2001 further categorizes controlled drugs into five schedules. Schedule 1 drugs are considered to have no therapeutic value and cannot be lawfully possessed of prescribed, while Schedule 2 drugs are available for medical use but require a controlled drug prescription. Schedule 3, 4, and 5 drugs have varying levels of restrictions and requirements.
It is important to note that a single drug can have multiple scheduling statuses, depending on factors such as strength and route of administration. For example, morphine and codeine can be either Schedule 2 of Schedule 5.
Overall, the Misuse of Drugs Act and Regulations aim to regulate and control the use of drugs in the UK, with the goal of reducing drug misuse and related harm.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 103
Incorrect
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Which client group experiences the most intense transference during therapy?
Your Answer:
Correct Answer: Borderline personality disorder
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.
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This question is part of the following fields:
- Psychotherapy
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Question 104
Incorrect
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A 35-year-old woman who has been struggling with anxiety for at least three years, reports that she often drinks alcohol before going to social events to calm her nerves.
Which of the following statements is accurate regarding her anxiety?Your Answer:
Correct Answer: It indicates alcohol dependence, and after initial worsening with withdrawal usually will improve after three weeks of abstinence from alcohol
Explanation:This man is experiencing anxiety in the morning due to his dependence on alcohol. Mild alcohol withdrawal commonly causes symptoms such as agitation, fever, sweats, and tremors, which can all be alleviated by consuming alcohol. However, if the patient continues to refrain from drinking, these symptoms typically reach their peak after 72 hours and can last up to a week of more, but usually subside within three weeks.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 105
Incorrect
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Which of the following is not useful in distinguishing between delirium and dementia?
Your Answer:
Correct Answer: Cognitive impairment
Explanation:Delirium (also known as acute confusional state) is a condition characterized by a sudden decline in consciousness and cognition, with a particular impairment in attention. It often involves perceptual disturbances, abnormal psychomotor activity, and sleep-wake cycle impairment. Delirium typically develops over a few days and has a fluctuating course. The causes of delirium are varied, ranging from metabolic disturbances to medications. It is important to differentiate delirium from dementia, as delirium has a brief onset, early disorientation, clouding of consciousness, fluctuating course, and early psychomotor changes. Delirium can be classified into three subtypes: hypoactive, hyperactive, and mixed. Patients with hyperactive delirium demonstrate restlessness, agitation, and hyper vigilance, while those with hypoactive delirium present with lethargy and sedation. Mixed delirium demonstrates both hyperactive and hypoactive features. The hypoactive form is most common in elderly patients and is often misdiagnosed as depression of dementia.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 106
Incorrect
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In drug testing, which substance commonly used for weight loss and bodybuilding, is known to cause inaccurate results?
Your Answer:
Correct Answer: Amphetamines
Explanation:Originally developed as a nasal decongestant, dimethylamylamine is now available as a dietary supplement for purposes such as weight loss, enhancing athletic abilities, and building muscle mass. However, it is important to note that this substance is artificially produced in a laboratory.
Drug Testing
There are two main approaches to testing for illicit substances: immunoassays and lab testing. Immunoassays are a cheap and quick screening method, but not very specific. Lab testing is more accurate but time-consuming and expensive. Drug testing can be done through urine, saliva, blood, hair, and sweat, although hair and sweat are rarely used in mental health settings.
False positives can occur when testing for illicit substances, so it’s important to check that patients are not taking other medications that could produce a false positive result. For example, common medications that can lead to false positive results include dimethylamylamine, ofloxacin, bupropion, phenothiazines, trazodone, and methylphenidate for amphetamines/methamphetamines; sertraline and efavirenz for benzodiazepines and cannabis; topical anesthetics for cocaine; codeine, dihydrocodeine, and methadone for opioids; lamotrigine, tramadol, and venlafaxine for PCP; and amitriptyline, bupropion, buspirone, chlorpromazine, fluoxetine, sertraline, and verapamil for LSD.
In summary, drug testing is an important tool in mental health settings, but it’s crucial to consider potential false positives and medication interactions when interpreting results.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 107
Incorrect
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A client is referred with depression and is eager to begin medication. You find out that they have hypertension. What would be the most suitable treatment option?
Your Answer:
Correct Answer: Fluoxetine
Explanation:Antidepressants and Diabetes
Depression is a prevalent condition among patients with diabetes. It is crucial to select the appropriate antidepressant as some may have negative effects on weight and glucose levels. The first-line treatment for depression in diabetic patients is selective serotonin reuptake inhibitors (SSRIs), with fluoxetine having the most supporting data. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also likely to be safe, but there is less evidence to support their use. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) should be avoided. These recommendations are based on the Maudsley Guidelines 10th Edition.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 108
Incorrect
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What is a true statement about self-harm?
Your Answer:
Correct Answer: There is a higher incidence of self-harm in people from sexual minorities
Explanation:Self-harm has become more common in the UK over the past two decades, but this trend differs from the patterns seen in completed suicides. Women and girls are more likely to engage in self-harm than men and boys, while completed suicides are more common among the latter group. Certain populations, such as prisoners, asylum seekers, veterans, those bereaved by suicide, and individuals from cultural of sexual minority groups, also have a higher incidence of self-harm. It’s important to note that self-harm does not always indicate an attempt of desire to commit suicide, and may even serve as a means of self-preservation.
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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 109
Incorrect
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What study design would be most suitable for investigating the potential association between childhood obesity in girls and the risk of polycystic ovarian syndrome, while also providing the strongest evidence for this link?
Your Answer:
Correct Answer: Cohort study
Explanation:An RCT is not feasible in this situation, but a cohort study would be more reliable than a case-control study in generating evidence.
Types of Primary Research Studies and Their Advantages and Disadvantages
Primary research studies can be categorized into six types based on the research question they aim to address. The best type of study for each question type is listed in the table below. There are two main types of study design: experimental and observational. Experimental studies involve an intervention, while observational studies do not. The advantages and disadvantages of each study type are summarized in the table below.
Type of Question Best Type of Study
Therapy Randomized controlled trial (RCT), cohort, case control, case series
Diagnosis Cohort studies with comparison to gold standard test
Prognosis Cohort studies, case control, case series
Etiology/Harm RCT, cohort studies, case control, case series
Prevention RCT, cohort studies, case control, case series
Cost Economic analysisStudy Type Advantages Disadvantages
Randomized Controlled Trial – Unbiased distribution of confounders – Blinding more likely – Randomization facilitates statistical analysis – Expensive – Time-consuming – Volunteer bias – Ethically problematic at times
Cohort Study – Ethically safe – Subjects can be matched – Can establish timing and directionality of events – Eligibility criteria and outcome assessments can be standardized – Administratively easier and cheaper than RCT – Controls may be difficult to identify – Exposure may be linked to a hidden confounder – Blinding is difficult – Randomization not present – For rare disease, large sample sizes of long follow-up necessary
Case-Control Study – Quick and cheap – Only feasible method for very rare disorders of those with long lag between exposure and outcome – Fewer subjects needed than cross-sectional studies – Reliance on recall of records to determine exposure status – Confounders – Selection of control groups is difficult – Potential bias: recall, selection
Cross-Sectional Survey – Cheap and simple – Ethically safe – Establishes association at most, not causality – Recall bias susceptibility – Confounders may be unequally distributed – Neyman bias – Group sizes may be unequal
Ecological Study – Cheap and simple – Ethically safe – Ecological fallacy (when relationships which exist for groups are assumed to also be true for individuals)In conclusion, the choice of study type depends on the research question being addressed. Each study type has its own advantages and disadvantages, and researchers should carefully consider these when designing their studies.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 110
Incorrect
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What is a true statement about individuals with rapid cycling bipolar disorder?
Your Answer:
Correct Answer: It lasts less than 2 years in approximately 50% of patients
Explanation:If rapid cycling bipolar disorder occurs, propranolol should be discontinued as it is believed to be a contributing factor.
Bipolar Disorder Diagnosis
Bipolar and related disorders are mood disorders characterized by manic, mixed, of hypomanic episodes alternating with depressive episodes. The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. Under the ICD-11, there are three subtypes of bipolar disorder: Bipolar I, Bipolar II, and Cyclothymic disorder.
Bipolar I disorder is diagnosed when an individual has a history of at least one manic of mixed episode. The typical course of the disorder is characterized by recurrent depressive and manic of mixed episodes. Onset of the first mood episode most often occurs during the late teen years, but onset of bipolar type I can occur at any time through the life cycle. The lifetime prevalence of bipolar I disorder is estimated to be around 2.1%.
Bipolar II disorder is diagnosed when an individual has a history of at least one hypomanic episode and at least one depressive episode. The typical course of the disorder is characterized by recurrent depressive and hypomanic episodes. Onset of bipolar type II most often occurs during the mid-twenties. The number of lifetime episodes tends to be higher for bipolar II disorder than for major depressive disorder of bipolar I disorder.
Cyclothymic disorder is diagnosed when an individual experiences mood instability over an extended period of time characterized by numerous hypomanic and depressive periods. The symptoms are present for more days than not, and there is no history of manic or mixed episodes. The course of cyclothymic disorder is often gradual and persistent, and onset commonly occurs during adolescence of early adulthood.
Rapid cycling is not a subtype of bipolar disorder but instead is a qualifier. It is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode. Rapid cycling is associated with an increased risk of suicide and tends to be precipitated by stressors such as life events, alcohol abuse, use of antidepressants, and medical disorders.
Overall, the diagnosis of bipolar disorder requires careful evaluation of an individual’s symptoms and history. Treatment typically involves a combination of medication and psychotherapy.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 111
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