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  • Question 1 - What is a true statement about transient global amnesia? ...

    Incorrect

    • What is a true statement about transient global amnesia?

      Your Answer: Short-term memory is characteristically impaired

      Correct Answer: Repetitive questioning is a common feature

      Explanation:

      Transient Global Amnesia: Definition, Diagnostic Criteria, and Possible Causes

      Transient global amnesia (TGA) is a clinical syndrome characterized by sudden and severe amnesia, often accompanied by repetitive questioning, that lasts for several hours. The term was first coined in 1964 by Fisher and Adams. To diagnose TGA, the following criteria have been established: (1) the attack must be witnessed, (2) there must be clear anterograde amnesia, (3) clouding of consciousness and loss of personal identity must be absent, (4) there should be no accompanying focal neurological symptoms, (5) epileptic features must be absent, (6) attacks must resolve within 24 hours, and (7) patients with recent head injury of known active epilepsy are excluded.

      Epidemiological studies have shown that thromboembolic cerebrovascular disease does not play a role in the causation of TGA. However, the incidence of migraine in patients with TGA is higher than in the general population. A small minority of cases with unusually brief and recurrent attacks eventually manifest temporal lobe epilepsy. EEG recording is typically normal after an attack, even when performed during the attack.

      Possible causes of TGA include venous congestion with Valsalva-like activities before symptom onset, arterial thromboembolic ischemia, and vasoconstriction due to hyperventilation. Precipitants of TGA often include exertion, cold, pain, emotional stress, and sexual intercourse.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 2 - A nationwide study on mental health found that the incidence of depression is...

    Correct

    • A nationwide study on mental health found that the incidence of depression is significantly higher among elderly individuals living in suburban areas compared to those residing in urban environments. What factors could explain this disparity?

      Your Answer: Reduced incidence in urban areas

      Explanation:

      The prevalence of schizophrenia may be higher in urban areas due to the social drift phenomenon, where individuals with severe and enduring mental illnesses tend to move towards urban areas. However, a reduced incidence of schizophrenia in urban areas could explain why there is an increased prevalence of the condition in rural settings. It is important to note that prevalence is influenced by both incidence and duration of illness, and can be reduced by increased recovery rates of death from any cause.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 3 - What is recommended by NICE guidelines to be provided to children diagnosed with...

    Incorrect

    • What is recommended by NICE guidelines to be provided to children diagnosed with anorexia nervosa?

      Your Answer: IPT

      Correct Answer: Family therapy

      Explanation:

      The National Institute for Health and Care Excellence (NICE) suggests that family therapy with a focus on anorexia nervosa is a recommended treatment for children and adolescents who have been diagnosed with anorexia nervosa.

      Eating Disorders: NICE Guidelines

      Anorexia:
      For adults with anorexia nervosa, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED), Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), of specialist supportive clinical management (SSCM). If these are not acceptable, contraindicated, of ineffective, consider eating-disorder-focused focal psychodynamic therapy (FPT). For children and young people, consider anorexia-nervosa-focused family therapy (FT-AN) of individual CBT-ED. Do not offer medication as the sole treatment.

      Bulimia:
      For adults, the first step is an evidence-based self-help programme. If this is not effective, consider individual CBT-ED. For children and young people, offer bulimia-nervosa-focused family therapy (FT-BN) of individual CBT-ED. Do not offer medication as the sole treatment.

      Binge Eating Disorder:
      The first step is a guided self-help programme. If this is not effective, offer group of individual CBT-ED. For children and young people, offer the same treatments recommended for adults. Do not offer medication as the sole treatment.

      Advice for those with eating disorders:
      Encourage people with an eating disorder who are vomiting to avoid brushing teeth immediately after vomiting, rinse with non-acid mouthwash, and avoid highly acidic foods and drinks. Advise against misusing laxatives of diuretics and excessive exercise.

      Additional points:
      Do not offer physical therapy as part of treatment. Consider bone mineral density scans after 1 year of underweight in children and young people, of 2 years in adults. Do not routinely offer oral of transdermal oestrogen therapy to treat low bone mineral density in children of young people with anorexia nervosa. Consider transdermal 17-β-estradiol of bisphosphonates for women with anorexia nervosa.

      Note: These guidelines are taken from NICE guidelines 2017.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 4 - Which symptom is not included in the somatic syndrome of depression? ...

    Correct

    • Which symptom is not included in the somatic syndrome of depression?

      Your Answer: Low mood

      Explanation:

      Anhedonia is commonly regarded as a psychological manifestation of depression.

      Depression (Biological Symptoms)

      Depression can be classified into biological (physical) of psychological symptoms. The terms used to describe biological symptoms include somatic, vital, melancholic, and endogenomorphic. These terms are used interchangeably in exams, so it is important to be familiar with them.

      Biological symptoms of depression include decreased appetite, weight loss, lack of emotional reactivity, anhedonia, early morning waking, depression worse in the mornings, psychomotor changes (retardation and agitation), fatigue, reduced libido, constipation, and insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 5 - On which principle does the Id operate? ...

    Correct

    • On which principle does the Id operate?

      Your Answer: Pleasure

      Explanation:

      Freud’s Structural Theory: Understanding the Three Areas of the Mind

      According to Freud’s structural model, the human mind is divided into three distinct areas: the Id, the Ego, and the Superego. The Id is the part of the mind that contains instinctive drives and operates on the ‘pleasure principle’. It functions without a sense of time and is governed by ‘primary process thinking’. The Ego, on the other hand, attempts to modify the drives from the Id with external reality. It operates on the ‘reality principle’ and has conscious, preconscious, and unconscious aspects. It is also home to the defense mechanisms. Finally, the Superego acts as a critical agency, constantly observing a person’s behavior. Freud believed that it developed from the internalized values of a child’s main caregivers. The Superego contains the ‘ego ideal’, which represents ideal attitudes and behavior. It is often referred to as the conscience. Understanding these three areas of the mind is crucial to understanding Freud’s structural theory.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 6 - A 27-year-old police officer presents following a recent traumatic incident where a fellow...

    Incorrect

    • A 27-year-old police officer presents following a recent traumatic incident where a fellow officer was killed in the line of duty. She describes recurrent nightmares and flashbacks which have been present for the past 3 months. A diagnosis of post-traumatic stress disorder is suspected. What is the most appropriate first-line treatment?

      Your Answer: Graded exposure therapy

      Correct Answer: Cognitive behavioural therapy

      Explanation:

      The recommended initial treatment approach is cognitive-behavioral therapy that specifically targets trauma.

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
      2011.3
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  • Question 7 - What is a correct statement about funnel plots? ...

    Incorrect

    • What is a correct statement about funnel plots?

      Your Answer:

      Correct Answer: Each dot represents a separate study result

      Explanation:

      An asymmetric funnel plot may indicate the presence of publication bias, although this is not a definitive confirmation. The x-axis typically represents a measure of effect, such as the risk ratio of odds ratio, although other measures may also be used.

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 8 - What is the condition that involves the gradual loss of myelin in the...

    Incorrect

    • What is the condition that involves the gradual loss of myelin in the corpus callosum and is commonly linked to alcohol abuse?

      Your Answer:

      Correct Answer: Marchiafava-Bignami disease

      Explanation:

      Marchiafava-Bignami Disease: A Rare Disorder Associated with Alcoholism and Malnutrition

      Marchiafava-Bignami disease is a rare condition that is commonly observed in individuals with alcoholism and malnutrition. The disease is characterized by the progressive demyelination and subsequent necrosis of the corpus callosum, which can lead to a range of nonspecific clinical symptoms such as motor of cognitive disturbances. The course of the disease can be either acute of chronic, and patients may experience dementia, spasticity, dysarthria, and an inability to walk. The outcome of the disease is unpredictable, with some patients lapsing into a coma and dying, while others may survive for many years in a demented state, of even recover.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 9 - A 65-year-old individual on clozapine develops neutropenia. Despite trying all other antipsychotics without...

    Incorrect

    • A 65-year-old individual on clozapine develops neutropenia. Despite trying all other antipsychotics without success, they had a positive response to clozapine. Is there a known medication that, when used in combination with clozapine, has been shown to increase the white cell count and allow for continued treatment?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 10 - What is a common characteristic observed in a patient diagnosed with DiGeorge syndrome?...

    Incorrect

    • What is a common characteristic observed in a patient diagnosed with DiGeorge syndrome?

      Your Answer:

      Correct Answer: Cleft palate

      Explanation:

      The condition associated with flapping hand movements is either Angelman syndrome of Fragile X, while hyperphagia is a symptom of Prader-Willi syndrome. Overlapping of fingers over thumb is seen in Patau syndrome, and pronounced self-injurious behavior is a feature of Lesch-Nyhan syndrome of Smith-Magenis syndrome. DiGeorge syndrome is typically caused by a deletion on chromosome 22 and presents with a variety of symptoms, including cardiac abnormalities (tetralogy of Fallot), abnormal facies (almond-shaped eyes, low-set ears), thymic aplasia (leading to recurrent infections), cleft palate, and hypocalcemia/hypoparathyroidism (resulting in short stature and seizures). Learning disabilities are also common in individuals with DiGeorge syndrome, and they may also be at increased risk for psychiatric conditions such as depression, ADHD, and schizophrenia.

      Genetic Conditions and Their Features

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 11 - You are requested to prepare a Court report for a client of yours...

    Incorrect

    • You are requested to prepare a Court report for a client of yours who is charged with grievous bodily harm, having stabbed a teacher at his school. The client is a 16-year-old boy, diagnosed with paranoid schizophrenia. Following his arrest for the stabbing, he informed the police that he attacked the victim as he had been hearing the victim's voice threatening to harm him. He also believed that the victim had been spying on him and spreading rumors about him. He tells you that he's happy that he stabbed the victim, but knew that what he was doing when he stabbed him was against the law.

      You assess him in a juvenile detention center, where he is being held. He discusses these experiences, and they appear to be auditory and visual hallucinations. He admits that he had been non-compliant with his oral risperidone for the past two months and had also been using £50 worth of cannabis a week.

      The defense attorney asks for your professional opinion as to whether the client could make a defense of Not Guilty by Reason of Insanity (NGRI).

      What would you advise?

      Your Answer:

      Correct Answer: He cannot make a defence of NGRI as he knew his actions were legally wrong

      Explanation:

      The defendant can only plead Not Guilty by Reason of Insanity (NGRI) if they have a defect of reason caused by a disease of the mind, which resulted in them not knowing the nature of their actions of not knowing that their actions were wrong. The causes of this defect of reason are broad, but acute intoxication is not included. However, if the defendant believed their actions were morally justified, this does not qualify as a defence of NGRI as the legal test only considers whether the defendant knew their actions were legally wrong. Despite feeling provoked and morally justified, the defendant still knew that stabbing someone was against the law. NGRI is a rare defence, used in less than 1% of cases, and is successful in only one in four of these cases.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 12 - What alternative treatment options are available for schizophrenia if clozapine proves to be...

    Incorrect

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

      Your Answer:

      Correct Answer: Olanzapine and allopurinol

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 13 - A 9-year-old boy has been referred by his GP due to problematic behaviour....

    Incorrect

    • A 9-year-old boy has been referred by his GP due to problematic behaviour. He has been physically aggressive towards his peers and consistently defiant with his mother. What would be the most appropriate course of action?

      Your Answer:

      Correct Answer: Group based parent training

      Explanation:

      According to the NICE guidelines from 2006, the behavior described is indicative of conduct disorder and group-based parental training/educational programs are recommended for managing children with this disorder.

      Disruptive Behaviour of Dissocial Disorders

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

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

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 14 - Regarding symptoms of withdrawal associated with prolonged alcohol consumption, which of the following...

    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.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 15 - What is the diagnosis criteria for depression according to the ICD-11? ...

    Incorrect

    • What is the diagnosis criteria for depression according to the ICD-11?

      Your Answer:

      Correct Answer: A diagnosis of a 'single episode depressive disorder' (ICD-11 6A70) should never be applied to individuals who have ever experienced a manic or hypomanic episodes

      Explanation:

      Individuals who have ever experienced manic or hypomanic episodes should not be diagnosed with a ‘single episode depressive disorder’ (ICD-11 6A70).

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 16 - How can we describe the consistency of a test in producing similar results...

    Incorrect

    • How can we describe the consistency of a test in producing similar results when measured multiple times?

      Your Answer:

      Correct Answer: Precision

      Explanation:

      Accuracy and reproducibility together make up precision.

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 17 - What is the purpose of descriptive statistics? ...

    Incorrect

    • What is the purpose of descriptive statistics?

      Your Answer:

      Correct Answer: To present characteristics features of a data set

      Explanation:

      Types of Statistics: Descriptive and Inferential

      Statistics can be divided into two categories: descriptive and inferential. Descriptive statistics are used to describe and summarize data without making any generalizations beyond the data at hand. On the other hand, inferential statistics are used to make inferences about a population based on sample data.

      Descriptive statistics are useful for identifying patterns and trends in data. Common measures used to describe a data set include measures of central tendency (such as the mean, median, and mode) and measures of variability of dispersion (such as the standard deviation of variance).

      Inferential statistics, on the other hand, are used to make predictions of draw conclusions about a population based on sample data. These statistics are also used to determine the probability that observed differences between groups are reliable and not due to chance.

      Overall, both descriptive and inferential statistics play important roles in analyzing and interpreting data. Descriptive statistics help us understand the characteristics of a data set, while inferential statistics allow us to make predictions and draw conclusions about larger populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 18 - Which of the following is not considered a characteristic of anorexia nervosa? ...

    Incorrect

    • Which of the following is not considered a characteristic of anorexia nervosa?

      Your Answer:

      Correct Answer: Hyperkalaemia

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 19 - Which of the following scenarios could be considered as a valid defence of...

    Incorrect

    • Which of the following scenarios could be considered as a valid defence of insane automatism?

      Your Answer:

      Correct Answer: Somnambulism

      Explanation:

      The origin of insane automatism is internal to the body, while in the case of sane automatism, it is caused by external factors.

      Criminal Responsibility and Age Limits

      To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

      Not Guilty by Reason of Insanity and Other Defenses

      A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 20 - A teenager prescribed clozapine for schizophrenia develops depression and is given an SSRI....

    Incorrect

    • A teenager prescribed clozapine for schizophrenia develops depression and is given an SSRI. Three days after starting the new tablets they have a seizure and are admitted to hospital. What is the most probable cause of the seizure?

      Your Answer:

      Correct Answer: Fluoxetine

      Explanation:

      When taken with clozapine, many SSRIs can cause an increase in its levels. However, citalopram and escitalopram are considered safe as they do not affect the cytochrome system. Although paroxetine is believed to interact, it has been proven safe when used at normal clinical doses alongside clozapine. Sertraline has minimal impact on clozapine levels.

      Interactions of Antidepressants with Cytochrome P450 System

      Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can have significant effects on the cytochrome P450 system. This can result in drug interactions that can affect the efficacy and safety of the medications.

      One example of such interaction is between fluvoxamine and theophylline. Fluvoxamine is a potent inhibitor of CYP1A2, which can lead to increased levels of theophylline in the body. This can cause adverse effects such as nausea, vomiting, and tremors.

      Another example is between fluoxetine and clozapine. Fluoxetine is a potent inhibitor of CYP2D6, which can increase the risk of seizures with clozapine. Clozapine is metabolized by CYP1A2, CYP3A4, and CYP2D6, and any inhibition of these enzymes can affect its metabolism and increase the risk of adverse effects.

      It is important to be aware of these interactions and monitor patients closely when prescribing antidepressants, especially in those who are taking other medications that are metabolized by the cytochrome P450 system.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 21 - Which term is used to describe the total number of newly diagnosed cases...

    Incorrect

    • Which term is used to describe the total number of newly diagnosed cases of a disease during a specific time frame?

      Your Answer:

      Correct Answer: Cumulative incidence

      Explanation:

      Measures of Disease Frequency: Incidence and Prevalence

      Incidence and prevalence are two important measures of disease frequency. Incidence measures the speed at which new cases of a disease are emerging, while prevalence measures the burden of disease within a population. Cumulative incidence and incidence rate are two types of incidence measures, while point prevalence and period prevalence are two types of prevalence measures.

      Cumulative incidence is the average risk of getting a disease over a certain period of time, while incidence rate is a measure of the speed at which new cases are emerging. Prevalence is a proportion and is a measure of the burden of disease within a population. Point prevalence measures the number of cases in a defined population at a specific point in time, while period prevalence measures the number of identified cases during a specified period of time.

      It is important to note that prevalence is equal to incidence multiplied by the duration of the condition. In chronic diseases, the prevalence is much greater than the incidence. The incidence rate is stated in units of person-time, while cumulative incidence is always a proportion. When describing cumulative incidence, it is necessary to give the follow-up period over which the risk is estimated. In acute diseases, the prevalence and incidence may be similar, while for conditions such as the common cold, the incidence may be greater than the prevalence.

      Incidence is a useful measure to study disease etiology and risk factors, while prevalence is useful for health resource planning. Understanding these measures of disease frequency is important for public health professionals and researchers in order to effectively monitor and address the burden of disease within populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 22 - What is the approximate occurrence rate of Tourette's syndrome among children? ...

    Incorrect

    • What is the approximate occurrence rate of Tourette's syndrome among children?

      Your Answer:

      Correct Answer: 1%

      Explanation:

      Tourette’s Syndrome: Understanding the Disorder and Management Options

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 23 - What is the most common personality disorder found among male prisoners in England...

    Incorrect

    • What is the most common personality disorder found among male prisoners in England and Wales?

      Your Answer:

      Correct Answer: Antisocial

      Explanation:

      The prevalent personality disorder among prisoners is antisocial.

      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.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 24 - Which of the following biochemical/haematological changes is associated with clozapine? ...

    Incorrect

    • Which of the following biochemical/haematological changes is associated with clozapine?

      Your Answer:

      Correct Answer: Raised ALP

      Explanation:

      Biochemical Changes Associated with Psychotropic Drugs

      Psychotropic drugs can have incidental biochemical of haematological effects that need to be identified and monitored. The evidence for many of these changes is limited to case reports of information supplied by manufacturers. The Maudsley Guidelines 14th Edition summarises the important changes to be aware of.

      One important parameter to monitor is ALT, a liver enzyme. Agents that can raise ALT levels include clozapine, haloperidol, olanzapine, quetiapine, chlorpromazine, mirtazapine, moclobemide, SSRIs, carbamazepine, lamotrigine, and valproate. On the other hand, vigabatrin can lower ALT levels.

      Another liver enzyme to monitor is ALP. Haloperidol, clozapine, olanzapine, duloxetine, sertraline, and carbamazepine can raise ALP levels, while buprenorphine and zolpidem (rarely) can lower them.

      AST levels are often associated with ALT levels. Trifluoperazine and vigabatrin can raise AST levels, while agents that raise ALT levels can also raise AST levels.

      TSH levels, which are associated with thyroid function, can be affected by aripiprazole, carbamazepine, lithium, quetiapine, rivastigmine, sertraline, and valproate (slightly). Moclobemide can lower TSH levels.

      Thyroxine levels can be affected by dexamphetamine, moclobemide, lithium (which can raise of lower levels), aripiprazole (rarely), and quetiapine (rarely).

      Overall, it is important to monitor these biochemical changes when prescribing psychotropic drugs to ensure the safety and well-being of patients.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 25 - What is a true statement about self harm? ...

    Incorrect

    • What is a true statement about self harm?

      Your Answer:

      Correct Answer: Older people who self-harm often have a degree of suicidal intent

      Explanation:

      Self Harm in Older Adults

      Self harm in older adults should be taken very seriously as it often indicates suicidal intent. The NICE guidelines on Self Harm (2004) recommend that all acts of self-harm in people over 65 years of age should be regarded as evidence of suicidal intent until proven otherwise. This is because the number of older adults who complete suicide is much higher than in younger adults.

      Unfortunately, many individuals who self-harm never receive psychiatric care and are discharged from emergency departments without any psychosocial needs assessment. This is contrary to the 2004 recommendations by the UK’s National Institute for Health and Clinical Excellence (NICE) for those who self-harm.

      Self harm can take many forms, including overdose, cutting, burning, hitting of mutilating body parts, and attempted hanging of strangulation. It is important to recognize the signs of self harm and provide appropriate support and care to those who engage in this behavior.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 26 - What is a true statement about Angelman syndrome? ...

    Incorrect

    • What is a true statement about Angelman syndrome?

      Your Answer:

      Correct Answer: It is caused by deleted material from the maternal chromosome

      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.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 27 - What was the degree of increase in the incidence of schizophrenia among Afro-Caribbeans...

    Incorrect

    • What was the degree of increase in the incidence of schizophrenia among Afro-Caribbeans in the AESOP study?

      Your Answer:

      Correct Answer: 9

      Explanation:

      The AESOP study is a first-presentation study of schizophrenia and other psychotic disorders that identified all people presenting to services with psychotic symptoms in well-defined catchment areas in South London, Nottingham and Bristol. The study aimed to elucidate the overall rates of psychotic disorder in the 3 centres, confirm and extend previous findings of raised rates of psychosis in certain migrant groups in the UK, and explore in detail the biological and social risk factors in these populations and their possible interactions. The study found that the incidence of all psychoses was higher in African-Caribbean and Black African populations, particularly in schizophrenia and manic psychosis. These groups were also more likely to be compulsorily admitted to hospital and come to the attention of mental health services via police of other criminal justice agencies, and less likely to come via the GP.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 28 - What is the appropriate term to describe the act of passing normal feces...

    Incorrect

    • What is the appropriate term to describe the act of passing normal feces in inappropriate locations?

      Your Answer:

      Correct Answer: Encopresis

      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.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 29 - What did Freud mean by the term eros and what drive does it...

    Incorrect

    • What did Freud mean by the term eros and what drive does it refer to?

      Your Answer:

      Correct Answer: Life

      Explanation:

      The death instinct is known as Thanatos, while the life instinct is represented by Eros.

      Freud’s Concepts of Thanatos and Eros

      Freud’s theories introduced two fundamental concepts: thanatos and eros. Thanatos, also known as the death instinct, refers to the innate drive that each person possesses to cause destruction and death. On the other hand, eros, also known as the life instinct, refers to the opposite drive towards life. These concepts are essential to understanding Freud’s theories on human behavior and the unconscious mind. By acknowledging the presence of both thanatos and eros, Freud believed that individuals could better understand their motivations and desires. The concepts of thanatos and eros continue to be studied and debated in the field of psychology today.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 30 - Among the given drugs, which one has the highest likelihood of causing myocarditis?...

    Incorrect

    • Among the given drugs, which one has the highest likelihood of causing myocarditis?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      Chest pain and palpitations are common symptoms of myocarditis, which can be identified through ECG changes such as widespread T wave inversion. Although it may resemble a heart attack, there is no obstruction in the coronary arteries. Although other antipsychotics have been linked to myocarditis, clozapine has the most significant correlation.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 31 - What is the recommended treatment for a stroke patient experiencing pathological crying? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Amitriptyline

      Explanation:

      Pathological Crying

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 32 - What is the most efficient medication for managing Parkinson's-related psychosis? ...

    Incorrect

    • What is the most efficient medication for managing Parkinson's-related psychosis?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      In Parkinson’s disease, only clozapine and quetiapine are appropriate antipsychotic medications, and if one is not well-tolerated, the other may be considered.

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 33 - A masters student had noticed that nearly all of her patients with arthritis...

    Incorrect

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

      Your Answer:

      Correct Answer: 3.77

      Explanation:

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

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 34 - How can somatoform disorder be best defined? ...

    Incorrect

    • How can somatoform disorder be best defined?

      Your Answer:

      Correct Answer: Da Costa's syndrome

      Explanation:

      Psychalgia refers to pain that has a psychological origin.

      Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 35 - Which epilepsy medication can alleviate concerns about weight gain and may even lead...

    Incorrect

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

      Your Answer:

      Correct Answer: Topiramate

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 36 - Which data type does age in years belong to? ...

    Incorrect

    • Which data type does age in years belong to?

      Your Answer:

      Correct Answer: Ratio

      Explanation:

      Age is a type of measurement that follows a ratio scale, which means that the values can be compared as multiples of each other. For instance, if someone is 20 years old, they are twice as old as someone who is 10 years old.

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 37 - Which option is not a type of descriptive statistic? ...

    Incorrect

    • Which option is not a type of descriptive statistic?

      Your Answer:

      Correct Answer: Student's t-test

      Explanation:

      A t-test is a statistical method used to determine if there is a significant difference between the means of two groups. It is a type of statistical inference.

      Types of Statistics: Descriptive and Inferential

      Statistics can be divided into two categories: descriptive and inferential. Descriptive statistics are used to describe and summarize data without making any generalizations beyond the data at hand. On the other hand, inferential statistics are used to make inferences about a population based on sample data.

      Descriptive statistics are useful for identifying patterns and trends in data. Common measures used to describe a data set include measures of central tendency (such as the mean, median, and mode) and measures of variability of dispersion (such as the standard deviation of variance).

      Inferential statistics, on the other hand, are used to make predictions of draw conclusions about a population based on sample data. These statistics are also used to determine the probability that observed differences between groups are reliable and not due to chance.

      Overall, both descriptive and inferential statistics play important roles in analyzing and interpreting data. Descriptive statistics help us understand the characteristics of a data set, while inferential statistics allow us to make predictions and draw conclusions about larger populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 38 - What diagnosis is suggested by the MRI findings of ventricular enlargement with preserved...

    Incorrect

    • What diagnosis is suggested by the MRI findings of ventricular enlargement with preserved medial temporal lobe structures in a patient with memory impairment?

      Your Answer:

      Correct Answer: Lewy body dementia

      Explanation:

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 39 - What is the ratio of the risk of stroke within a 3 year...

    Incorrect

    • What is the ratio of the risk of stroke within a 3 year period for high-risk psychiatric patients taking the new oral antithrombotic drug compared to those taking warfarin, based on the given data below? Number who had a stroke within a 3 year period vs Number without stroke New drug: 10 vs 190 Warfarin: 10 vs 490

      Your Answer:

      Correct Answer: 2.5

      Explanation:

      The relative risk (RR) of the event of interest in the exposed group compared to the unexposed group is 2.5.

      RR = EER / CER
      EER = 10 / 200 = 0.05
      CER = 10 / 500 = 0.02
      RR = EER / CER
      = 0.05 / 0.02 = 2.5

      This means that the exposed group has a 2.5 times higher risk of experiencing the event compared to the unexposed group.

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 40 - Which of the following factors does not increase the risk of self-injury in...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 41 - How should the norclozapine ratios be interpreted in therapeutic drug monitoring of clozapine?...

    Incorrect

    • How should the norclozapine ratios be interpreted in therapeutic drug monitoring of clozapine?

      Your Answer:

      Correct Answer: Levels taken less than 11 hours after the last dose are likely to result in high ratios

      Explanation:

      It is important to take clozapine levels as trough samples, which means they should be taken 11-13 hours after the last dose. Samples taken outside of this time frame may produce inaccurate results. If the levels are taken too early (before 11 hours), the clozapine levels may be artificially high, resulting in high ratios. Conversely, if the levels are taken too late (after 11 hours), the clozapine levels may be artificially low, resulting in low ratios.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 42 - Which of the following is an atypical characteristic of PANDAS? ...

    Incorrect

    • Which of the following is an atypical characteristic of PANDAS?

      Your Answer:

      Correct Answer: Hallucinations

      Explanation:

      PANDAS: A Disorder Linked to Streptococcal Infections

      PANDAS, of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a condition that affects children who develop sudden onset of obsessive-compulsive disorder (OCD) and/of tic disorders like Tourette’s Syndrome after contracting strep infections such as Strep throat of Scarlet Fever. The National Institute of Mental Health (NIMH) has identified five criteria for diagnosing PANDAS, including the presence of OCD and/of tic disorder, pediatric onset of symptoms, episodic course of symptom severity, association with group A Beta-hemolytic streptococcal infection, and association with neurological abnormalities. The anti streptococcal DNAse B (Anti DNAse-B) titre is commonly used to determine if there is immunologic evidence of a previous strep infection. PANDAS is linked to basal ganglia dysfunction.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 43 - A 7-year-old girl is brought to your clinic by her parents who are...

    Incorrect

    • A 7-year-old girl is brought to your clinic by her parents who are worried about her excessive need for order and cleanliness. Upon examination, you observe signs of obsessive rumination and compulsions. The girl has a history of streptococcal sore throat, leading you to suspect that it may have played a role in the development of her condition. Which of the following serum titres would be most likely to be elevated if this is the case?

      Your Answer:

      Correct Answer: Anti-DNAse

      Explanation:

      Elevated ASLO of antistreptolysin O titres, which are anti-DNAse, are often present in cases of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), a syndrome that may be linked to the development of childhood obsessive-compulsive disorder (OCD).

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 44 - What is the subtype of Niemann-Pick disease that manifests in the first few...

    Incorrect

    • What is the subtype of Niemann-Pick disease that manifests in the first few weeks of life and is identified by symptoms such as abdominal swelling, a cherry red spot, feeding challenges, and a gradual decline in early motor abilities?

      Your Answer:

      Correct Answer: Type A

      Explanation:

      Niemann-Pick disease is a group of inherited diseases where lipids accumulate in the cells of the liver, spleen, and brain. Niemann-Pick Type C (NPC) is the most relevant type for psychiatric presentations, with about one-third of cases presenting in adolescence of adulthood. Symptoms include progressive ataxia/dystonia, cognitive decline, and atypical psychotic symptoms. There are four other types of Niemann-Pick disease, each with their own causes and symptoms. Type A and B have a lack of sphingomyelinase and present in early childhood of mid-childhood/adolescence, respectively. Type C has reduced sphingomyelinase activity and can present at any age, with symptoms including enlarged liver and spleen, learning difficulties, seizures, and slurred speech. Type D is a variant of Type C and has similar symptoms. Type E has reduced sphingomyelinase activity and presents in adulthood with similar symptoms to the other types.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 45 - What defence mechanism is commonly observed in individuals in the paranoid-schizoid position? ...

    Incorrect

    • What defence mechanism is commonly observed in individuals in the paranoid-schizoid position?

      Your Answer:

      Correct Answer: Splitting

      Explanation:

      Melanie Klein, a prominent psychoanalyst, introduced two significant concepts in her work: the paranoid-schizoid position and the depressive position. The paranoid-schizoid position is a state of mind where the individual perceives the world as fragmented, dividing it into good and bad. This position is characterized by the defense mechanism of splitting, where the individual separates the good and bad aspects of themselves and others.

      On the other hand, the depressive position follows the paranoid-schizoid position and is characterized by the ability to accept ambivalence, where something can be both good and bad. This position represents a more integrated state of mind, where the individual can hold conflicting emotions and thoughts simultaneously. These concepts have been influential in psychoanalytic theory and have contributed to our understanding of the human psyche.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 46 - What substance is involved in the abnormal ingestion known as amylophagia in cases...

    Incorrect

    • What substance is involved in the abnormal ingestion known as amylophagia in cases of pica?

      Your Answer:

      Correct Answer: Starch

      Explanation:

      Pregnant women often exhibit a type of pica known as amylophagia.

      Pica: Eating Non-Nutritive Substances

      Pica is a condition where a person persistently eats non-nutritive substances for at least a month. The name pica comes from the Latin word for magpie, a bird known for its large and random appetite. To be diagnosed with pica, the behavior must be developmentally inappropriate, not culturally sanctioned, and severe enough to require clinical attention. It is more common in young people than adults and is often associated with mental retardation.

      There are various causes of pica, including mental disorders such as autism and schizophrenia, iron and zinc deficiency (although this is rare and not clear if it is a cause of effect), and pregnancy. The DSM-5 requires a minimum age of 2 before a diagnosis can be made. Pregnant women have been reported to experience certain forms of pica, such as geophagia (clay eating) and amylophagia (starch eating).

      Pica affects both sexes equally and is estimated to occur in up to 15% of those with severe intellectual disability. However, aside from cases of autistic spectrum disorder of intellectual disability, pica usually remits by adolescence.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 47 - You begin treating a geriatric patient with depression with an SSRI and schedule...

    Incorrect

    • You begin treating a geriatric patient with depression with an SSRI and schedule a follow-up appointment six weeks later. What rating scale would be best to use in order to monitor changes in their symptoms?

      Your Answer:

      Correct Answer: Montgomery-Asberg Depression Rating Scale

      Explanation:

      The Morgan-Russell Scale is specifically utilized for anorexia nervosa, while the Historical Clinical Risk 20 is a semi-structured tool employed by professionals to evaluate the likelihood of violent behavior. However, the MADRS is uniquely designed to detect changes in depression resulting from treatment.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 48 - A middle-aged patient in a psychiatric hospital is prescribed quetiapine for treatment-resistant aggressive...

    Incorrect

    • A middle-aged patient in a psychiatric hospital is prescribed quetiapine for treatment-resistant aggressive behaviour. What potential adverse effects are associated with antipsychotic use in this age group?

      Your Answer:

      Correct Answer: Stroke

      Explanation:

      Elderly individuals who take antipsychotic medications have a higher likelihood of experiencing a stroke.

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 49 - A 25-year-old woman presents to your clinic with concerns about her body image...

    Incorrect

    • A 25-year-old woman presents to your clinic with concerns about her body image and eating habits. Despite having a healthy BMI of 20 kg/m2, she feels overweight and restricts her food intake at times while bingeing at other times. She has not experienced amenorrhea. You decide to utilize the Eating Attitudes Test to assist in your diagnosis.
      What is the rating system for this assessment tool?

      Your Answer:

      Correct Answer: Self rated

      Explanation:

      The EAT, of Eating Attitudes Test, is a commonly used screening tool for diagnosing eating disorders. It is a self-rated test that evaluates attitudes towards food and eating. The test has been extensively studied and has been found to have good psychometric properties. For more information, see Garner et al.’s 1982 article in Psychol Med of visit the EAT-26 website.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 50 - What factor is most likely to impact the generalizability of a study's findings...

    Incorrect

    • What factor is most likely to impact the generalizability of a study's findings to the larger population?

      Your Answer:

      Correct Answer: Reactive effects of the research setting

      Explanation:

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 51 - What is the illicit substance with the highest lifetime prevalence of use in...

    Incorrect

    • What is the illicit substance with the highest lifetime prevalence of use in Europe?

      Your Answer:

      Correct Answer: Cannabis

      Explanation:

      Drug usage patterns in the UK are comparable to those observed throughout Europe, as reported by the EMCDDA. Cannabis remains the most frequently used drug in the UK, followed by amphetamines, hallucinogens, cocaine, and ecstasy.

      Illicit Drug Use Epidemiology

      The EMCDDA regularly gathers data on the misuse of illicit drugs. A survey conducted between 2004 and 2008 revealed the following results regarding the lifetime prevalence of drug use:

      – Cannabis: 22.5%
      – Cocaine: 4.1%
      – Amphetamine: 3.7%
      – Ecstasy: 3.3%
      – Opioids*: 0.5%

      *Note that opioids were only included if they were taken for illicit purposes, rather than for pain relief.

      The above figures provide insight into the extent of illicit drug use across Europe during the survey period. While cannabis was the most commonly used drug, followed by cocaine, amphetamine, and ecstasy, opioid use was relatively low. These findings can inform public health policies and interventions aimed at reducing drug-related harm.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 52 - What is a true statement about bodily distress disorder? ...

    Incorrect

    • What is a true statement about bodily distress disorder?

      Your Answer:

      Correct Answer: Prevalence is higher in females

      Explanation:

      Children experience a particular symptom more frequently than adults do.

      Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 53 - What falls under the category of class C according to the Misuse of...

    Incorrect

    • What falls under the category of class C according to the Misuse of Drugs Act?

      Your Answer:

      Correct Answer: Benzodiazepines

      Explanation:

      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.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 54 - The patient's presentation with a first episode psychosis, myeloneuropathy with ataxia, low B12...

    Incorrect

    • The patient's presentation with a first episode psychosis, myeloneuropathy with ataxia, low B12 level, and elevated homocysteine levels is most likely due to the use of a recreational drug. The patient's brother suspects that the patient has been using recreational drugs recently. However, the specific recreational drug responsible for the patient's presentation cannot be determined without further information of testing.

      Your Answer:

      Correct Answer: Nitrous oxide

      Explanation:

      Understanding Vitamin B12 Deficiency

      Vitamin B12 deficiency is a common condition, especially among older adults, and can lead to various psychiatric symptoms. This water-soluble vitamin occurs in three different forms in the human body, and it is absorbed in the terminal ileum after binding with intrinsic factor. Vitamin B12 is a cofactor for two important metabolic reactions, and its deficiency can cause the accumulation of precursors, which can be diagnosed by measuring homocysteine and methylmalonic acid. Common dietary sources of vitamin B12 include meat, fish, and dairy products, and deficiency can be caused by decreased intake, poor absorption, intrinsic factor deficiency, chronic pancreatic disease, parasites, intestinal disease, of metabolic impairment. Symptoms of vitamin B12 deficiency are often nonspecific and can include weakness, fatigue, irritability, developmental delay/regression, paresthesias, anemia, and more. Neurologic changes can occur without hematologic abnormality.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 55 - A 25-year-old woman is brought to your outpatient clinic by her partner. She...

    Incorrect

    • A 25-year-old woman is brought to your outpatient clinic by her partner. She believes she is overweight despite having a healthy BMI of 22. She engages in excessive exercise and restrictive eating habits, causing her to lose weight rapidly. She has not had a menstrual cycle in eight months.
      You decide to treat her using a combination of initial inpatient feeding and later outpatient cognitive behavioural therapy.
      Which of the following scales would you utilize to evaluate the effectiveness of your treatment?

      Your Answer:

      Correct Answer: Morgan Russell scale

      Explanation:

      Anorexia Nervosa and Morgan Russell Scale

      The patient is exhibiting symptoms of anorexia nervosa, a serious eating disorder characterized by a distorted body image and an intense fear of gaining weight. To measure the outcome of treatment for anorexia nervosa, the Morgan Russell scale is commonly used. This scale consists of two scores: an average outcome score and a general outcome score, with a possible total of 12.

      The average outcome score is based on the patient’s progress in five areas: nutritional status, menstrual function, mental state, sexual adjustment, and socioeconomic status. By assessing these areas, healthcare professionals can determine the effectiveness of treatment and make necessary adjustments to improve the patient’s overall well-being.

      The Morgan Russell scale is a valuable tool in the treatment of anorexia nervosa, as it provides a comprehensive evaluation of the patient’s progress and helps healthcare professionals tailor treatment plans to meet the patient’s specific needs.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 56 - What is the estimated percentage of women who go through temporary periods of...

    Incorrect

    • What is the estimated percentage of women who go through temporary periods of emotional instability after giving birth?

      Your Answer:

      Correct Answer: 40

      Explanation:

      Perinatal Depression, Baby Blues, and Postpartum Depression

      Perinatal depression, also known as postpartum depression, is a common mood disorder experienced by new mothers after childbirth. The term baby blues is used to describe the emotional lability that some mothers experience during the first week after childbirth, which usually resolves by day 10 without treatment. The prevalence of baby blues is around 40%. Postpartum depression, on the other hand, refers to depression that occurs after childbirth. While neither DSM-5 nor ICD-11 specifically mention postpartum depression, both diagnostic systems offer categories that encompass depression during pregnancy of in the weeks following delivery. The prevalence of postpartum depression is approximately 10-15%.

      Various factors have been shown to increase the risk of postnatal depression, including youth, marital and family conflict, lack of social support, anxiety and depression during pregnancy, substance misuse, previous pregnancy loss, ambivalence about the current pregnancy, and frequent antenatal admissions to a maternity hospital. However, obstetric factors such as length of labor, assisted delivery, of separation of the mother from the baby in the Special Care Baby Unit do not seem to influence the development of postnatal depression. Additionally, social class does not appear to be associated with postnatal depression.

      Puerperal psychosis, along with severe depression, is thought to be mainly caused by biological factors, while psychosocial factors are most important in the milder postnatal depressive illnesses.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 57 - Researchers have conducted a study comparing a new blood pressure medication with a...

    Incorrect

    • Researchers have conducted a study comparing a new blood pressure medication with a standard blood pressure medication. 200 patients are divided equally between the two groups. Over the course of one year, 20 patients in the treatment group experienced a significant reduction in blood pressure, compared to 35 patients in the control group.

      What is the number needed to treat (NNT)?

      Your Answer:

      Correct Answer: 7

      Explanation:

      The Relative Risk Reduction (RRR) is calculated by subtracting the experimental event rate (EER) from the control event rate (CER), dividing the result by the CER, and then multiplying by 100 to get a percentage. In this case, the RRR is (35-20)÷35 = 0.4285 of 42.85%.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 58 - A 50-year-old man, who has a past of opioid addiction, is interested in...

    Incorrect

    • A 50-year-old man, who has a past of opioid addiction, is interested in exploring pharmacological maintenance therapy in conjunction with psychosocial interventions. What would be your recommendation for the most suitable choice?

      Your Answer:

      Correct Answer: Buprenorphine

      Explanation:

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 59 - What is the estimated percentage of 10 year olds affected by encopresis? ...

    Incorrect

    • What is the estimated percentage of 10 year olds affected by encopresis?

      Your Answer:

      Correct Answer: 1.60%

      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.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 60 - What is the approximate occurrence rate of functional psychosis among male remand prisoners...

    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.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 61 - A teenager comes to your office and discloses that they have been using...

    Incorrect

    • A teenager comes to your office and discloses that they have been using a substance called Khat. Which of the following commonly known illegal drugs is it most comparable to?

      Your Answer:

      Correct Answer: Amphetamine

      Explanation:

      Khat: A Stimulant Drug Similar to Amphetamine

      Khat is a drug that shares similarities with amphetamine, a stimulant that can cause euphoria and loss of appetite. It comes from a plant that is typically chewed to release its active ingredient, cathinone. This drug is known for its stimulating effects and is commonly used in some parts of the world, particularly in East Africa and the Arabian Peninsula. However, it is also considered a controlled substance in many countries due to its potential for abuse and addiction.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 62 - What is the approach of the criminal justice system towards managing young individuals?...

    Incorrect

    • What is the approach of the criminal justice system towards managing young individuals?

      Your Answer:

      Correct Answer: A Child Safety Order can be imposed for a child under 10 who breaks the law

      Explanation:

      Criminal Responsibility and Age Limits

      To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

      Not Guilty by Reason of Insanity and Other Defenses

      A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 63 - What is the appropriate age range for diagnosing very early onset schizophrenia? ...

    Incorrect

    • What is the appropriate age range for diagnosing very early onset schizophrenia?

      Your Answer:

      Correct Answer: Under 13

      Explanation:

      Schizophrenia in children is rare compared to adults, with a prevalence estimate of 0.05% for those under 15 years old. There are two classifications based on age of onset: early onset schizophrenia (EOS) when symptoms appear between 13-18 years old, and very early onset schizophrenia (VEOS) when symptoms appear at of before 13 years old. EOS and VEOS have atypical features compared to adult-onset schizophrenia, including insidious onset, more severe neurodevelopmental abnormalities, terrifying visual hallucinations, constant inappropriate of blunted affects, higher rates of familial psychopathology, minor response to treatment, and poorer outcomes. Preliminary data suggests that VEOS and EOS may be due to greater familial vulnerability from genetic, psychosocial, and environmental factors. Poor outcomes are most reliably linked to a positive history of premorbid difficulties, greater symptom severity (especially negative symptoms) at baseline, and longer duration of untreated psychosis. Age at psychosis onset and sex are not consistent predictors of outcome.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 64 - A teenager presents with a three-year history of feeling sad for most of...

    Incorrect

    • A teenager presents with a three-year history of feeling sad for most of the day for approximately 2-3 weeks every month. Low mood is accompanied by reduced concentration and mild insomnia. They deny alterations in appetite, low self-worth, and any marked loss of interest of pleasure. They deny that their condition has ever been more severe than this. They report brief periods of feeling okay in between these episodes of low mood. There is no evidence of any history of elevated mood states, and they are otherwise fit and well with no issues of substance misuse. They claim to function reasonably well but emphasise that this requires significant effort when they are feeling down.
      Which of the following ICD-11 diagnosis is most suggested by this description?:

      Your Answer:

      Correct Answer: Dysthymic disorder

      Explanation:

      Based on the patient report, it appears that they are experiencing symptoms consistent with Dysthymic Disorder. There is no indication that they have experienced a depressive episode that meets the criteria for a diagnosis of either single of recurrent depression. Additionally, there is no evidence of extended periods without symptoms, which would exclude a diagnosis of Dysthymic Disorder. The absence of elevated mood suggests that neither Cyclothymic Disorder nor Bipolar Disorder Type I of II are likely diagnoses.

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 65 - Which of the following is excluded from the yearly examination for patients who...

    Incorrect

    • Which of the following is excluded from the yearly examination for patients who are prescribed antipsychotic drugs?

      Your Answer:

      Correct Answer: TFTs

      Explanation:

      Physical Monitoring for Patients on Antipsychotics

      Monitoring the physical health of patients on antipsychotic medications is an important aspect of their care. The Maudsley Guidelines provide recommendations for the frequency of various tests and parameters that should be monitored. These include baseline and yearly tests for urea and electrolytes, full blood count, blood lipids, weight, plasma glucose, ECG, blood pressure, prolactin, and liver function tests. Additionally, creatinine phosphokinase should be monitored if neuroleptic malignant syndrome is suspected. Patients on quetiapine should also have yearly thyroid function tests. It is important for healthcare providers to stay up-to-date on these guidelines and ensure that patients are receiving appropriate physical monitoring.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 66 - What is the most frequently observed defence mechanism in individuals with borderline personality...

    Incorrect

    • What is the most frequently observed defence mechanism in individuals with borderline personality disorder?

      Your Answer:

      Correct Answer: Projection

      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.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 67 - You are asked to evaluate a 35 year-old man on the medical ward...

    Incorrect

    • You are asked to evaluate a 35 year-old man on the medical ward with HIV. He has just recuperated from an episode of mania and has a history of bipolar disorder. You observe that he recently visited the HIV specialist in clinic and had an eGFR of 45. What would be the most suitable medication for the extended management of this man's bipolar disorder?

      Your Answer:

      Correct Answer: Valproate

      Explanation:

      The individual has bipolar disorder and needs ongoing treatment. The recommended initial medications are Lithium and Valproate. However, due to the person’s eGFR of 45, which indicates stage 3a CKD, Lithium is not a viable option. It is important to note that an eGFR < 90 in a working age adult is a strong indication of renal impairment, although a detailed understanding of CKD is not necessary for the MRCPsych exams. Therefore, Valproate is the preferred treatment in this case. HIV and Mental Health: Understanding the Relationship and Treatment Options Human immunodeficiency virus (HIV) is a blood-borne virus that causes cellular immune deficiency, resulting in a decrease in the number of CD4+ T-cells. People with severe mental illness are at increased risk of contracting and transmitting HIV, and the prevalence of HIV infection among them is higher than in the general population. Antiretroviral drugs are used to manage HIV, but they are not curative. Depression is the most common mental disorder in the HIV population, and it can result from HIV of the psycho-social consequences of having the condition. HIV-associated neurocognitive disorder (HAND) is the umbrella term for the spectrum of neurocognitive impairment induced by HIV, ranging from mild impairment through to dementia. Poor episodic memory is the most frequently reported cognitive difficulty in HIV-positive individuals. Treatment options for mental health issues in people with HIV include atypical antipsychotics for psychosis, SSRIs for depression and anxiety, valproate for bipolar disorder, and antiretroviral therapy for HAND. It is important to avoid benzodiazepines for delirium and MAOIs for depression. Understanding the relationship between HIV and mental health and providing appropriate treatment options can improve the quality of life for people living with HIV.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 68 - What is the recommended initial treatment for insomnia that has persisted for 2...

    Incorrect

    • What is the recommended initial treatment for insomnia that has persisted for 2 months and is not expected to improve in the near future?

      Your Answer:

      Correct Answer: CBT-I

      Explanation:

      Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, waking up too early, of feeling unrefreshed after sleep. The management of insomnia depends on whether it is short-term (lasting less than 3 months) of long-term (lasting more than 3 months). For short-term insomnia, sleep hygiene and a sleep diary are recommended first. If severe daytime impairment is present, a short course of a non-benzodiazepine hypnotic medication may be considered for up to 2 weeks. For long-term insomnia, cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment.

      Pharmacological therapy should be avoided, but a short-term hypnotic medication may be appropriate for some individuals with severe symptoms of an acute exacerbation. Referral to a sleep clinic of neurology may be necessary if another sleep disorder is suspected of if long-term insomnia has not responded to primary care management. Good sleep hygiene practices include establishing fixed sleep and wake times, relaxing before bedtime, maintaining a comfortable sleeping environment, avoiding napping during the day, avoiding caffeine, nicotine, and alcohol before bedtime, avoiding exercise before bedtime, avoiding heavy meals late at night, and using the bedroom only for sleep and sexual activity.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 69 - What is the most accurate approximation of the lifetime occurrence rate of major...

    Incorrect

    • What is the most accurate approximation of the lifetime occurrence rate of major depression?

      Your Answer:

      Correct Answer: 15%

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 70 - What is the DSM-5's definition of 'gender dysphoria'? ...

    Incorrect

    • What is the DSM-5's definition of 'gender dysphoria'?

      Your Answer:

      Correct Answer: To meet the diagnostic threshold the condition must be associated with significant distress

      Explanation:

      The main requirement is a mismatch between an individual’s biological sex and their gender identity, which causes significant distress.

      Gender identity is the person’s identification of lived role in society, which is separate from their biological sex. Gender can include non-binary and pangender identities, and cisgender refers to people whose gender is congruent with their biological sex. Gender identity is not the same as sexual preference, which is covered by separate diagnostic categories. The ICD-11 has redefined gender identity-related health, replacing diagnostic categories like “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood”, respectively. The DSM-5 uses the term ‘gender dysphoria’ to cover the whole range of gender identity disorders, which is characterized by a marked incongruence between one’s experienced/expressed gender and their assigned gender, lasting at least 6 months, and associated with clinically significant distress of impairment in social, occupational, of other important areas of functioning.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 71 - What medication is approved for managing agitation in individuals with Alzheimer's disease? ...

    Incorrect

    • What medication is approved for managing agitation in individuals with Alzheimer's disease?

      Your Answer:

      Correct Answer: Risperidone

      Explanation:

      The use of risperidone for behavioural issues in Alzheimer’s patients can be a complex topic. While there are warnings about the potential risk of stroke with risperidone and olanzapine in dementia patients, risperidone is still considered the preferred treatment for managing psychosis and agitation in this population.

      Management of Non-Cognitive Symptoms in Dementia

      Non-cognitive symptoms of dementia can include agitation, aggression, distress, psychosis, depression, anxiety, sleep problems, wandering, hoarding, sexual disinhibition, apathy, and shouting. Non-pharmacological measures, such as music therapy, should be considered before prescribing medication. Pain may cause agitation, so a trial of analgesics is recommended. Antipsychotics, such as risperidone, olanzapine, and aripiprazole, may be used for severe distress of serious risk to others, but their use is controversial due to issues of tolerability and an association with increased mortality. Cognitive enhancers, such as AChE-Is and memantine, may have a modest benefit on BPSD, but their effects may take 3-6 months to take effect. Benzodiazepines should be avoided except in emergencies, and antidepressants, such as citalopram and trazodone, may have mixed evidence for BPSD. Mood stabilizers, such as valproate and carbamazepine, have limited evidence to support their use. Sedating antihistamines, such as promethazine, may cause cognitive impairment and should only be used short-term. Melatonin has limited evidence to support its use but is safe to use and may be justified in some cases where benefits are seen. For Lewy Body dementia, clozapine is favored over risperidone, and quetiapine may be a reasonable choice if clozapine is not appropriate. Overall, medication should only be used when non-pharmacological measures are ineffective, and the need is balanced with the increased risk of adverse effects.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 72 - Which of the following skills is not considered a micro-counselling technique utilized in...

    Incorrect

    • Which of the following skills is not considered a micro-counselling technique utilized in motivational interviewing?

      Your Answer:

      Correct Answer: Facilitations

      Explanation:

      Motivational Interviewing: A Model for Resolving Ambivalence and Facilitating Change

      Motivational interviewing (MI) is an evidence-based method used for people with substance misuse problems. It was introduced by William Miller in 1983, based on his experience with alcoholics. MI focuses on exploring and resolving ambivalence and centres on the motivational process that facilitates change. It is based on three key elements: collaboration, evocation, and autonomy.

      There are four principles of MI: expressing empathy, supporting self-efficacy, rolling with resistance, and developing discrepancy. MI involves the use of micro-counseling skills called OARS, which stands for open-ended questions, affirmations, reflections, and summaries.

      Change talk is defined as statements by the client that reveal consideration of, motivation for, of commitment to change. In MI, the therapist aims to guide the client to expression of change talk. Types of change talk can be remembered by the mnemonic DARN-CAT, which stands for desire, ability, reason, need, commitment, activation, and taking steps.

      Overall, MI is a model for resolving ambivalence and facilitating change that emphasizes collaboration, evocation, and autonomy. It is a useful tool for therapists working with clients with substance misuse problems.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 73 - How does the suicide rate in patients with epilepsy compare to the general...

    Incorrect

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

      Your Answer:

      Correct Answer: 3 times higher

      Explanation:

      Suicide Risk in Epilepsy

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 74 - What is a true statement about supportive psychotherapy? ...

    Incorrect

    • What is a true statement about supportive psychotherapy?

      Your Answer:

      Correct Answer: It aims to increase the patients self-esteem

      Explanation:

      Supportive Psychotherapy: An Overview

      Supportive psychotherapy is a widely used approach in psychiatry, often reserved for clients who are not suitable for other forms of therapy. It aims to provide emotional support and encouragement to help people cope with overwhelming stress and restore them to their previous level of functioning. This therapy is not based on any specific psychological theory and is eclectic in approach.

      Supportive psychotherapy is generally used with two different patient groups: those who were otherwise functioning well but have become symptomatic due to stress, and those who are not suitable for other forms of therapy. The goal of therapy is to help the patient get on with their life as best as possible, without disrupting reasonable defenses of generating conflicts.

      The therapist avoids confrontation and transference issues are rarely analyzed. However, the therapeutic aims of long-term supportive psychotherapy include establishing a therapeutic alliance, holding and containing, promoting awareness of transference issues, promoting stability, facilitating the maturation of defenses, and promoting better adaptation to reality.

      Supportive psychotherapy has been dismissed as ‘hand holding,’ but it should not be underestimated. It is suitable for most patients and is often the only therapy that can help when others have failed. Much of the work doctors do in outpatient clinics could be classified as supportive psychotherapy.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 75 - What is a commonly used tool for predicting the likelihood of someone committing...

    Incorrect

    • What is a commonly used tool for predicting the likelihood of someone committing a sexual offense again?

      Your Answer:

      Correct Answer: RRASOR

      Explanation:

      The Beck Hopelessness Scale (BHS) is a recognized instrument utilized for forecasting suicidal tendencies.

      Methods of Risk Assessment

      Methods of risk assessment are important in determining the potential harm that an individual may pose to others. There are three main methods for assessing risk to others: unstructured clinical approach, actuarial risk assessment, and structured professional judgment. The unstructured clinical approach is based solely on professional experience and does not involve any specific framework. Actuarial risk assessment uses tools that are based on statistical models of weighted factors supported by research as being predictive for future risk. Structured professional judgment combines professional judgment with a consideration of static and dynamic risk factors. Following this, the risk is formulated, and a plan is devised. There are various tools available for each method, such as the Historical-Clinical-Risk Management-20 (HCR-20) for violence, the Risk of Sexual Violence Protocol (RSVP) for sexual risk, and the Hare Psychopathy Checklist (PCL-R) for violence. It is important to use a multidisciplinary approach and consider all relevant risk factors in the formulation.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 76 - A 26-year-old male is admitted to the Emergency Department with severe abdominal pain....

    Incorrect

    • A 26-year-old male is admitted to the Emergency Department with severe abdominal pain. He is shivering and writhing in pain on the trolley. He has a history of recurrent abdominal pain with no identifiable cause. He insists on receiving morphine for pain relief and threatens to harm himself if he does not receive it.
      Upon reviewing his medical records, you observe a consistent pattern of this behavior.
      What is the most probable diagnosis from the options provided?

      Your Answer:

      Correct Answer: Malingering

      Explanation:

      This is a challenging situation as the individual may be experiencing opiate withdrawal due to their history of substance abuse. Nevertheless, based on the given choices, the most suitable term to describe the patient’s behavior is malingering, as they are feigning symptoms in order to obtain morphine.

      Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 77 - What are the factors that have been demonstrated to elevate the likelihood of...

    Incorrect

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

      Your Answer:

      Correct Answer: Being on remand

      Explanation:

      Suicide in Prison: High Rates and Risk Factors

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

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

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

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 78 - You are part of a team creating a community program for adolescents with...

    Incorrect

    • 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).

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 79 - What is the typical age range of individuals who are diagnosed with Munchausen's...

    Incorrect

    • What is the typical age range of individuals who are diagnosed with Munchausen's syndrome by proxy?

      Your Answer:

      Correct Answer: 4 years

      Explanation:

      Munchausen’s syndrome by proxy, also known as fabricated or induced illness, is a rare form of child abuse where a caregiver, usually the mother, falsifies illness in a child by fabricating of producing symptoms and presenting the child for medical care while denying knowledge of the cause. It is most commonly seen in children under the age of 4, with symptoms including apnoea, anorexia, feeding problems, and seizures. The disorder is now recognized as ‘Factitious Disorder Imposed on Another’ in the DSM-5, with criteria including falsification of physical of psychological signs of symptoms, presentation of the victim as ill, and evident deceptive behavior. The perpetrator, not the victim, receives this diagnosis. Presenting signs of symptoms can take the form of covert injury, fabrication of symptoms, of exaggeration of existing symptoms. Symptoms are often subjective and easy to fake.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 80 - Which of the following treatment options for acute mania has been found to...

    Incorrect

    • Which of the following treatment options for acute mania has been found to be less effective than a placebo?

      Your Answer:

      Correct Answer: Topiramate

      Explanation:

      Antimanic Drugs: Efficacy and Acceptability

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 81 - Which of the following is cognitive distortion? ...

    Incorrect

    • Which of the following is cognitive distortion?

      Your Answer:

      Correct Answer: Personalisation

      Explanation:

      Personalisation can be considered a type of cognitive distortion, while the other options are classified as defence mechanisms.

      Cognitive Therapy and Negative Automatic Thoughts

      Cognitive therapy is a present-focused approach that aims to help clients overcome difficulties by identifying and changing dysfunctional thinking. This therapy is based on collaboration between the client and therapist and on testing beliefs through collaborative empiricism. One of the techniques used in cognitive therapy is Socratic questioning, which helps elicit false beliefs called negative automatic thoughts.

      Negative automatic thoughts, also known as cognitive distortions, can be categorized into different types. Dichotomous thinking is the tendency to see things as black and white rather than shades of grey. Personalization is the incorrect assumption that things happen due to us, while overgeneralization involves coming to a general conclusion based on a single piece of evidence. Arbitrary inference is drawing an unjustified conclusion, while selective abstraction involves concentrating on the negative while ignoring the positives. Catastrophizing is expecting disaster from relatively trivial events, while filtering involves selecting out only negative aspects of a situation and leaving out the positive.

      Control fallacies involve believing that we are responsible for everything (internal control fallacy) of nothing (external control fallacy). The fallacy of fairness is believing that life is fair, while blaming involves holding others responsible for our distress. Shoulds are preconceived rules we believe (often incorrect) which makes us angry when others don’t obey them. Magnification is a tendency to exaggerate the importance of negative information of experiences, while trivializing of reducing the significance of positive information of experiences. Minimization involves an undervaluation of positive attributes, while emotional reasoning is believing what we feel must be true.

      The fallacy of change involves expecting others to change just because it suits us, while global labeling involves exaggerating and labeling behavior (e.g. when you fail at something, saying ‘I’m a loser’). Always being right is when the need to be right dominates all other needs, while the heaven’s reward fallacy involves expecting our sacrifices will pay off. Finally, magical thinking is incorrectly believing that our actions influence the outcomes.

      Overall, cognitive therapy helps individuals identify and challenge negative automatic thoughts to improve their mental health and well-being.

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 82 - Which medication is approved for treating symptoms of opiate withdrawal in the UK?...

    Incorrect

    • Which medication is approved for treating symptoms of opiate withdrawal in the UK?

      Your Answer:

      Correct Answer: Lofexidine

      Explanation:

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 83 - What is the most suitable significance test to examine the potential association between...

    Incorrect

    • What is the most suitable significance test to examine the potential association between serum level and degree of sedation in patients who are prescribed clozapine, where sedation is measured on a scale of 1-10?

      Your Answer:

      Correct Answer: Logistic regression

      Explanation:

      This scenario involves examining the correlation between two variables: the sedation scale (which is ordinal) and the serum clozapine level (which is a ratio scale). While the serum clozapine level can be measured using arithmetic and is considered a parametric variable, the sedation scale cannot be treated in the same way due to its non-parametric nature. Therefore, the analysis of the correlation between these two variables will need to take into account the limitations of the sedation scale as an ordinal variable.

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 84 - What is a true statement about frontotemporal lobar degeneration? ...

    Incorrect

    • What is a true statement about frontotemporal lobar degeneration?

      Your Answer:

      Correct Answer: Behavioural variant is the most common subtype of frontotemporal lobar degeneration

      Explanation:

      Frontotemporal Lobar Degeneration

      Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.

      The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).

      As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.

      In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 85 - What is the percentage of completed suicides that occur in individuals aged 65...

    Incorrect

    • What is the percentage of completed suicides that occur in individuals aged 65 and above?

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Suicide in the Elderly

      Self-harm in older individuals should be approached with caution as approximately 20% of completed suicides occur in those over the age of 65. Studies have consistently found that more than half of those who commit suicide after the age of 65 are suffering from a depressive disorder at the time of death. Personality traits also appear to play a role, with an association between suicide in older individuals and anankastic (obsessional) and anxious personality traits observed in one study. Dissocial of borderline disorders are more commonly found in younger suicide victims. It is important to be aware of these factors when assessing and treating suicidal behavior in the elderly.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 86 - What is a known contributing factor to the development of ADHD? ...

    Incorrect

    • What is a known contributing factor to the development of ADHD?

      Your Answer:

      Correct Answer: Low birth weight

      Explanation:

      Risk Factors for ADHD

      There are several risk factors associated with the development of ADHD. According to the NICE guidelines, these include maternal smoking, alcohol consumption, and heroin use during pregnancy, as well as low birth weight and fetal hypoxia. Additionally, severe early psychosocial adversity has also been identified as a potential risk factor for ADHD. This refers to experiences of significant stress of trauma during early childhood, such as abuse, neglect, of exposure to violence. These factors can have a lasting impact on a child’s development and may contribute to the development of ADHD symptoms. It is important for healthcare professionals to be aware of these risk factors and to provide appropriate support and interventions to children and families who may be affected.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 87 - In chronic opiate use, which effect is most likely to continue over time?...

    Incorrect

    • In chronic opiate use, which effect is most likely to continue over time?

      Your Answer:

      Correct Answer: Constipation

      Explanation:

      Tolerance in Opiate Abuse

      Tolerance is a common phenomenon that occurs in opiate abuse. It develops regarding the analgesic, euphoric, sedative, respiratory depressant, and nauseating effects of opioids. However, it does not develop to their effects on miosis and bowel motility, which can cause constipation. This means that individuals who abuse opioids may require higher doses to achieve the desired effects, leading to an increased risk of overdose and other adverse effects. Understanding the mechanisms involved in tolerance can help in developing effective interventions to prevent and treat opiate abuse.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 88 - You are asked to assess a teenage girl with borderline personality disorder who...

    Incorrect

    • You are asked to assess a teenage girl with borderline personality disorder who is admitted to one of the general adolescent wards. She discloses to you that she ingested 200 paracetamol tablets an hour ago. However, the nurse in charge expresses skepticism about the patient's account, stating that she frequently fabricates stories. What is the most suitable course of action for managing this situation?

      Your Answer:

      Correct Answer: Wait a further 3 hours and take paracetamol levels

      Explanation:

      In cases of paracetamol overdose, it is recommended to measure the levels of the drug in the patient’s system 4 hours after the incident, if possible. Treatment should be based on the results of this test. However, in this particular case, since the patient has sought medical attention early, there is sufficient time to obtain the test results before initiating treatment. Blind treatment is only considered when the levels cannot be measured within 8 hours, of when the patient has ingested more than 150 mg/kg of paracetamol, of when the overdose was taken in a staggered manner of the timing is uncertain, as the test results may not be reliable in such cases.

      Self-Harm and its Management

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 89 - What is another term used to refer to Neyman bias? ...

    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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 90 - What are the common symptoms of Lennox-Gastaut syndrome? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Seizures

      Explanation:

      Understanding Lennox-Gastaut Syndrome

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 91 - Which of the following statements accurately describes significance tests? ...

    Incorrect

    • Which of the following statements accurately describes significance tests?

      Your Answer:

      Correct Answer: Chi-squared test is used to compare non-parametric data

      Explanation:

      The chi-squared test is a statistical test that does not rely on any assumptions about the underlying distribution of the data, making it a non-parametric 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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 92 - A woman is referred by her GP due to her persistent belief that...

    Incorrect

    • A woman is referred by her GP due to her persistent belief that she has stomach cancer. She remains convinced of this despite multiple normal investigations and reassurance from medical specialists. What is the most probable diagnosis for her condition?

      Your Answer:

      Correct Answer: Hypochondriasis

      Explanation:

      There is often confusion between hypochondriasis and bodily distress disorder. Hypochondriasis involves a fixation on having a particular illness, while bodily distress disorder is characterized by a preoccupation with symptoms rather than a specific diagnosis.

      Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterized by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behavior. Somatoform disorders are characterized by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterized by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. Dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. The symptoms of these disorders result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning. Diagnosis of these disorders involves a thorough evaluation of the individual’s symptoms and medical history, as well as ruling out other possible causes of the symptoms.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 93 - Which of the following is the least probable cause for the development of...

    Incorrect

    • Which of the following is the least probable cause for the development of PTSD?

      Your Answer:

      Correct Answer: Natural disaster

      Explanation:

      The rates of PTSD vary depending on the type of traumatic event experienced.

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 94 - The level one treatment in the STAR*D study involved the use of which...

    Incorrect

    • The level one treatment in the STAR*D study involved the use of which SSRI?

      Your Answer:

      Correct Answer: Citalopram

      Explanation:

      STAR*D Study

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 95 - What is a criterion used to evaluate the quality of reporting in randomized...

    Incorrect

    • What is a criterion used to evaluate the quality of reporting in randomized controlled trials?

      Your Answer:

      Correct Answer: CONSORT

      Explanation:

      As an AI language model, I do not have personal opinions of beliefs. However, I can provide information and guidance on the standards of reporting for different types of research studies. The guidelines mentioned above are essential for ensuring that research studies are reported accurately and transparently, which is crucial for the scientific community to evaluate and replicate the findings. It is important for researchers to be familiar with these standards and follow them when reporting their studies to ensure the quality and integrity of their research.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 96 - For which medical condition is the hormone cholecystokinin being considered as a potential...

    Incorrect

    • For which medical condition is the hormone cholecystokinin being considered as a potential treatment?

      Your Answer:

      Correct Answer: Bulimia

      Explanation:

      The Role of Cholecystokinin in Bulimia

      Bulimia is a disorder characterized by binge eating followed by purging behaviors. Research has shown that cholecystokinin (CCK), a hormone that signals satiety and reduces food intake, may play a role in the development of bulimia. Studies have found that bulimic women have lower levels of CCK compared to non-bulimic women, which may contribute to their bingeing behavior.

      CCK has been shown to cause laboratory animals to feel full and stop eating. However, in bulimic individuals, the decrease in CCK levels may lead to a lack of satiety signals, causing them to continue eating beyond their normal limits. This may trigger feelings of guilt and shame, leading to purging behaviors such as vomiting of excessive exercise.

      Understanding the role of CCK in bulimia may lead to new treatment options for this disorder. By targeting CCK levels, it may be possible to reduce binge eating behaviors and improve overall health outcomes for those with bulimia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 97 - What is a true statement about transvestic disorder / transvestism in relation to...

    Incorrect

    • What is a true statement about transvestic disorder / transvestism in relation to paraphilias?

      Your Answer:

      Correct Answer: Transvestic disorder is nearly exclusively reported in males

      Explanation:

      It should be noted that the ICD-11 has reclassified gender incongruence from the ‘Mental and behavioural disorders’ chapter to the new ‘Conditions related to sexual health’ chapter, indicating that it is not considered a mental disorder. However, the DSM-5 still lists gender dysphoria as a mental disorder. Additionally, the DSM-5 specifies that transvestic disorder only applies when cross-dressing is accompanied by sexual excitement and emotional distress. This may involve wearing one of two articles of clothing of dressing completely in the clothing and accessories of the opposite sex, including wigs and makeup for men.

      Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 98 - The application of technology in mental health care is advancing quickly. What technological...

    Incorrect

    • The application of technology in mental health care is advancing quickly. What technological advancements have been effective in managing auditory hallucinations?

      Your Answer:

      Correct Answer: Avatar therapy

      Explanation:

      The advancements in technology and the widespread availability of smartphones and internet access can be utilized to improve patient care and equip clinicians with more tools for diagnosing and treating mental illnesses. One promising approach is avatar therapy, which has shown positive results in treating auditory hallucinations in patients who did not respond well to medication. Additionally, automated objective behavioral analysis has been used to monitor and predict mood and emotional responses. However, online cognitive behavioral therapy has not been found to be effective in treating auditory hallucinations. Personal Zen is a mobile and tablet app that gamifies techniques proven to be helpful in managing anxiety and stress. Finally, virtual reality exposure therapy has been used to treat post-traumatic stress disorder.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 99 - What is the difference between rapid cycling and non-rapid cycling bipolar disorder? ...

    Incorrect

    • What is the difference between rapid cycling and non-rapid cycling bipolar disorder?

      Your Answer:

      Correct Answer: Rapid cycling is more common in women

      Explanation:

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 100 - Which condition is primarily associated with cortical dementia rather than subcortical dementia? ...

    Incorrect

    • Which condition is primarily associated with cortical dementia rather than subcortical dementia?

      Your Answer:

      Correct Answer: Pick's disease

      Explanation:

      Distinguishing Cortical and Subcortical Dementia: A Contested Area

      Attempts have been made to differentiate between cortical and subcortical dementia based on clinical presentation, but this remains a contested area. Some argue that the distinction is not possible. Cortical dementia is characterized by impaired memory, visuospatial ability, executive function, and language. Examples of cortical dementias include Alzheimer’s disease, Pick’s disease, and Creutzfeldt-Jakob disease. On the other hand, subcortical dementia is characterized by general slowing of mental processes, personality changes, mood disorders, and abnormal movements. Examples of subcortical dementias include Binswanger’s disease, dementia associated with Huntington’s disease, AIDS, Parkinson’s disease, Wilson’s disease, and progressive supranuclear palsy. Despite ongoing debate, questions on this topic may appear in exams.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 101 - What is the most suitable course of action for a man with advanced...

    Incorrect

    • What is the most suitable course of action for a man with advanced multiple sclerosis who experiences pathological crying and has not shown improvement with citalopram?

      Your Answer:

      Correct Answer: Dextromethorphan and quinidine

      Explanation:

      According to the 13th edition of the Maudsley Guidelines, the effectiveness of dextromethorphan and quinidine in treating pseudobulbar affect has been demonstrated. Out of the options provided, this is the only one that has been supported by evidence.

      Pathological Crying

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 102 - What is the typical age when males begin to experience puberty? ...

    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.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 103 - Which intervention would be most likely to decrease a patient's alanine aminotransferase (ALT)...

    Incorrect

    • Which intervention would be most likely to decrease a patient's alanine aminotransferase (ALT) levels?

      Your Answer:

      Correct Answer: Vigabatrin

      Explanation:

      Vigabatrin, an AED, is recognized for its ability to decrease AST and ALT levels, but it is also associated with the development of visual field impairments.

      Biochemical Changes Associated with Psychotropic Drugs

      Psychotropic drugs can have incidental biochemical of haematological effects that need to be identified and monitored. The evidence for many of these changes is limited to case reports of information supplied by manufacturers. The Maudsley Guidelines 14th Edition summarises the important changes to be aware of.

      One important parameter to monitor is ALT, a liver enzyme. Agents that can raise ALT levels include clozapine, haloperidol, olanzapine, quetiapine, chlorpromazine, mirtazapine, moclobemide, SSRIs, carbamazepine, lamotrigine, and valproate. On the other hand, vigabatrin can lower ALT levels.

      Another liver enzyme to monitor is ALP. Haloperidol, clozapine, olanzapine, duloxetine, sertraline, and carbamazepine can raise ALP levels, while buprenorphine and zolpidem (rarely) can lower them.

      AST levels are often associated with ALT levels. Trifluoperazine and vigabatrin can raise AST levels, while agents that raise ALT levels can also raise AST levels.

      TSH levels, which are associated with thyroid function, can be affected by aripiprazole, carbamazepine, lithium, quetiapine, rivastigmine, sertraline, and valproate (slightly). Moclobemide can lower TSH levels.

      Thyroxine levels can be affected by dexamphetamine, moclobemide, lithium (which can raise of lower levels), aripiprazole (rarely), and quetiapine (rarely).

      Overall, it is important to monitor these biochemical changes when prescribing psychotropic drugs to ensure the safety and well-being of patients.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 104 - What type of regression is appropriate for analyzing data with dichotomous variables? ...

    Incorrect

    • What type of regression is appropriate for analyzing data with dichotomous variables?

      Your Answer:

      Correct Answer: Logistic

      Explanation:

      Logistic regression is employed when dealing with dichotomous variables, which are variables that have only two possible values, such as live/dead of head/tail.

      Stats: Correlation and Regression

      Correlation and regression are related but not interchangeable terms. Correlation is used to test for association between variables, while regression is used to predict values of dependent variables from independent variables. Correlation can be linear, non-linear, of non-existent, and can be strong, moderate, of weak. The strength of a linear relationship is measured by the correlation coefficient, which can be positive of negative and ranges from very weak to very strong. However, the interpretation of a correlation coefficient depends on the context and purposes. Correlation can suggest association but cannot prove of disprove causation. Linear regression, on the other hand, can be used to predict how much one variable changes when a second variable is changed. Scatter graphs are used in correlation and regression analyses to visually determine if variables are associated and to detect outliers. When constructing a scatter graph, the dependent variable is typically placed on the vertical axis and the independent variable on the horizontal axis.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 105 - Which statement accurately describes the use of cholinesterase inhibitors for treating dementia caused...

    Incorrect

    • Which statement accurately describes the use of cholinesterase inhibitors for treating dementia caused by Parkinson's disease?

      Your Answer:

      Correct Answer: They are more effective than placebo in treating cognitive problems

      Explanation:

      Dementia with Parkinson’s Disease: Understanding Cognitive Symptoms

      Dementia with Parkinson’s disease is a syndrome that involves a decline in memory and other cognitive domains, leading to social and occupational dysfunction. Along with motor problems, non-motor symptoms such as cognitive, behavioral, and psychological issues can also arise. There is debate over whether Lewy body dementia and dementia due to Parkinson’s are different conditions. Drugs used to treat Parkinson’s can interfere with cognitive function, and people with this type of dementia tend to have marked problems with executive function. Cholinesterase inhibitors can improve cognitive performance, but they are not well tolerated and can cause side effects. Understanding the cognitive symptoms of dementia with Parkinson’s disease is crucial for effective clinical management.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 106 - Which drug interacts with a G-coupled receptor to exert its effects? ...

    Incorrect

    • Which drug interacts with a G-coupled receptor to exert its effects?

      Your Answer:

      Correct Answer: Heroin

      Explanation:

      The mechanism of action of heroin involves attaching to opiate receptors, which are G-coupled. This attachment results in the suppression of cellular activity through stimulation.

      Mechanisms of action for illicit drugs can be classified based on their effects on ionotropic receptors of ion channels, G coupled receptors, of monoamine transporters. Cocaine and amphetamine both increase dopamine levels in the synaptic cleft, but through different mechanisms. Cocaine directly blocks the dopamine transporter, while amphetamine binds to the transporter and increases dopamine efflux through various mechanisms, including inhibition of vesicular monoamine transporter 2 and monoamine oxidase, and stimulation of the intracellular receptor TAAR1. These mechanisms result in increased dopamine levels in the synaptic cleft and reuptake inhibition.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 107 - What is the Department of Health's guidance on maintaining relational security? ...

    Incorrect

    • What is the Department of Health's guidance on maintaining relational security?

      Your Answer:

      Correct Answer: See Think Act

      Explanation:

      – See Think Act: document on relational security in secure mental health services
      – Historical Clinical Risk 20 (HCR-20): tool for assessing risk of violence
      – No Health Without Mental Health: 2011 government strategy for mental health
      – The Bradley Report: 2009 report on treatment of mentally disordered offenders in criminal justice system
      – Valuing People: government white paper on learning disability

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 108 - What is the relationship between cannabis use and the likelihood of developing schizophrenia?...

    Incorrect

    • What is the relationship between cannabis use and the likelihood of developing schizophrenia?

      Your Answer:

      Correct Answer: The younger a person starts using cannabis the higher their subsequent risk

      Explanation:

      Consistent evidence suggests a link between cannabis use and schizophrenia risk, with the risk increasing as the age of first use decreases.

      Schizophrenia and Cannabis Use

      The relationship between cannabis use and the risk of developing schizophrenia is a topic of ongoing debate. However, research suggests that cannabis use may increase the risk of later schizophrenia of schizophreniform disorder by two-fold (Arseneault, 2004). The risk of developing schizophrenia appears to be higher in individuals who start using cannabis at a younger age. For instance, regular cannabis smokers at the age of 15 are 4.5 times more likely to develop schizophrenia at the age of 26, compared to those who did not report regular use until age 18 (Murray, 2004).

      A systematic review published in the Lancet in 2007 found that the lifetime risk of developing psychosis increased by 40% in individuals who had ever used cannabis (Moore, 2007). Another meta-analysis reported that the age at onset of psychosis was 2.70 years younger in cannabis users than in non-users (Large, 2011). These findings suggest that cannabis use may have a significant impact on the development of schizophrenia and related disorders.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 109 - What are the typical features of post-traumatic stress disorder? ...

    Incorrect

    • What are the typical features of post-traumatic stress disorder?

      Your Answer:

      Correct Answer: Exaggerated startle response

      Explanation:

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 110 - Which of the following statements regarding the onset and progression of Alzheimer's disease...

    Incorrect

    • Which of the following statements regarding the onset and progression of Alzheimer's disease is accurate?

      Your Answer:

      Correct Answer: Schizophrenia is commoner in individuals not in stable relationships

      Explanation:

      The high concordance rate of 50% among monozygotic twins and the 10% likelihood of offspring being affected indicate a significant genetic component in the development of schizophrenia.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 111 - Compared to other research models, which one yields the most robust and reliable...

    Incorrect

    • Compared to other research models, which one yields the most robust and reliable findings?

      Your Answer:

      Correct Answer: Randomised control trials (RCTs) with non-definitive results

      Explanation:

      According to Greenhalgh (1997), when making decisions about clinical interventions, the standard notation for the relative weight carried by different types of primary studies is arranged in a hierarchy of evidence. Randomised control trials with non-definitive results are ranked third in this hierarchy, carrying stronger relative weight than cohort studies, case-control studies, cross-sectional surveys, and case reports. The top two positions are occupied by systematic reviews/meta-analyses and RCTs with definitive results, respectively.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 112 - What type of sampling method is quota sampling commonly used for in qualitative...

    Incorrect

    • What type of sampling method is quota sampling commonly used for in qualitative research?

      Your Answer:

      Correct Answer: Purposive sampling

      Explanation:

      Qualitative research is a method of inquiry that seeks to understand the meaning and experience dimensions of huma