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Question 1
Incorrect
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At what stage of behaviour change, as defined by Prochaska and DiClemente (1993), is a patient ready to receive constructive advice, commit to planned behaviour change, establish objectives, and evaluate past achievements and setbacks?
Your Answer: Contemplation
Correct Answer: Preparation
Explanation:Their preparedness suggests that they are getting ready to make a change.
Stages of Change Model
Prochaska and DiClemente’s Stages of Change Model identifies five stages that individuals go through when making a change. The first stage is pre-contemplation, where the individual is not considering change. There are different types of precontemplators, including those who lack knowledge about the problem, those who are afraid of losing control, those who feel hopeless, and those who rationalize their behavior.
The second stage is contemplation, where the individual is ambivalent about change and is sitting on the fence. The third stage is preparation, where the individual has some experience with change and is trying to change, testing the waters. The fourth stage is action, where the individual has started to introduce change, and the behavior is defined as action during the first six months of change.
The final stage is maintenance, where the individual is involved in ongoing efforts to maintain change. Action becomes maintenance once six months have elapsed. Understanding these stages can help individuals and professionals in supporting behavior change.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 2
Incorrect
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What is the relationship between suicide and deliberate self-harm (DSH)?
Your Answer:
Correct Answer: DSH is the strongest risk factor for suicide
Explanation:Patients who have a history of repeated DSH are at a significantly higher risk for suicide. While high suicidal intent is associated with greater risk of suicide, it is not a reliable predictor for individual patients, particularly in the first year following DSH. DSH remains the strongest risk factor for suicide.
Suicide Rates Following Self-Harm
Most individuals who engage in self-harm do not go on to commit suicide, which makes risk assessment challenging. A study conducted in the UK in 2015 by Hawton found that 0.5% of individuals died by suicide in the first year following self-harm, with a higher rate among males (0.82%) than females (0.27%). Over the two-year period following self-harm, 1.6% died by suicide, with more occurrences in the second year. Interestingly, a study by Murphy in 2012 found that the rate of suicide following self-harm was higher in the elderly (those over 60), with a rate of 1.5 suicides in the first 12 months. The only significant risk factor for suicide following self-harm in this study was the use of a violent method in the initial episode.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 3
Incorrect
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What was the condition that Pritchard had, which was relevant to the issue of fitness to plead in the case of R v Pritchard?
Your Answer:
Correct Answer: Deafness
Explanation:Pritchard, a person who was unable to hear of speak, was charged with engaging in sexual activity with an animal.
Fitness to Plead: Criteria and Process
Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 4
Incorrect
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One of the following treatments would not be recommended for a young girl with attention deficit hyperactivity disorder who also has liver disease.
Your Answer:
Correct Answer: Pemoline
Explanation:Pemoline, which is utilized to treat ADHD as a CNS stimulant, has been linked to severe liver failure that can be fatal.
ADHD (Diagnosis and Management in Children)
ADHD is a behavioural syndrome characterised by symptoms of inattention, hyperactivity, and impulsivity. The DSM-5 and ICD-11 provide diagnostic criteria for the condition, with both recognising three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
Treatment for children under 5 involves offering an ADHD-focused group parent-training programme as a first-line option. Medication should only be considered after obtaining advice from a specialist ADHD service. For children and young people aged 5-18, advice and support should be given, along with an ADHD-focused group parent-training programme. Medication should only be offered if ADHD symptoms persist after environmental modifications have been implemented and reviewed. Cognitive behavioural therapy may also be considered for those who have benefited from medication but still experience significant impairment.
NICE advises against elimination diets, dietary fatty acid supplementation, and the use of the ‘few foods diet’. Methylphenidate of lisdexamfetamine is the first-line medication option, with dexamphetamine considered for those who respond to lisdexamfetamine but cannot tolerate the longer effect profile. Atomoxetine of guanfacine may be offered for those who cannot tolerate methylphenidate of lisdexamfetamine. Clonidine and atypical antipsychotics should only be used with advice from a tertiary ADHD service.
Drug holidays may be considered for children and young people who have not met the expected height for their age due to medication. However, NICE advises that withdrawal from treatment is associated with a risk of symptom exacerbation.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 5
Incorrect
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What is a known factor that can increase the likelihood of language development difficulties?
Your Answer:
Correct Answer: Being from a lower socioeconomic class
Explanation:Linguistic Development and Risk Factors for Delayed Speech and Language
The development of language skills is an important aspect of a child’s growth. The prelinguistic period, from birth to 12 months, is marked by crying, babbling, and echolalia. From 6 to 12 months, a child responds to their name and can differentiate between angry and friendly tones. By 18 to 24 months, a child can use up to 40-50 words, mainly nouns, and starts to combine words in short phrases. By 36 to 48 months, a child has a vocabulary of 900-1000 words, can use plurals and past tense, and can handle three-word sentences easily.
However, there are risk factors associated with delayed speech and language development. These include a positive family history, male gender, twins, lower maternal education, childhood illness, being born late in the family order, young mother at birth, and low socioeconomic status. of these, a positive family history is considered the most reliable risk factor. It is important to monitor a child’s language development and seek professional help if there are concerns about delayed speech and language.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 6
Incorrect
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Which statement accurately describes the CATIE study?
Your Answer:
Correct Answer: Olanzapine was found to be more effective than the other atypical antipsychotics used in phase I
Explanation:Olanzapine was found to have the highest duration of treatment before discontinuation due to inadequate efficacy, the longest period of successful treatment, and the lowest number of hospitalizations caused by worsening of schizophrenia among the patients.
CATIE Study: Comparing Antipsychotic Medications for Schizophrenia Treatment
The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study, funded by the National Institute of Mental Health (NIMH), was a nationwide clinical trial that aimed to compare the effectiveness of older and newer antipsychotic medications used to treat schizophrenia. It is the largest, longest, and most comprehensive independent trial ever conducted to examine existing therapies for schizophrenia. The study consisted of two phases.
Phase I of CATIE compared four newer antipsychotic medications to one another and an older medication. Participants were followed for 18 months to evaluate longer-term patient outcomes. The study involved over 1400 participants and was conducted at various treatment sites, representative of real-life settings where patients receive care. The results from CATIE are applicable to a wide range of people with schizophrenia in the United States.
The medications were comparably effective, but high rates of discontinuation were observed due to intolerable side-effects of failure to adequately control symptoms. Olanzapine was slightly better than the other drugs but was associated with significant weight gain as a side-effect. Surprisingly, the older, less expensive medication (perphenazine) used in the study generally performed as well as the four newer medications. Movement side effects primarily associated with the older medications were not seen more frequently with perphenazine than with the newer drugs.
Phase II of CATIE sought to provide guidance on which antipsychotic to try next if the first failed due to ineffectiveness of intolerability. Participants who discontinued their first antipsychotic medication because of inadequate management of symptoms were encouraged to enter the efficacy (clozapine) pathway, while those who discontinued their first treatment because of intolerable side effects were encouraged to enter the tolerability (ziprasidone) pathway. Clozapine was remarkably effective and was substantially better than all the other atypical medications.
The CATIE study also looked at the risk of metabolic syndrome (MS) using the US National Cholesterol Education Program Adult Treatment Panel criteria. The prevalence of MS at baseline in the CATIE group was 40.9%, with female patients being three times as likely to have MS compared to matched controls and male patients being twice as likely.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 7
Incorrect
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According to Maudsley Guidelines, what is the recommended maximum length of time for prescribing benzodiazepines for anxiety?
Your Answer:
Correct Answer: 4 weeks
Explanation:Benzodiazepines and Addiction
Benzodiazepines are known to be addictive and should only be prescribed as a hypnotic or anxiolytic for a maximum of 4 weeks. Withdrawal symptoms can be physical of psychological, including stiffness, weakness, GI disturbance, paraesthesia, flu-like symptoms, visual disturbance, anxiety, insomnia, nightmares, depersonalisation, decreased memory and concentration, delusions, and hallucinations. Patients who wish to withdraw from short-acting benzodiazepines should first be converted to diazepam, which has a longer half-life and produces less severe withdrawal. The table provides approximate equivalent doses for different benzodiazepines. These guidelines are from the Maudsley Guidelines 10th Edition.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 8
Incorrect
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What factor indicates a poor outcome for individuals with anorexia nervosa?
Your Answer:
Correct Answer: Late onset
Explanation:Contrary to traditional beliefs, the latest evidence indicates that being male is actually a positive prognostic indicator in anorexia.
Anorexia Prognosis
The long-term outcomes of anorexia are difficult to determine due to high drop-out rates from follow-up. However, one study found that over a 29 year period, half of patients recovered completely, a third recovered partially, 20% had a chronic eating disorder, and 5% died. Factors associated with a poor prognosis include a long duration of hospital care, psychiatric comorbidity, being adopted, growing up in a one-parent household, and having a young mother. Other factors that have been found to contribute to a poor prognosis include lower minimum weight, poor family relationships, failed treatment, late age of onset, and social problems.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 9
Incorrect
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What is the standardized score (z-score) for a woman whose haemoglobin concentration is 150 g/L, given that the mean haemoglobin concentration for healthy women is 135 g/L and the standard deviation is 15 g/L?
Your Answer:
Correct Answer: 1
Explanation:Z Scores: A Special Application of Transformation Rules
Z scores are a unique way of measuring how much and in which direction an item deviates from the mean of its distribution, expressed in units of its standard deviation. To calculate the z score for an observation x from a population with mean and standard deviation, we use the formula z = (x – mean) / standard deviation. For example, if our observation is 150 and the mean and standard deviation are 135 and 15, respectively, then the z score would be 1.0. Z scores are a useful tool for comparing observations from different distributions and for identifying outliers.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 10
Incorrect
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Which antipsychotic medication is most likely responsible for a female patient with schizophrenia experiencing cessation of her menstrual cycle and painful intercourse with her partner, after being prescribed a new medication six months ago?
Your Answer:
Correct Answer: Haloperidol
Explanation:Her symptoms are indicative of hyperprolactinemia.
Antipsychotics: Common Side Effects and Relative Adverse Effects
Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.
Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.
Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.
Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.
Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.
The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.
Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
Amisulpride – + + + – – +++
Aripiprazole – +/- – +/- – – –
Asenapine + + +/- +/- – – +/-
Clozapine +++ +++ +++ – +++ +++ –
Flupentixol + ++ + ++ ++ + +++
Fluphenazine + + + +++ ++ + +++
Haloperidol + + +/- +++ + + +++
Olanzapine ++ +++ +++ +/- + + +
Paliperidone + ++ + + + ++ +++
Pimozide + + – + + + +++
Quetiapine ++ ++ ++ – + ++ –
Risperidone + ++ + + + ++ +++
Zuclopenthixol ++ ++ + ++ ++ + +++Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 11
Incorrect
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Which risk factor is the strongest predictor of future sexual reoffending?
Your Answer:
Correct Answer: Phallometric confirmation of sexual interest in children
Explanation:Research has shown that phallometric assessment, which confirms sexual interest in children, is the most accurate predictor of sexual re-offending. According to a meta-analysis by Hanson and Bussière, offenders who demonstrated a sexual interest in children had a re-offending rate of 32%. Other factors associated with re-offending included a diagnosis of antisocial personality disorder (14%), a history of previous offenses (13%), failure to complete treatment (17%), and being single (never married) (11%).
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This question is part of the following fields:
- Forensic Psychiatry
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Question 12
Incorrect
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What type of scale does the Beck Depression Inventory belong to?
Your Answer:
Correct Answer: Ordinal
Explanation:The Beck Depression Inventory cannot be classified as a ratio of interval scale as the scores do not have a consistent and meaningful numerical value. Instead, it is considered an ordinal scale where scores can be ranked in order of severity, but the difference between scores may not be equal in terms of the level of depression experienced. For example, a change from 8 to 13 may be more significant than a change from 35 to 40.
Scales of Measurement in Statistics
In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.
Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.
Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.
Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 13
Incorrect
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A young adult with multiple sclerosis is admitted to the ward with thoughts of self-harm, pervasive mood change and diurnal mood variation. You establish a diagnosis of depression, rule out iatrogenic causes, and confirm that there is no history of mania. Which of the following medications would be most appropriate to manage the patient's depression?
Your Answer:
Correct Answer: Sertraline
Explanation:According to the Maudsley Prescribing Guidelines 11th Edition 2012, SSRIs are the preferred first-line treatment for MS due to their minimal side effects. In a single trial, sertraline was found to be equally effective as CBT. However, there is currently no published research on the effectiveness of mirtazapine for MS.
Psychiatric Consequences of Multiple Sclerosis
Multiple sclerosis (MS) is a neurological disorder that affects individuals between the ages of 20 and 40. It is characterized by multiple demyelinating lesions in the optic nerves, cerebellum, brainstem, and spinal cord. MS presents with diverse neurological signs, including optic neuritis, internuclear ophthalmoplegia, and ocular motor cranial neuropathy.
Depression is the most common psychiatric condition seen in MS, with a lifetime prevalence of 25-50%. The symptoms of depression in people with MS tend to be different from those without MS. The preferred diagnostic indicators for depression in MS include pervasive mood change, diurnal mood variation, suicidal ideation, functional change not related to physical disability, and pessimistic of negative patterns of thinking. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for depression in patients with MS.
Suicide is common in MS, with recognized risk factors including male gender, young age at onset of illness, current of previous history of depression, social isolation, and substance misuse. Mania is more common in people with MS, and mood stabilizers are recommended for treatment. Pathological laughing and crying, defined as uncontrollable laughing and/of crying without the associated affect, occurs in approximately 10% of cases of MS. Emotional lability, defined as an excessive emotional response to a minor stimulus, is also common in MS and can be treated with amitriptyline and SSRIs.
The majority of cases of neuropsychiatric side effects from corticosteroids fit an affective profile of mania and/of depression. Psychotic symptoms, particularly hallucinations, are present in up to half of these cases. Glatiramer acetate has not been associated with neuropsychiatric side-effects. The data regarding the risk of mood symptoms related to interferon use is conflicting.
In conclusion, MS has significant psychiatric consequences, including depression, suicide, mania, pathological laughing and crying, emotional lability, and neuropsychiatric side effects from treatment. Early recognition and treatment of these psychiatric symptoms are essential for improving the quality of life of individuals with MS.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 14
Incorrect
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What is the most indicative symptom of atypical depression?
Your Answer:
Correct Answer: Increased sex drive
Explanation:Atypical Depression: Symptoms and Treatment
Atypical depression is a subtype of major depressive disorder that is characterized by low mood with mood reactivity and a reversal of the typical features seen in depression. This includes hypersomnia, hyperphagia, weight gain, and libidinal increases. People with atypical depression tend to respond best to MAOIs, while their response to tricyclics is poor, and SSRIs perform somewhere in the middle.
The DSM-5 defines atypical depression as a subtype of major depressive disorder ‘with atypical features’, which includes mood reactivity, significant weight gain of increase in appetite, hypersomnia, leaden paralysis, and a long-standing pattern of interpersonal rejection sensitivity that results in significant social of occupational impairment. However, this subtype is not specifically recognized in ICD-11.
If you of someone you know is experiencing symptoms of atypical depression, it is important to seek professional help. Treatment options may include therapy, medication, of a combination of both. MAOIs may be the most effective medication for atypical depression, but it is important to work with a healthcare provider to determine the best course of treatment.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 15
Incorrect
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Which of the following statements accurately describes significance tests?
Your Answer:
Correct Answer: The type I error level is not affected by sample size
Explanation:The α value, also known as the type I error, is the predetermined probability that is considered acceptable for making an error. If the P value is lower than the predetermined α value, then the null hypothesis (Ho) is rejected, and it is concluded that the observed difference, association, of correlation is statistically significant.
Understanding Hypothesis Testing in Statistics
In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.
The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.
Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.
P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 16
Incorrect
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Sara is referred to you by her GP. Sara had a road traffic accident 3 months ago and is suffering with symptoms of PTSD. She is struggling to sleep and is experiencing problems in her relationship. She also reports thoughts of self-harm since the incident and last week took an overdose of tablets.
All of the following would be appropriate to offer, except:Your Answer:
Correct Answer: Supported trauma-focused computerised CBT
Explanation:Computer-based CBT should not be provided in situations where there is a potential for self-harm.
Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 17
Incorrect
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A middle-aged man is experiencing fluctuations in his levels of cognition. His wife has also noticed that he appears to be 'seeing things' and has become unable to turn himself over when in bed. What do you suspect could be the cause of these symptoms?
Your Answer:
Correct Answer: Lewy body dementia
Explanation:Lewy body dementia is a type of dementia that is becoming more recognized and accounts for up to 20% of cases. It is characterized by the presence of alpha-synuclein cytoplasmic inclusions (Lewy bodies) in certain areas of the brain. The relationship between Parkinson’s disease and Lewy body dementia is complex, as dementia is often seen in Parkinson’s disease and up to 40% of Alzheimer’s patients have Lewy bodies. Neuroleptics should be avoided in Lewy body dementia, except in cases of psychosis of aggression. Cholinesterase inhibitors are the first line of treatment for psychosis with Lewy body dementia, and antipsychotics are the second line. Clozapine is the preferred antipsychotic for Lewy body dementia, but if it is not appropriate, quetiapine is a reasonable choice. The features of Lewy body dementia include progressive cognitive impairment, parkinsonism, visual hallucinations, and other symptoms such as delusions and non-visual hallucinations. Additional features that support the diagnosis include fluctuating cognition, repeated falls, syncope, and neuroleptic sensitivity. Diagnosis is usually clinical, but single-photon emission computed tomography (SPECT) is increasingly used with a sensitivity of around 90% and a specificity of 100%.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 18
Incorrect
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A male patient with anorexia nervosa would likely have elevated levels of which of the following?
Your Answer:
Correct Answer: Liver enzymes
Explanation:In individuals with anorexia, the majority of their blood test results are typically below normal levels, with the exception of growth hormone, cholesterol, and cortisol.
Eating Disorders: Lab Findings and Medical Complications
Eating disorders can lead to a range of medical complications, including renal failure, peripheral edema, sinus bradycardia, QT-prolongation, pericardial effusion, and slowed GI motility. Other complications include constipation, cathartic colon, esophageal esophagitis, hair loss, and dental erosion. Blood abnormalities are also common in patients with eating disorders, including hyponatremia, hypokalemia, hypophosphatemia, and hypoglycemia. Additionally, patients may experience leucopenia, anemia, low albumin, elevated liver enzymes, and vitamin deficiencies. These complications can cause significant morbidity and mortality in patients with eating disorders. It is important for healthcare providers to monitor patients for these complications and provide appropriate treatment.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 19
Incorrect
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What is a true statement about lamotrigine?
Your Answer:
Correct Answer: Valproate increases lamotrigine concentrations more than 2-fold
Explanation:Antiepileptic drugs (AEDs) are commonly used for the treatment of epilepsy, but many of them also have mood stabilizing properties and are used for the prophylaxis and treatment of bipolar disorder. However, some AEDs carry product warnings for serious side effects such as hepatic failure, pancreatitis, thrombocytopenia, and skin reactions. Additionally, some AEDs have been associated with an increased risk of suicidal behavior and ideation.
Behavioral side-effects associated with AEDs include depression, aberrant behaviors, and the development of worsening of irritability, impulsivity, anger, hostility, and aggression. Aggression can occur before, after, of in between seizures. Some AEDs are considered to carry a higher risk of aggression, including levetiracetam, perampanel, and topiramate. However, data on the specific risk of aggression for other AEDs is lacking of mixed. It is important for healthcare providers to carefully consider the potential risks and benefits of AEDs when prescribing them for patients with epilepsy of bipolar disorder.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 20
Incorrect
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What factor is the most probable cause of tardive dyskinesia?
Your Answer:
Correct Answer: Haloperidol
Explanation:Tardive Dyskinesia: Symptoms, Causes, Risk Factors, and Management
Tardive dyskinesia (TD) is a condition that affects the face, limbs, and trunk of individuals who have been on neuroleptics for months to years. The movements fluctuate over time, increase with emotional arousal, decrease with relaxation, and disappear with sleep. The cause of TD remains theoretical, but the postsynaptic dopamine (D2) receptor supersensitivity hypothesis is the most persistent. Other hypotheses include the presynaptic dopaminergic/noradrenergic hyperactivity hypothesis, the cholinergic interneuron burnout hypothesis, the excitatory/oxidative stress hypothesis, and the synaptic plasticity hypothesis. Risk factors for TD include advancing age, female sex, ethnicity, longer illness duration, intellectual disability and brain damage, negative symptoms in schizophrenia, mood disorders, diabetes, smoking, alcohol and substance misuse, FGA vs SGA treatment, higher antipsychotic dose, anticholinergic co-treatment, and akathisia.
Management options for TD include stopping any anticholinergic, reducing antipsychotic dose, changing to an antipsychotic with lower propensity for TD, and using tetrabenazine, vitamin E, of amantadine as add-on options. Clozapine is the antipsychotic most likely to be associated with resolution of symptoms. Vesicular monoamine transporter type 2 (VMAT2) inhibitors are agents that cause a depletion of neuroactive peptides such as dopamine in nerve terminals and are used to treat chorea due to neurodegenerative diseases of dyskinesias due to neuroleptic medications (tardive dyskinesia).
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This question is part of the following fields:
- General Adult Psychiatry
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Question 21
Incorrect
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What does a smaller p-value indicate in terms of the strength of evidence?
Your Answer:
Correct Answer: The alternative hypothesis
Explanation:A p-value represents the likelihood of rejecting a null hypothesis that is actually true. A smaller p-value indicates a lower chance of mistakenly rejecting the null hypothesis, providing evidence in favor of the alternative hypothesis.
Understanding Hypothesis Testing in Statistics
In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.
The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.
Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.
P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 22
Incorrect
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A 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:
Correct 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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 23
Incorrect
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What is a true statement about dyslexia?
Your Answer:
Correct Answer: It is more common in boys than in girls
Explanation:Dyslexia is characterized by typical levels of intellectual ability. However, if there is an intellectual disability, a diagnosis of dyslexia can only be made if the challenges with reading and writing are more severe than what is typically seen with the learning disability.
Dyslexia is a specific learning disorder that affects a person’s ability to read and process information. It is not caused by intellectual disabilities, visual of auditory impairments, of inadequate education. Dyslexia can affect both reading and writing skills, as well as the processing of information that is seen of heard. It is a lifelong condition that occurs across the range of intellectual abilities, with boys being diagnosed more often than girls. The prevalence of dyslexia is around 5-10% among school-aged children. Signs of dyslexia include poor spelling, difficulty with written information, confusion with letter order, and poor handwriting. Dyslexia is often associated with other disorders such as ADHD, conduct disorder, and oppositional defiant disorder.
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This question is part of the following fields:
- Learning Disability
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Question 24
Incorrect
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Under what circumstances should Opioid detoxification not be offered as a standard practice, as per the NICE guidelines?
Your Answer:
Correct Answer: When a patient is serving a short prison sentence
Explanation:It is not recommended to offer opioid detoxification to individuals with urgent medical conditions. However, for those in police custody of serving a short prison sentence, of those presenting in an acute of emergency setting, consideration should be given to treating opioid withdrawal symptoms with medication and referring them to further drug services as needed. If an individual seeking opioid detoxification also misuses alcohol, healthcare professionals should address their alcohol misuse, as it may worsen during opioid withdrawal of be substituted for previous opioid misuse. For those who are alcohol dependent, alcohol detoxification should be offered before starting opioid detoxification in a community of prison setting, but can be done concurrently with opioid detoxification in an inpatient setting of with stabilisation in a community setting.
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.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 25
Incorrect
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What is the most appropriate way to describe the method of data collection used for the Likert scale questionnaire created by the psychiatrist and administered to 100 community patients to better understand their religious needs?
Your Answer:
Correct Answer: Ordinal
Explanation:Likert scales are a type of ordinal scale used in surveys to measure attitudes of opinions. Respondents are presented with a series of statements of questions and asked to rate their level of agreement of frequency of occurrence on a scale of options. For instance, a Likert scale question might ask how often someone prays, with response options ranging from never to daily. While the responses are ordered in terms of frequency, the intervals between each option are not necessarily equal of quantifiable. Therefore, Likert scales are considered ordinal rather than interval scales.
Scales of Measurement in Statistics
In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.
Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.
Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.
Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 26
Incorrect
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Which statement accurately describes atomoxetine?
Your Answer:
Correct Answer: It can increase the risk of suicidal ideation
Explanation:Patients should be cautioned about the potential for short-term suicidal thoughts when using atomoxetine, particularly if previous treatments with methylphenidate and lisdexamfetamine have been unsuccessful.
ADHD (Diagnosis and Management in Children)
ADHD is a behavioural syndrome characterised by symptoms of inattention, hyperactivity, and impulsivity. The DSM-5 and ICD-11 provide diagnostic criteria for the condition, with both recognising three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
Treatment for children under 5 involves offering an ADHD-focused group parent-training programme as a first-line option. Medication should only be considered after obtaining advice from a specialist ADHD service. For children and young people aged 5-18, advice and support should be given, along with an ADHD-focused group parent-training programme. Medication should only be offered if ADHD symptoms persist after environmental modifications have been implemented and reviewed. Cognitive behavioural therapy may also be considered for those who have benefited from medication but still experience significant impairment.
NICE advises against elimination diets, dietary fatty acid supplementation, and the use of the ‘few foods diet’. Methylphenidate of lisdexamfetamine is the first-line medication option, with dexamphetamine considered for those who respond to lisdexamfetamine but cannot tolerate the longer effect profile. Atomoxetine of guanfacine may be offered for those who cannot tolerate methylphenidate of lisdexamfetamine. Clonidine and atypical antipsychotics should only be used with advice from a tertiary ADHD service.
Drug holidays may be considered for children and young people who have not met the expected height for their age due to medication. However, NICE advises that withdrawal from treatment is associated with a risk of symptom exacerbation.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 27
Incorrect
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What substance of drug directly inhibits the dopamine transporter, resulting in elevated levels of dopamine in the synaptic cleft?
Your Answer:
Correct Answer: Cocaine
Explanation:Amphetamine engages in competition with the DAT instead of obstructing it.
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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 28
Incorrect
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Prior to initiating lithium treatment for an adult with a learning disability and comorbid affective disorder, which baseline investigation should be conducted?
Your Answer:
Correct Answer: ECG
Explanation:Lithium – Clinical Usage
Lithium is primarily used as a prophylactic agent for bipolar disorder, where it reduces the severity and number of relapses. It is also effective as an augmentation agent in unipolar depression and for treating aggressive and self-mutilating behavior, steroid-induced psychosis, and to raise WCC in people using clozapine.
Before prescribing lithium, renal, cardiac, and thyroid function should be checked, along with a Full Blood Count (FBC) and BMI. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.
Once daily administration is preferred, and various preparations are available. Abrupt discontinuation of lithium increases the risk of relapse, and if lithium is to be discontinued, the dose should be reduced gradually over a period of at least 4 weeks.
Inadequate monitoring of patients taking lithium is common, and it is often an exam hot topic. Lithium salts have a narrow therapeutic/toxic ratio, and samples should ideally be taken 12 hours after the dose. The target range for prophylaxis is 0.6–0.75 mmol/L.
Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI and neuro symptoms.
The severity of toxicity can be assessed using the AMDISEN rating scale.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 29
Incorrect
-
What is a true statement about the utilization of lithium?
Your Answer:
Correct Answer: People over the age of 65 should have lithium levels checked every 3 months once stabilised
Explanation:It is recommended to check lithium levels every 6 months if the person has been stabilized for over a year, of every 3 months if there are additional factors such as older age, drug interactions, impaired renal of thyroid function, raised calcium levels, poor symptom control, poor adherence, of previous plasma lithium levels of 0.8 mmol per litre of higher. Thyroid function should also be checked every 6 months. Lithium is typically taken at night to allow for a blood test at least 12 hours after the last dose, and once-daily prescribing is preferred.
Lithium – Clinical Usage
Lithium is primarily used as a prophylactic agent for bipolar disorder, where it reduces the severity and number of relapses. It is also effective as an augmentation agent in unipolar depression and for treating aggressive and self-mutilating behavior, steroid-induced psychosis, and to raise WCC in people using clozapine.
Before prescribing lithium, renal, cardiac, and thyroid function should be checked, along with a Full Blood Count (FBC) and BMI. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.
Once daily administration is preferred, and various preparations are available. Abrupt discontinuation of lithium increases the risk of relapse, and if lithium is to be discontinued, the dose should be reduced gradually over a period of at least 4 weeks.
Inadequate monitoring of patients taking lithium is common, and it is often an exam hot topic. Lithium salts have a narrow therapeutic/toxic ratio, and samples should ideally be taken 12 hours after the dose. The target range for prophylaxis is 0.6–0.75 mmol/L.
Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI and neuro symptoms.
The severity of toxicity can be assessed using the AMDISEN rating scale.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 30
Incorrect
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What is a correct statement about the pathology of Wernicke's encephalopathy?
Your Answer:
Correct Answer: There is demyelination of periventricular grey matter
Explanation:Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment
Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.
The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.
Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.
Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 31
Incorrect
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What is a true statement about strategic family therapy?
Your Answer:
Correct Answer: The main problem is assumed to be one of communication rather than structure
Explanation:Strategic family therapy prioritizes communication over structure.
Family Therapy Models
Family therapy emerged in the 1950s, shifting the focus from individual problems to the context of the environment. There are five main models of family therapy: structural, strategic, systemic, transgenerational, and solution-focused.
Structural therapy, developed by Salvador Minuchin, assumes that the family’s structure is wrong and aims to establish clear boundaries and no coalitions. Dysfunctional families are marked by impaired boundaries, inappropriate alignments, and power imbalances.
Strategic therapy, associated with Jay Haley and Cloe Madanes, claims that difficulties in families arise due to distorted hierarchies. Dysfunctional families communicate in problematic repetitive patterns that kept them dysfunctional. Key terms include task setting and goal setting.
Systemic therapy, associated with Mara Selvini-Palazzoli, sees the family as a self-regulating system that controls itself according to rules formed over time. The focus is on exploring differences between family members’ behaviors, emotional responses, and beliefs at different points in time. Key terms include hypothesizing, neutrality, positive connotation, paradox and counterparadox, circular and interventive questioning, and the use of reflecting teams.
Transgenerational family therapy aims to understand how families, across generations, develop patterns of behaving and responding to stress in ways that prevent health development and lead to problems. Seven interlocking concepts make up the theory.
Solution-focused therapy emphasizes solutions over problems and collaborates with the family through in-depth questioning to focus on the solutions already being used by the clients. The therapist is non-interventionist, and the focus is on the present and the future. Blame, shame, and conflict are seen as issues that impede people from realizing these solutions.
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This question is part of the following fields:
- Psychotherapy
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Question 32
Incorrect
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A study is designed to assess a new proton pump inhibitor (PPI) in middle-aged patients who are taking aspirin. The new PPI is given to 120 patients whilst a control group of 240 is given the standard PPI. Over a five year period 24 of the group receiving the new PPI had an upper GI bleed compared to 60 who received the standard PPI. What is the absolute risk reduction?
Your Answer:
Correct Answer: 5%
Explanation:Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 33
Incorrect
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The initial application of deep brain stimulation (DBS) was for the treatment of which condition?
Your Answer:
Correct Answer: Chronic pain
Explanation:The human cortex was first directly stimulated in 1874, followed by the use of frontal tract stimulation for chronic pain in 1948. Thalamic stimulation for tremor was introduced in 1960, and basal ganglia stimulation for Parkinson’s tremor in 1968. The effectiveness of stimulation in treating epilepsy was discovered in 1973, and for depression in 1987.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 34
Incorrect
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How is a brief episode of psychotic symptoms lasting less than three months referred to in the ICD-11?
Your Answer:
Correct Answer: Acute and transient psychotic disorder
Explanation:The ICD-11 categorizes brief psychotic episodes that occur suddenly without warning as acute and transient psychotic disorder, lasting for less than three months but typically less than one month. Meanwhile, the DSM-5 distinguishes between two similar conditions: brief psychotic disorder, which resolves within a month, and schizophreniform disorder, which persists for more than one month but less than six months.
– Schizophrenia and other primary psychotic disorders are characterized by impairments in reality testing and alterations in behavior.
– Schizophrenia is a chronic mental health disorder with symptoms including delusions, hallucinations, disorganized speech of behavior, and impaired cognitive ability.
– The essential features of schizophrenia include persistent delusions, persistent hallucinations, disorganized thinking, experiences of influence, passivity of control, negative symptoms, grossly disorganized behavior, and psychomotor disturbances.
– Schizoaffective disorder is diagnosed when all diagnostic requirements for schizophrenia are met concurrently with mood symptoms that meet the diagnostic requirements of a moderate or severe depressive episode, a manic episode, of a mixed episode.
– Schizotypal disorder is an enduring pattern of unusual speech, perceptions, beliefs, and behaviors that are not of sufficient intensity of duration to meet the diagnostic requirements of schizophrenia, schizoaffective disorder, of delusional disorder.
– Acute and transient psychotic disorder is characterized by an acute onset of psychotic symptoms, which can include delusions, hallucinations, disorganized thinking, of experiences of influence, passivity of control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks.
– Delusional disorder is diagnosed when there is a presence of a delusion of set of related delusions, typically persisting for at least 3 months and often much longer, in the absence of a depressive, manic, of mixed episode. -
This question is part of the following fields:
- General Adult Psychiatry
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Question 35
Incorrect
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In Korsakoff syndrome, which aspect of memory is most significantly impacted?
Your Answer:
Correct Answer: Episodic
Explanation:Korsakoff’s Syndrome
Korsakoff’s Syndrome, also known as amnesic syndrome, is a chronic condition that affects recent and anterograde memory in an alert and responsive patient. It is caused by prolonged thiamine (vitamin B1) deficiency and often follows Wernicke’s encephalopathy. The syndrome is characterized by a lack of insight, apathy, and confabulation. Thiamine is essential for glucose metabolism in the brain, and its deficiency leads to a toxic buildup of glucose, causing neuronal loss. The Mammillary bodies are the main areas affected in Korsakoff’s syndrome.
While intelligence on the WAIS is preserved, episodic memory is severely affected in Korsakoff’s syndrome. Semantic memory is variably affected, but implicit aspects of memory, such as response to priming and procedural memory, are preserved. Immediate memory tested with the digit span is normal, but information can only be retained for a few minutes at most. Patients with Korsakoff’s syndrome often display apathy, lack of initiative, and profound lack of insight.
Source: Kopelman M (2009) The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol and Alcoholism 44 (2): 148-154.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 36
Incorrect
-
What is a fact about self-harm among youth?
Your Answer:
Correct Answer: It is more common in girls than boys
Explanation:Self-harm is a common issue among young people, particularly girls, with rates appearing to have risen over the past decade. It is most likely to occur between the ages of 12 and 15 years and is associated with a range of psychiatric problems. Short-term management involves a psychosocial assessment and consideration of activated charcoal for drug overdose. Longer-term management may involve psychological interventions, but drug treatment should not be offered as a specific intervention to reduce self-harm. Risk assessment tools should not be used to predict future suicide of repetition of self-harm, but certain factors such as male gender, substance misuse, and parental mental disorder may be associated with a higher risk of completed suicide. It is important to seek professional help if you of someone you know is engaging in self-harm.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 37
Incorrect
-
After how much time since the last drink do the symptoms of alcohol withdrawal typically start?
Your Answer:
Correct Answer: 3-12 hrs
Explanation:Alcohol withdrawal is characterized by overactivity of the autonomic nervous system, resulting in symptoms such as agitation, tremors, sweating, nausea, vomiting, fever, and tachycardia. These symptoms typically begin 3-12 hours after drinking stops, peak between 24-48 hours, and can last up to 14 days. Withdrawal seizures may occur before blood alcohol levels reach zero, and a small percentage of people may experience delirium tremens (DT), which can be fatal if left untreated. Risk factors for DT include abnormal liver function, old age, severity of withdrawal symptoms, concurrent medical illness, heavy alcohol use, self-detox, previous history of DT, low potassium, low magnesium, and thiamine deficiency.
Pharmacologically assisted detox is often necessary for those who regularly consume more than 15 units of alcohol per day, and inpatient detox may be needed for those who regularly consume more than 30 units per day. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) can be used to assess the severity of withdrawal symptoms and guide treatment decisions. Benzodiazepines are the mainstay of treatment, as chronic alcohol exposure results in decreased overall brain excitability and compensatory decrease of GABA-A neuroreceptor response to GABA. Chlordiazepoxide is a good first-line agent, while oxazepam, temazepam, and lorazepam are useful in patients with liver disease. Clomethiazole is effective but carries a high risk of respiratory depression and is not recommended. Thiamine should be offered to prevent Wernicke’s encephalopathy, and long-acting benzodiazepines can be used as prophylaxis for withdrawal seizures. Haloperidol is the treatment of choice if an antipsychotic is required.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 38
Incorrect
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What is the conventional cutoff for a p-value of 0.05 and what does it mean in terms of the likelihood of detecting a difference by chance?
Your Answer:
Correct Answer: 1 in 14 times
Explanation:The probability of detecting a difference by chance is 1 in 20 times when the p-value is 0.05, which is the conventional cutoff. In this case, the answer is 1 in 14 times, which is equivalent to a p-value of 0.07.
Understanding Hypothesis Testing in Statistics
In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.
The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.
Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.
P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 39
Incorrect
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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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 40
Incorrect
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Which principle was not mentioned by Yalom as a therapeutic aspect of group therapy?
Your Answer:
Correct Answer: Autonomy
Explanation:Group Psychotherapy: Yalom’s Therapeutic Principles
Group psychotherapy involves a trained therapist and a group of individuals. Yalom, a prominent figure in group therapy, outlined the therapeutic principles of group psychotherapy. These principles include universality, altruism, instillation of hope, imparting information, corrective recapitulation of the primary family experience, development of socializing techniques, imitative behavior, cohesiveness, existential factors, catharsis, interpersonal learning, and self-understanding. Psychodrama, a specific form of group therapy, involves examining relationships and problems through drama.
Bion and Basic Assumption Groups
Bion, a psychoanalyst interested in group dynamics, believed that groups had a collective unconscious that operated similarly to an individual’s. He distinguished between two types of groups: working groups and basic assumption groups. Basic assumption groups act out primitive fantasies and prevent things from getting done. Bion described different types of basic assumption groups, including dependency, fight-flight, and pairing. Dependency involves the group turning to a leader to protect them from anxiety. Fight-flight involves the group acting as if there is an enemy who must be attacked of avoided. Pairing involves the group acting as if the answer lies in the pairing of two members.
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This question is part of the following fields:
- Psychotherapy
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Question 41
Incorrect
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What is the most prevalent personality disorder among women incarcerated in England and Wales?
Your Answer:
Correct Answer: Antisocial
Explanation:Prisoner Mental Health: Epidemiological Data from the UK
The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.
Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 42
Incorrect
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What is the most suitable option for managing schizophrenia that does not respond to treatment?
Your Answer:
Correct Answer: Clozapine
Explanation:Clozapine is an effective antipsychotic drug used in the management of treatment-resistant schizophrenia (TRS). It was reintroduced in the 1990s with mandatory blood monitoring due to the risk of agranulocyte
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This question is part of the following fields:
- General Adult Psychiatry
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Question 43
Incorrect
-
What is a distinguishing trait of being intoxicated with phencyclidine?
Your Answer:
Correct Answer: Analgesia
Explanation:PCP Intoxication: A Dangerous Hallucinogenic
Phencyclidine (PCP), also known as angel dust, is a hallucinogenic drug that is popular for inducing feelings of euphoria, superhuman strength, and social and sexual prowess. It is a NMDA receptor antagonist that has dissociative properties, similar to ketamine. PCP was previously used as an anesthetic and animal tranquilizer, but was soon recalled due to its adverse effects, including psychosis, agitation, and dysphoria post-operatively.
PCP is available in various forms, including white crystalline powder, tablets, crystals, and liquid. It can be snorted, smoked, ingested, of injected intravenously or subcutaneously. People who have taken PCP often present with violent behavior, nystagmus, tachycardia, hypertension, anesthesia, and analgesia. Other symptoms include impaired motor function, hallucinations, delusions, and paranoia.
PCP intoxication is best managed with benzodiazepines along with supportive measures for breathing and circulation. Antipsychotics are not recommended as they can amplify PCP-induced hyperthermia, dystonic reactions, and lower the seizure threshold. However, haloperidol may be useful for treating PCP-induced psychosis in patients who are not hyperthermic. Most deaths in PCP-intoxicated patients result from violent behavior rather than direct effects of the drug.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 44
Incorrect
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What is the accurate formula for determining the likelihood ratio of a positive test outcome?
Your Answer:
Correct Answer: Sensitivity / (1 - specificity)
Explanation: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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 45
Incorrect
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What is the standard deviation of the sample mean height of 100 adults who were administered steroids during childhood, given that the average height of the adults is 169cm and the standard deviation is 16cm?
Your Answer:
Correct Answer: 1.6
Explanation:The standard error of the mean is 1.6, calculated by dividing the standard deviation of 16 by the square root of the number of patients, which is 100.
Measures of dispersion are used to indicate the variation of spread of a data set, often in conjunction with a measure of central tendency such as the mean of median. The range, which is the difference between the largest and smallest value, is the simplest measure of dispersion. The interquartile range, which is the difference between the 3rd and 1st quartiles, is another useful measure. Quartiles divide a data set into quarters, and the interquartile range can provide additional information about the spread of the data. However, to get a more representative idea of spread, measures such as the variance and standard deviation are needed. The variance gives an indication of how much the items in the data set vary from the mean, while the standard deviation reflects the distribution of individual scores around their mean. The standard deviation is expressed in the same units as the data set and can be used to indicate how confident we are that data points lie within a particular range. The standard error of the mean is an inferential statistic used to estimate the population mean and is a measure of the spread expected for the mean of the observations. Confidence intervals are often presented alongside sample results such as the mean value, indicating a range that is likely to contain the true value.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 46
Incorrect
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With which of the following is John Bowlby most closely associated?
Your Answer:
Correct Answer: Attachment theory
Explanation:Neo-Freudians were therapists who developed their own theories while still retaining core Freudian components. Some important neo-Freudians include Alfred Adler, Carl Jung, Erik Erickson, Harry Stack Sullivan, Wilfred Bion, John Bowlby, Anna Freud, Otto Kernberg, Margaret Mahler, and Donald Winnicott. Each of these individuals contributed unique ideas to the field of psychology. For example, Carl Jung introduced the concept of the persona and differentiated between the personal and collective unconscious, while Erik Erickson is known for his stages of psychosocial development. Margaret Mahler developed theories on child development, including the three main phases of autistic, symbiotic, and separation-individuation. Donald Winnicott introduced the concept of the transitional object and the good enough mother. Overall, neo-Freudians expanded upon Freud’s ideas and helped to shape modern psychotherapy.
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This question is part of the following fields:
- Psychotherapy
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Question 47
Incorrect
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Which antipsychotic medication would be the most suitable for a patient with epilepsy who has developed a psychotic illness, considering its minimal impact on seizure threshold?
Your Answer:
Correct Answer: Haloperidol
Explanation:Psychotropics and Seizure Threshold in People with Epilepsy
People with epilepsy are at an increased risk for various mental health conditions, including depression, anxiety, psychosis, and suicide. It is important to note that the link between epilepsy and mental illness is bidirectional, as patients with mental health conditions also have an increased risk of developing new-onset epilepsy. Psychotropic drugs are often necessary for people with epilepsy, but they can reduce the seizure threshold and increase the risk of seizures. The following tables provide guidance on the seizure risk associated with different classes of antidepressants, antipsychotics, and ADHD medications. It is important to use caution and carefully consider the risks and benefits of these medications when treating people with epilepsy.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 48
Incorrect
-
Which of the following is an example of secondary evidence?
Your Answer:
Correct Answer: A Cochrane review on the evidence of exercise for reducing the duration of depression relapses
Explanation:Scientific literature can be classified into two main types: primary and secondary sources. Primary sources are original research studies that present data and analysis without any external evaluation of interpretation. Examples of primary sources include randomized controlled trials, cohort studies, case-control studies, case-series, and conference papers. Secondary sources, on the other hand, provide an interpretation and analysis of primary sources. These sources are typically removed by one of more steps from the original event. Examples of secondary sources include evidence-based guidelines and textbooks, meta-analyses, and systematic reviews.
Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.
When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.
There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 49
Incorrect
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What is another term used to refer to a type II error in hypothesis testing?
Your Answer:
Correct Answer: False negative
Explanation:Hypothesis testing involves the possibility of two types of errors: type I and type II errors. A type I error occurs when the null hypothesis is wrongly rejected of the alternative hypothesis is wrongly accepted. This error is also referred to as an alpha error, error of the first kind, of a false positive. On the other hand, a type II error occurs when the null hypothesis is wrongly accepted. This error is also known as the beta error, error of the second kind, of the false negative.
Understanding Hypothesis Testing in Statistics
In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.
The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.
Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.
P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 50
Incorrect
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Among which group did the AESOP study report the least occurrence of psychosis?
Your Answer:
Correct Answer: White British
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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 51
Incorrect
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What test would be appropriate for comparing the proportion of individuals who experience agranulocytosis while taking clozapine versus those who experience it while taking olanzapine?
Your Answer:
Correct Answer: Chi-squared test
Explanation:The dependent variable in this scenario is categorical, as individuals either experience agranulocytosis of do not. The independent variable is also categorical, with two options: olanzapine of clozapine. While there are various types of chi-squared tests, it is not necessary to focus on the distinctions between them.
Choosing the right statistical test can be challenging, but understanding the basic principles can help. Different tests have different assumptions, and using the wrong one can lead to inaccurate results. To identify the appropriate test, a flow chart can be used based on three main factors: the type of dependent variable, the type of data, and whether the groups/samples are independent of dependent. It is important to know which tests are parametric and non-parametric, as well as their alternatives. For example, the chi-squared test is used to assess differences in categorical variables and is non-parametric, while Pearson’s correlation coefficient measures linear correlation between two variables and is parametric. T-tests are used to compare means between two groups, and ANOVA is used to compare means between more than two groups. Non-parametric equivalents to ANOVA include the Kruskal-Wallis analysis of ranks, the Median test, Friedman’s two-way analysis of variance, and Cochran Q test. Understanding these tests and their assumptions can help researchers choose the appropriate statistical test for their data.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 52
Incorrect
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Which of the following is one of the Pritchard criteria?
Your Answer:
Correct Answer: Ability to follow the court proceedings
Explanation:Fitness to Plead: Criteria and Process
Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 53
Incorrect
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Which defence mechanism is most commonly linked to narcissism?
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.
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This question is part of the following fields:
- Psychotherapy
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Question 54
Incorrect
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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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 55
Incorrect
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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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 56
Incorrect
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What is the recommended course of action for a child with autism who has sleep issues and has not shown improvement with non-pharmacological interventions?
Your Answer:
Correct Answer: Melatonin
Explanation:According to Maudsley (2012), melatonin is the preferred medication for childhood insomnia. Administering melatonin approximately 30 minutes before bedtime can be helpful in inducing sleep. However, it may not be as effective for early waking issues (Allington-Smith, 2006), although a gradual-release form of melatonin may work for certain cases.
Autism Spectrum Disorder (ASD) is a lifelong disorder characterized by deficits in communication and social understanding, as well as restrictive and repetitive behaviors. The distinction between autism and Asperger’s has been abandoned, and they are now grouped together under the ASD category. Intellectual ability is difficult to assess in people with ASD, with an estimated 33% having an intellectual disability. ASD was first described in Europe and the United States using different terms, with Leo Kanner and Hans Asperger being the pioneers. Diagnosis is based on persistent deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior. The worldwide population prevalence is about 1%, with comorbidity being common. Heritability is estimated at around 90%, and both genetic and environmental factors seem to cause ASD. Currently, there are no validated pharmacological treatments that alleviate core ASD symptoms, but second-generation antipsychotics are the first-line pharmacological treatment for children and adolescents with ASD and associated irritability.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 57
Incorrect
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In adapted ECT, what does the term 'adapted' refer to in terms of its implementation?
Your Answer:
Correct Answer: Anaesthetic and muscle relaxant
Explanation:The use of both an anaesthetic induction agent and muscle relaxant characterizes ‘Modified’ ECT, while ‘Unmodified’ ECT is no longer employed. Anticholinergics may be administered to reduce parasympathetic stimulation, and beta-blockers can be used to decrease sympathetic stimulation. EEG monitoring is a requirement when administering ECT.
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This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
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Question 58
Incorrect
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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.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 59
Incorrect
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Which statement accurately describes antisocial personality disorder?
Your Answer:
Correct Answer: The term antisocial personality disorder is used in the DSM-5
Explanation:Personality Disorder (Antisocial / Dissocial)
Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.
The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.
Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.
The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.
The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 60
Incorrect
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What is the recommended course of action when a patient with psychotic depression cannot tolerate a tricyclic antidepressant?
Your Answer:
Correct Answer: SSRI with antipsychotic augmentation
Explanation:Psychotic Depression
Psychotic depression is a type of depression that is characterized by the presence of delusions and/of hallucinations in addition to depressive symptoms. This condition is often accompanied by severe anhedonia, loss of interest, and psychomotor retardation. People with psychotic depression are tormented by hallucinations and delusions with typical themes of worthlessness, guilt, disease, of impending disaster. This condition affects approximately 14.7-18.5% of depressed patients and is estimated to affect around 0.4% of community adult samples, with a higher prevalence in the elderly community at around 1.4-3.0%. People with psychotic depression are at a higher risk of attempting and completing suicide than those with non-psychotic depression.
Diagnosis
Psychotic depression is currently classified as a subtype of depression in both the ICD-11 and the DSM-5. The main difference between the two is that in the ICD-11, the depressive episode must be moderate of severe to qualify for a diagnosis of depressive episode with psychotic symptoms, whereas in the DSM-5, the diagnosis can be applied to any severity of depressive illness.
Treatment
The recommended treatment for psychotic depression is tricyclics as first-line treatment, with antipsychotic augmentation. Second-line treatment includes SSRI/SNRI. Augmentation of antidepressant with olanzapine or quetiapine is recommended. The optimum dose and duration of antipsychotic augmentation are unknown. If one treatment is to be stopped during the maintenance phase, then this should be the antipsychotic. ECT should be considered where a rapid response is required of where other treatments have failed. According to NICE (ng222), combination treatment with antidepressant medication and antipsychotic medication (such as olanzapine or quetiapine) should be considered for people with depression with psychotic symptoms. If a person with depression with psychotic symptoms does not wish to take antipsychotic medication in addition to an antidepressant, then treat with an antidepressant alone.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 61
Incorrect
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What is the intervention (buprenorphine) relative risk reduction for non-prescription opioid use at six months in the group of patients with opioid dependence who received the treatment compared to those who did not receive it?
Your Answer:
Correct Answer: 0.45
Explanation:Relative risk reduction (RRR) is calculated as the percentage decrease in the occurrence of events in the experimental group (EER) compared to the control group (CER). It can be expressed as:
RRR = 1 – (EER / CER)
For example, if the EER is 18 and the CER is 33, then the RRR can be calculated as:
RRR = 1 – (18 / 33) = 0.45 of 45%
Alternatively, the RRR can be calculated as the difference between the CER and EER divided by the CER:
RRR = (CER – EER) / CER
Using the same example, the RRR can be calculated as:
RRR = (33 – 18) / 33 = 0.45 of 45%
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 62
Incorrect
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Which item is excluded from the scope of the Misuse of Drugs Act 1971?
Your Answer:
Correct Answer: Amyl nitrite
Explanation:Poppers, also known as liquid gold, amyl of butyl nitrite, are not considered illegal to purchase of possess under the MDA. They are commonly sold in sex shops, joke shops, and other retail locations frequented by young people, such as pubs, clubs, tobacconists, music stores, and clothing shops. While the legality of poppers has not been fully tested in court, the Medicines Control Agency has classified them as a medicine and therefore subject to the Medicines Act 1968. This means that only licensed outlets, such as chemists, are permitted to sell the drug. Additionally, poppers are not regulated under the Psychoactive Substances Act 2016.
Drug Misuse (Law and Scheduling)
The Misuse of Drugs Act (1971) regulates the possession and supply of drugs, classifying them into three categories: A, B, and C. The maximum penalty for possession varies depending on the class of drug, with Class A drugs carrying a maximum sentence of 7 years.
The Misuse of Drugs Regulations 2001 further categorizes controlled drugs into five schedules. Schedule 1 drugs are considered to have no therapeutic value and cannot be lawfully possessed of prescribed, while Schedule 2 drugs are available for medical use but require a controlled drug prescription. Schedule 3, 4, and 5 drugs have varying levels of restrictions and requirements.
It is important to note that a single drug can have multiple scheduling statuses, depending on factors such as strength and route of administration. For example, morphine and codeine can be either Schedule 2 of Schedule 5.
Overall, the Misuse of Drugs Act and Regulations aim to regulate and control the use of drugs in the UK, with the goal of reducing drug misuse and related harm.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 63
Incorrect
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What is the maintenance treatment used for individuals with opioid dependence syndrome?
Your Answer:
Correct Answer: Methadone
Explanation:Synthetic opioids like methadone and buprenorphine are utilized as a replacement for heroin. Alpha2 adrenergic agonists such as clonidine and lofexidine are employed in detox settings to alleviate a range of opioid withdrawal symptoms.
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.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 64
Incorrect
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Which receptors are believed to be hypersensitive and responsible for causing tardive dyskinesia?
Your Answer:
Correct Answer: D2
Explanation:The development of tardive dyskinesia is thought to be caused by an increased sensitivity of postsynaptic D2 receptors in the nigrostriatal pathway. Therefore, clozapine is recommended as a treatment option since it has minimal binding affinity for D2 receptors.
Tardive Dyskinesia: Symptoms, Causes, Risk Factors, and Management
Tardive dyskinesia (TD) is a condition that affects the face, limbs, and trunk of individuals who have been on neuroleptics for months to years. The movements fluctuate over time, increase with emotional arousal, decrease with relaxation, and disappear with sleep. The cause of TD remains theoretical, but the postsynaptic dopamine (D2) receptor supersensitivity hypothesis is the most persistent. Other hypotheses include the presynaptic dopaminergic/noradrenergic hyperactivity hypothesis, the cholinergic interneuron burnout hypothesis, the excitatory/oxidative stress hypothesis, and the synaptic plasticity hypothesis. Risk factors for TD include advancing age, female sex, ethnicity, longer illness duration, intellectual disability and brain damage, negative symptoms in schizophrenia, mood disorders, diabetes, smoking, alcohol and substance misuse, FGA vs SGA treatment, higher antipsychotic dose, anticholinergic co-treatment, and akathisia.
Management options for TD include stopping any anticholinergic, reducing antipsychotic dose, changing to an antipsychotic with lower propensity for TD, and using tetrabenazine, vitamin E, of amantadine as add-on options. Clozapine is the antipsychotic most likely to be associated with resolution of symptoms. Vesicular monoamine transporter type 2 (VMAT2) inhibitors are agents that cause a depletion of neuroactive peptides such as dopamine in nerve terminals and are used to treat chorea due to neurodegenerative diseases of dyskinesias due to neuroleptic medications (tardive dyskinesia).
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This question is part of the following fields:
- General Adult Psychiatry
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Question 65
Incorrect
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How can you identify advanced heroin withdrawal in a young man who presents in A&E?
Your Answer:
Correct Answer: Piloerection
Explanation:The initial symptoms of heroin withdrawal consist of restlessness, frequent yawning, muscle pain, excessive sweating, anxiety, increased tearing, and a runny nose. As the withdrawal progresses, more severe symptoms may occur, such as abdominal cramps, vomiting, dilated pupils, diarrhea, and nausea.
Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.
Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.
Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.
MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.
Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.
Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.
Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 66
Incorrect
-
What measure of deprivation was created specifically to assess the workload of General Practice?
Your Answer:
Correct Answer: Jarman Score
Explanation:It is advisable not to focus too much on this unusual question in the college exams. It is important to keep in mind that the Jarman Score is the commonly used score in general practice.
Measuring Deprivation: Common Indices
Deprivation indices are used to measure the proportion of households in a small geographical area that have low living standards of a high need for services, of both. Several measures of deprivation are commonly used, including the Jarman Score, Townsend Index, Carstairs Index, Index of Multiple Deprivation, and Index of Local Conditions. The Townsend and Carstairs indices were developed to measure material deprivation, while the Jarman Underprivileged Area Score was initially designed to measure General Practice workload.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 67
Incorrect
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Which of the following is characterised by fluent, empty speech?
Your Answer:
Correct Answer: Semantic dementia
Explanation:Frontotemporal Lobar Degeneration
Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.
The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).
As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.
In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 68
Incorrect
-
What is the primary treatment option for catatonia?
Your Answer:
Correct Answer: Lorazepam
Explanation:When treating catatonia, the preferred initial treatment is benzodiazepines such as lorazepam. If this approach is unsuccessful, electroconvulsive therapy (ECT) should be considered.
Catatonia Treatment
Catatonia can lead to complications such as dehydration, deep vein thrombosis, pulmonary embolism, and pneumonia. Therefore, prompt treatment is essential. The first-line treatment is benzodiazepines, particularly lorazepam. If this is ineffective, electroconvulsive therapy (ECT) may be considered. The use of antipsychotics is controversial and should be avoided during the acute phase of catatonia.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 69
Incorrect
-
Which of the following variables is most appropriately classified as nominal?
Your Answer:
Correct Answer: Ethnic group
Explanation:Scales of Measurement in Statistics
In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.
Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.
Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.
Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 70
Incorrect
-
What is the classification of reactive attachment disorder in the ICD-11?
Your Answer:
Correct Answer: It cannot be diagnosed before the age of 1
Explanation:A diagnosis of reactive attachment disorder cannot be made until the child reaches at least one year of age.
Disorders resulting from inadequate caregiving during childhood are recognised by both the DSM-5 and the ICD-11, with two distinct forms of disorder identified: Reactive attachment disorder and Disinhibited social engagement disorder. Reactive attachment disorder is characterised by social withdrawal and aberrant attachment behaviour, while Disinhibited social engagement disorder is characterised by socially disinhibited behaviour. Diagnosis of these disorders involves a history of grossly insufficient care, and symptoms must be evident before the age of 5. Treatment options include video feedback programs for preschool aged children and parental training with group play sessions for primary school aged children. Pharmacological interventions are not recommended in the absence of coexisting mental health problems.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 71
Incorrect
-
A new drug which may reduce the chance of elderly patients developing arthritis is introduced. In one study of 2,000 elderly patients, 1,200 received the new drug and 120 patients developed arthritis. The remaining 800 patients received a placebo and 200 developed arthritis. What is the absolute risk reduction of developing arthritis?
Your Answer:
Correct Answer: 15%
Explanation:To calculate the ARR, we first need to find the CER and EER. The CER is the conversion rate of the control group, which is 200 out of 800, of 0.25. The EER is the conversion rate of the experimental group, which is 120 out of 1,200, of 0.1.
To find the ARR, we subtract the EER from the CER:
ARR = CER – EER
ARR = 0.25 – 0.1
ARR = 0.15Therefore, the ARR is 0.15 of 15%.
Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 72
Incorrect
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What type of dementia is categorized as subcortical?
Your Answer:
Correct Answer: AIDS dementia complex
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.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 73
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.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 74
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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 75
Incorrect
-
Which of the following does not indicate a possible diagnosis of post traumatic stress disorder?
Your Answer:
Correct Answer: Hypersomnia
Explanation:Individuals with PTSD often struggle with sleep disturbances, while atypical depression is characterized by hypersomnia of excessive sleeping.
Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 76
Incorrect
-
What is the maximum duration of psychotic symptoms required for a diagnosis of acute and transient psychotic disorder according to the ICD-11?
Your Answer:
Correct Answer: 3 months
Explanation:– Schizophrenia and other primary psychotic disorders are characterized by impairments in reality testing and alterations in behavior.
– Schizophrenia is a chronic mental health disorder with symptoms including delusions, hallucinations, disorganized speech of behavior, and impaired cognitive ability.
– The essential features of schizophrenia include persistent delusions, persistent hallucinations, disorganized thinking, experiences of influence, passivity of control, negative symptoms, grossly disorganized behavior, and psychomotor disturbances.
– Schizoaffective disorder is diagnosed when all diagnostic requirements for schizophrenia are met concurrently with mood symptoms that meet the diagnostic requirements of a moderate or severe depressive episode, a manic episode, of a mixed episode.
– Schizotypal disorder is an enduring pattern of unusual speech, perceptions, beliefs, and behaviors that are not of sufficient intensity of duration to meet the diagnostic requirements of schizophrenia, schizoaffective disorder, of delusional disorder.
– Acute and transient psychotic disorder is characterized by an acute onset of psychotic symptoms, which can include delusions, hallucinations, disorganized thinking, of experiences of influence, passivity of control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks.
– Delusional disorder is diagnosed when there is a presence of a delusion of set of related delusions, typically persisting for at least 3 months and often much longer, in the absence of a depressive, manic, of mixed episode. -
This question is part of the following fields:
- General Adult Psychiatry
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Question 77
Incorrect
-
Which item is excluded from the Violence Risk Assessment Guide?
Your Answer:
Correct Answer: History of illicit drug use
Explanation:The VRAG takes into account the misuse of alcohol but does not factor in the use of illegal drugs.
Overview of the Violence Risk Assessment Guide
The Violence Risk Assessment Guide (VRAG) is a commonly used actuarial tool for predicting the likelihood of violence offence recidivism. It consists of 12 items that are used to assess an individual’s risk of committing violent acts in the future. These items include factors such as the individual’s score on the Revised Psychopathy Checklist, their history of alcohol problems, criminal history for non-violent offences, and age at the time of the index offence.
Each factor is assigned a weight based on how different the individual’s score is from the base rate. For example, if an individual has a high score on the Revised Psychopathy Checklist, this factor would be given a higher weight than if they had a low score. The VRAG is designed to provide a standardized and objective assessment of an individual’s risk of committing violent acts, which can be used to inform decisions about their treatment and management.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 78
Incorrect
-
A patient with chronic depression presents with unusual somatic symptoms after trying a medication called hypericum perforatum that she purchased in Germany. Which of the following symptoms could be attributed to the new medication?
Your Answer:
Correct Answer: Headache
Explanation:St John’s Wort may cause several side effects, including dry mouth, nausea, rash, diarrhea, fatigue, dizziness, headache, and restlessness.
Herbal Remedies for Depression and Anxiety
Depression can be treated with Hypericum perforatum (St John’s Wort), which has been found to be more effective than placebo and as effective as standard antidepressants. However, its use is not advised due to uncertainty about appropriate doses, variation in preparations, and potential interactions with other drugs. St John’s Wort can cause serotonin syndrome and decrease levels of drugs such as warfarin and ciclosporin. The effectiveness of the combined oral contraceptive pill may also be reduced.
Anxiety can be reduced with Piper methysticum (kava), but it cannot be recommended for clinical use due to its association with hepatotoxicity.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 79
Incorrect
-
A 68-year-old woman is referred to your clinic.
Her husband has noticed that she has become more forgetful over the last six months and has also noticed that there are episodes of confusion. There is a history of repeated falls but no serious head injury.
She does not drink alcohol but has a tremor and is slow in her movements. Her elderly husband is perplexed as his wife states that she sees a bird in the living room, which he cannot see. She is also convinced that their daughter is stealing money from them.
What treatment option do you recommend?Your Answer:
Correct Answer: Rivastigmine
Explanation:The man is exhibiting typical symptoms of Lewy body dementia, such as cognitive decline, sporadic confusion, motor parkinsonian features, frequent falls, and early visual hallucinations. While memantine has demonstrated some efficacy, acetylcholinesterase inhibitors are the preferred initial treatment for Lewy body dementia. There is limited high-quality evidence for treating this condition. Although donepezil may also be a suitable first-line therapy, it is not authorized in the UK for treating dementia in Parkinson’s disease, whereas rivastigmine is.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 80
Incorrect
-
A 75 year old man presents to the emergency department in a state of agitation and obvious distress. According to his son, he has been deteriorating over the past few days, displaying confusion and disorientation, and appears to be suffering from a chest infection. Despite being typically healthy, the man's condition has rapidly declined. An ECG reveals no abnormalities. What medication would you recommend to alleviate the man's distress?
Your Answer:
Correct Answer: Haloperidol
Explanation:Based on the patient’s history, it appears that they are experiencing delirium. Therefore, the appropriate medication to use would be haloperidol. Lorazepam would only be considered if haloperidol is not a viable option due to contraindications.
Delirium Management
Pharmacological management of delirium includes the use of haloperidol as a prophylactic measure. NICE guidelines recommend short-term use of haloperidol in cases where delirium is associated with distress of risk to self/others. Quetiapine is also considered a first-choice option in many units. Lorazepam can be used as an alternative if haloperidol is contraindicated, but it is more likely to cause respiratory depression, over-sedation, and paradoxical excitement.
Non-pharmacological management of delirium includes appropriate lighting and clear signage, talking to the person to reorient them, cognitively stimulating activities, regular visits from family and friends, and promoting good sleep patterns. Additional options such as donepezil, rivastigmine, melatonin, trazodone, and sodium valproate are not recommended. It is important to carefully consider the individual’s needs and medical history when choosing a management plan for delirium.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 81
Incorrect
-
Which of the following symptoms is most indicative of anxiety?
Your Answer:
Correct Answer: Tightness in the throat
Explanation:Globus, a sensation of tightness of feeling of something stuck in the throat, can be caused by stress of anxiety. It is a common symptom that often improves after eating and is not considered a serious condition. Despite being bothersome, globus is generally harmless.
Generalised Anxiety Disorder: Symptoms and Diagnosis
Generalised anxiety disorder is a condition characterized by persistent symptoms of anxiety that last for several months and occur on most days. The symptoms can be either general apprehension of excessive worry about multiple everyday events, such as family, health, finances, and work of school. In addition to these symptoms, individuals with generalised anxiety disorder may experience muscular tension, motor restlessness, sympathetic autonomic overactivity, nervousness, difficulty concentrating, irritability, of sleep disturbance.
To diagnose generalised anxiety disorder, healthcare professionals look for specific essential features. These include marked symptoms of anxiety that are not restricted to any particular environmental circumstance, and are accompanied by additional characteristic symptoms such as muscle tension, autonomic overactivity, nervousness, difficulty concentrating, irritability, and sleep disturbances. The symptoms must persist for at least several months, for more days than not, and cannot be better accounted for by another mental disorder of medical condition. The symptoms must also result in significant distress of impairment in personal, family, social, educational, occupational, of other important areas of functioning.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 82
Incorrect
-
Which studies are most susceptible to the Hawthorne effect?
Your Answer:
Correct Answer: Compliance with antipsychotic medication
Explanation:The Hawthorne effect is a phenomenon where individuals may alter their actions of responses when they are aware that they are being monitored of studied. Out of the given choices, the only one that pertains to a change in behavior is the adherence to medication. The remaining options related to outcomes that are not under conscious control.
Types of Bias in Statistics
Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.
There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 83
Incorrect
-
A 35-year-old woman who has been struggling with anxiety for at least three years, reports that she often drinks alcohol before going to social events to calm her nerves.
Which of the following statements is accurate regarding her anxiety?Your Answer:
Correct Answer: It indicates alcohol dependence, and after initial worsening with withdrawal usually will improve after three weeks of abstinence from alcohol
Explanation:This man is experiencing anxiety in the morning due to his dependence on alcohol. Mild alcohol withdrawal commonly causes symptoms such as agitation, fever, sweats, and tremors, which can all be alleviated by consuming alcohol. However, if the patient continues to refrain from drinking, these symptoms typically reach their peak after 72 hours and can last up to a week of more, but usually subside within three weeks.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 84
Incorrect
-
What is a biological characteristic of depression?
Your Answer:
Correct Answer: Reduced appetite
Explanation: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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 85
Incorrect
-
What is a characteristic of the tics seen in individuals with Tourette's syndrome?
Your Answer:
Correct Answer: They are often associated with antecedent sensory phenomena (premonitory urges)
Explanation:Tourette’s tics are often accompanied by strong urges that are difficult to resist and can be painful, causing significant mental distress for some individuals. After performing a tic, there is often a brief sense of physical relief of a reduction in inner tension, indicating the involvement of reward pathways in the brain. Interestingly, activities that require focused attention and fine motor skills, such as playing a musical instrument of engaging in certain sports, can temporarily improve tics. Dr. Carl Bennett, a surgeon in British Columbia who has Tourette’s, is an example of someone who has found ways to manage his symptoms through his work and hobbies. More information about his story can be found in Oliver Sacks’ book, An Anthropologist on Mars (1995).
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.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 86
Incorrect
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What characteristic distinguishes mania from hypomania?
Your Answer:
Correct Answer: Delusions of grandeur
Explanation:While psychotic symptoms such as delusions and hallucinations can manifest during mania, they are not a requirement for diagnosis. Hypomania, on the other hand, is a milder form of mania that does not involve psychotic symptoms.
Bipolar Disorder Diagnosis
Bipolar and related disorders are mood disorders characterized by manic, mixed, of hypomanic episodes alternating with depressive episodes. The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. Under the ICD-11, there are three subtypes of bipolar disorder: Bipolar I, Bipolar II, and Cyclothymic disorder.
Bipolar I disorder is diagnosed when an individual has a history of at least one manic of mixed episode. The typical course of the disorder is characterized by recurrent depressive and manic of mixed episodes. Onset of the first mood episode most often occurs during the late teen years, but onset of bipolar type I can occur at any time through the life cycle. The lifetime prevalence of bipolar I disorder is estimated to be around 2.1%.
Bipolar II disorder is diagnosed when an individual has a history of at least one hypomanic episode and at least one depressive episode. The typical course of the disorder is characterized by recurrent depressive and hypomanic episodes. Onset of bipolar type II most often occurs during the mid-twenties. The number of lifetime episodes tends to be higher for bipolar II disorder than for major depressive disorder of bipolar I disorder.
Cyclothymic disorder is diagnosed when an individual experiences mood instability over an extended period of time characterized by numerous hypomanic and depressive periods. The symptoms are present for more days than not, and there is no history of manic or mixed episodes. The course of cyclothymic disorder is often gradual and persistent, and onset commonly occurs during adolescence of early adulthood.
Rapid cycling is not a subtype of bipolar disorder but instead is a qualifier. It is defined as the presence of at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, of major depressive episode. Rapid cycling is associated with an increased risk of suicide and tends to be precipitated by stressors such as life events, alcohol abuse, use of antidepressants, and medical disorders.
Overall, the diagnosis of bipolar disorder requires careful evaluation of an individual’s symptoms and history. Treatment typically involves a combination of medication and psychotherapy.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 87
Incorrect
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Which investigation is not typically performed as part of a dementia diagnosis?
Your Answer:
Correct Answer: EEG
Explanation:According to NICE, the use of electroencephalography for the diagnosis of Alzheimer’s disease is not recommended.
As an AI language model, I do not have the ability to perform investigations of provide medical advice. However, I can provide information on the NICE guidelines for investigations in people with dementia. The guidelines suggest routine blood tests to exclude reversible causes, such as full blood count, ESR, CRP, urea and electrolytes, calcium, HbA1c, liver function tests, thyroid function tests, and serum B12 and folate levels. Other investigations that may be appropriate if clinically indicated include urine microscopy and culture, chest X-ray, ECG, syphilis serology, and HIV testing. Structural imaging and CSF analysis may also be necessary to exclude other cerebral pathologies and establish the subtype diagnosis. Magnetic resonance imaging (MRI) is preferred over CT if the subtype is unclear and vascular is suspected. FDG-PET of perfusion SPECT may be considered if the diagnosis is uncertain and frontotemporal dementia of dementia with Lewy bodies is suspected. However, it is important to note that Apolipoprotein E genotyping and electroencephalography should not be used to diagnose Alzheimer’s disease. It is recommended to consult with a healthcare professional for proper evaluation and management of dementia.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 88
Incorrect
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A 9-year-old girl is being seen in the Enuresis clinic. She continues to experience bedwetting at night despite utilizing an enuresis alarm for the last three months. She has no issues with urination during the day and has a daily bowel movement. What treatment option is most probable to be recommended?
Your Answer:
Correct Answer: Oral desmopressin 200 micrograms once daily
Explanation:Desmopressin, a man-made version of vasopressin, is approved for treating bedwetting in children aged 5 to 17. The recommended dosage is a single daily dose of 200 mcg.
Elimination Disorders
Elimination disorders refer to conditions that affect a child’s ability to control their bladder of bowel movements. Enuresis, of lack of control over the bladder, typically occurs between the ages of 1-3, while control over the bowel usually occurs before that of the bladder for most toddlers. Toilet training can be influenced by various factors, including intellectual capacity, cultural determinants, and psychological interactions between the child and their parents.
Enuresis is characterized by involuntary voiding of urine, by day and/of by night, which is abnormal in relation to the individual’s age and is not a result of any physical abnormality. It is not normally diagnosed before age 5 and may be primary (the child never having achieved continence) of secondary. Treatment options include reassurance, enuresis alarms, and medication.
Encopresis refers to repeated stool evacuation in inappropriate places in children over the age of four. The behavior can be either involuntary of intentional and may be due to unsuccessful toilet training (primary encopresis) of occur after a period of normal bowel control (secondary encopresis). Treatment generally involves bowel clearance, prevention of impaction, and behavioral therapy.
Before a diagnosis of encopresis is made, organic causes must be excluded. Hirschsprung’s disease is a condition that results from an absence of parasympathetic ganglion cells in the rectum, colon, and sometimes the small intestine. It leads to a colonic obstruction and is diagnosed in at least half of all cases in the first year of life. It is twice as common in boys than in girls.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 89
Incorrect
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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).
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This question is part of the following fields:
- Forensic Psychiatry
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Question 90
Incorrect
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What hierarchical language does NLM utilize to enhance search strategies and index articles?
Your Answer:
Correct Answer: MeSH
Explanation:NLM’s hierarchical vocabulary, known as MeSH (Medical Subject Heading), is utilized for the purpose of indexing articles in PubMed.
Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.
When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.
There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 91
Incorrect
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Which trial did not show any advantage of the assertive outreach intensive case management system?
Your Answer:
Correct Answer: UK700
Explanation:UK700 Trial on Assertive Community Treatment
Assertive community treatment was created to assist patients who have difficulty staying out of the hospital to live more successfully in the community. The UK700 case management trial aimed to determine if enhanced outcomes could be achieved under CPA by reducing case-load size. The trial tested the hypothesis that reducing CPA case-loads to 10-15 patients (intensive case management) would result in less hospitalization. However, the findings did not support the hypothesis.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 92
Incorrect
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In an economic evaluation study, which of the options below would be considered an indirect cost?
Your Answer:
Correct Answer: Costs of lost work due to absenteeism
Explanation:Methods of Economic Evaluation
There are four main methods of economic evaluation: cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), cost-utility analysis (CUA), and cost-minimisation analysis (CMA). While all four methods capture costs, they differ in how they assess health effects.
Cost-effectiveness analysis (CEA) compares interventions by relating costs to a single clinical measure of effectiveness, such as symptom reduction of improvement in activities of daily living. The cost-effectiveness ratio is calculated as total cost divided by units of effectiveness. CEA is typically used when CBA cannot be performed due to the inability to monetise benefits.
Cost-benefit analysis (CBA) measures all costs and benefits of an intervention in monetary terms to establish which alternative has the greatest net benefit. CBA requires that all consequences of an intervention, such as life-years saved, treatment side-effects, symptom relief, disability, pain, and discomfort, are allocated a monetary value. CBA is rarely used in mental health service evaluation due to the difficulty in converting benefits from mental health programmes into monetary values.
Cost-utility analysis (CUA) is a special form of CEA in which health benefits/outcomes are measured in broader, more generic ways, enabling comparisons between treatments for different diseases and conditions. Multidimensional health outcomes are measured by a single preference- of utility-based index such as the Quality-Adjusted-Life-Years (QALY). QALYs are a composite measure of gains in life expectancy and health-related quality of life. CUA allows for comparisons across treatments for different conditions.
Cost-minimisation analysis (CMA) is an economic evaluation in which the consequences of competing interventions are the same, and only inputs, i.e. costs, are taken into consideration. The aim is to decide the least costly way of achieving the same outcome.
Costs in Economic Evaluation Studies
There are three main types of costs in economic evaluation studies: direct, indirect, and intangible. Direct costs are associated directly with the healthcare intervention, such as staff time, medical supplies, cost of travel for the patient, childcare costs for the patient, and costs falling on other social sectors such as domestic help from social services. Indirect costs are incurred by the reduced productivity of the patient, such as time off work, reduced work productivity, and time spent caring for the patient by relatives. Intangible costs are difficult to measure, such as pain of suffering on the part of the patient.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 93
Incorrect
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By implementing a double-blinded randomised controlled trial to evaluate the efficacy of a new medication for Lewy Body Dementia, what type of bias can be prevented by ensuring that both the patient and doctor are blinded?
Your Answer:
Correct Answer: Expectation bias
Explanation:Types of Bias in Statistics
Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.
There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 94
Incorrect
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A 32-year-old man is referred by his primary care service due to concerns about social anxiety and isolation.
His mother reports that he avoids socialising and instead spends his time on the internet in chat rooms. He expresses numerous beliefs that are considered to be paranoid, for example, that the government is trying to suppress the minds of the public by encouraging unhealthy diets.
He is highly animated throughout the discussion and smiles and laughs for much of the interview. He states that the COVID pandemic introduced him to the concept of viruses and that this was a sign to him that his purpose in life is to educate the public that viruses are not real.
He is very suspicious of psychiatrists and suggests that as an arm of the state they will try and limit him so that the government remains in power.
Based on this presentation, which personality disorder would you most expect to be present?Your Answer:
Correct Answer: Schizotypal
Explanation:Paranoid personality disorder and schizotypal personality disorder share some common traits such as suspiciousness, interpersonal aloofness, and paranoid ideation. However, schizotypal personality disorder also includes symptoms like magical thinking, unusual perceptual experiences, and odd thinking and speech. In this particular case, the individual’s inappropriate affect and ideas of reference suggest schizotypal personality disorder rather than paranoid personality disorder. Individuals with schizoid personality disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually exhibit prominent paranoid ideation. Interestingly, research has shown that schizotypal personality disorder is a significant predictor of belief in conspiracy theories (March, 2019).
Schizotypal Personality Disorder: Symptoms and Diagnostic Criteria
Schizotypal personality disorder is a type of personality disorder that is characterized by a pervasive pattern of discomfort with close relationships, distorted thinking and perceptions, and eccentric behavior. This disorder typically begins in early adulthood and is present in a variety of contexts. To be diagnosed with schizotypal personality disorder, an individual must exhibit at least five of the following symptoms:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs of magical thinking that influences behavior and is inconsistent with subcultural norms.
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech.
5. Suspiciousness of paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior of appearance that is odd, eccentric, of peculiar.
8. Lack of close friends of confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.It is important to note that the ICD-11 does not have a specific category for schizotypal personality disorder, as it has abandoned the categorical approach in favor of a dimensional one.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 95
Incorrect
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What is the average age of the 7 women who participated in the qualitative study on self-harm among females, with ages of 18, 22, 40, 17, 23, 18, and 44?
Your Answer:
Correct Answer: 18
Explanation:Measures of Central Tendency
Measures of central tendency are used in descriptive statistics to summarize the middle of typical value of a data set. There are three common measures of central tendency: the mean, median, and mode.
The median is the middle value in a data set that has been arranged in numerical order. It is not affected by outliers and is used for ordinal data. The mode is the most frequent value in a data set and is used for categorical data. The mean is calculated by adding all the values in a data set and dividing by the number of values. It is sensitive to outliers and is used for interval and ratio data.
The appropriate measure of central tendency depends on the measurement scale of the data. For nominal and categorical data, the mode is used. For ordinal data, the median of mode is used. For interval data with a normal distribution, the mean is preferable, but the median of mode can also be used. For interval data with skewed distribution, the median is used. For ratio data, the mean is preferable, but the median of mode can also be used for skewed data.
In addition to measures of central tendency, the range is also used to describe the spread of a data set. It is calculated by subtracting the smallest value from the largest value.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 96
Incorrect
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How would you rephrase the question to refer to the test's capacity to identify a person with a disease as positive?
Your Answer:
Correct Answer: Sensitivity
Explanation: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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 97
Incorrect
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What is a true statement about frontotemporal lobar dementias?
Your Answer:
Correct Answer: Compared to Alzheimer's recent memory is preserved better than remote memory
Explanation:Frontotemporal Lobar Degeneration
Frontotemporal lobar degeneration (FTLD) is a group of neurodegenerative disorders that involve the atrophy of the frontal and temporal lobes. The disease is characterized by progressive dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. FTLD is the third most common form of dementia across all age groups and a leading type of early-onset dementia.
The disease has common features such as onset before 65, insidious onset, relatively preserved memory and visuospatial skills, personality change, and social conduct problems. There are three recognized subtypes of FTLD: behavioral-variant (bvFTD), language variant – primary progressive aphasia (PPA), and the language variant is further subdivided into semantic variant PPA (aka semantic dementia) and non-fluent agrammatic variant PPA (nfvPPA).
As the disease progresses, the symptoms of the three clinical variants can converge, as an initially focal degeneration becomes more diffuse and spreads to affect large regions in the frontal and temporal lobes. The key differences between the subtypes are summarized in the table provided. The bvFTD subtype is characterized by poor personal and social decorum, disinhibition, poor judgment and problem-solving, apathy, compulsive/perseverative behavior, hyperorality of dietary changes, and loss of empathy. The nfvPPA subtype is characterized by slow/slurred speech, decreased word output and phrase length, word-finding difficulties, apraxia of speech, and spared single-word comprehension. The svPPA subtype is characterized by intact speech fluency, word-finding difficulties (anomia), impaired single-word comprehension, repetitive speech, and reduced word comprehension.
In conclusion, FTLD is a progressive, heterogeneous, neurodegenerative disorder that affects the frontal and temporal lobes. The disease is characterized by dysfunction in executive functioning, behavior, and language, and can mimic psychiatric disorders due to its prominent behavioral features. There are three recognized subtypes of FTLD, and as the disease progresses, the symptoms of the three clinical variants can converge.
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This question is part of the following fields:
- Old Age Psychiatry
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Question 98
Incorrect
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You have been asked to assess a 60-year-old female at the cardiac unit of the local general hospital. She suffered a myocardial (MI) infarction three weeks ago and has been recovering well physically.
The medical team are concerned that she is experiencing frequent crying spells. You observe evidence of low mood, anhedonia and sleep disturbance.
The woman feels hopeless about the future and has fleeting thoughts of suicide. She has a history of depression which responded well to antidepressant treatment.
Which antidepressant would you recommend based on its demonstrated safety post-myocardial infarction?Your Answer:
Correct Answer: Sertraline
Explanation:According to a study published in JAMA, sertraline is a safe and effective treatment for depression in patients who have recently experienced a myocardial infarction (MI) of unstable angina. The study found that sertraline not only has antidepressant effects but also inhibits platelet aggregation. This suggests that sertraline may have additional benefits for patients with cardiovascular disease. For more information, refer to Glassman et al.’s study in JAMA.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 99
Incorrect
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Which of the following options is not a possible value for Pearson's correlation coefficient?
Your Answer:
Correct Answer: 1.5
Explanation: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.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 100
Incorrect
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What changes would be anticipated when transitioning a middle-aged man with long-term schizophrenia from a conventional antipsychotic to a newer atypical antipsychotic medication?
Your Answer:
Correct Answer: A reduction in extrapyramidal side effects
Explanation:Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 101
Incorrect
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Which statement accurately describes conduct disorder?
Your Answer:
Correct Answer: Males develop the condition at a younger age than females
Explanation:Disruptive Behaviour of Dissocial Disorders
Conduct disorders are the most common reason for referral of young children to mental health services. These disorders are characterized by a repetitive and persistent pattern of antisocial, aggressive, of defiant conduct that goes beyond ordinary childish mischief of adolescent rebelliousness. Oppositional defiant disorder (ODD) shares some negative attributes but in a more limited fashion.
ICD-11 terms the disorder as ‘Conduct-dissocial disorder’, while DSM-5 recognizes three separate conditions related to emotional/behavioral problems seen in younger people: conduct disorder, oppositional defiant disorder, and intermittent explosive disorder. Conduct disorder is about poorly controlled behavior, intermittent explosive disorder is about poorly controlled emotions, and ODD is in between. Conduct disorders are further divided into childhood onset (before 10 years) and adolescent onset (10 years of older).
The behavior pattern of conduct disorders must be persistent and recurrent, including multiple incidents of aggression towards people of animals, destruction of property, deceitfulness of theft, and serious violations of rules. The pattern of behavior must result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.
Oppositional defiant disorder represents a less severe form of conduct disorder, where there is an absence of more severe dissocial of aggressive acts. The behavior pattern of ODD includes persistent difficulty getting along with others, provocative, spiteful, of vindictive behavior, and extreme irritability of anger.
The prevalence of conduct disorders increases throughout childhood and is more common in boys than girls. The most frequent comorbid problem seen with conduct disorder is hyperactivity. The conversion rate from childhood conduct disorder to adult antisocial personality disorder varies from 40 to 70% depending on the study.
NICE recommends group parent-based training programs of parent and child training programs for children with complex needs for ages 3-11, child-focused programs for ages 9-14, and multimodal interventions with a family focus for ages 11-17. Medication is not recommended in routine practice, but risperidone can be used where other approaches fail and they are seriously aggressive.
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This question is part of the following fields:
- Child And Adolescent Psychiatry
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Question 102
Incorrect
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What is the truth about criminal defences in psychiatry?
Your Answer:
Correct Answer: In England, children under 10 cannot be held criminally responsible for their actions
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.
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This question is part of the following fields:
- Forensic Psychiatry
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Question 103
Incorrect
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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.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 104
Incorrect
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Which of the following is not a recommended treatment for restless leg syndrome?
Your Answer:
Correct Answer: SSRIs
Explanation:Restless Leg Syndrome, also known as Wittmaack-Ekbom syndrome, is a condition that causes an irresistible urge to move in order to alleviate uncomfortable sensations, primarily in the legs but sometimes in other areas of the body. The symptoms are exacerbated by rest and tend to worsen at night. Treatment options for this condition include dopamine agonists, opioids, benzodiazepines, and anticonvulsants. Sibler (2004) has developed an algorithm for managing Restless Leg Syndrome.
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This question is part of the following fields:
- General Adult Psychiatry
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Question 105
Incorrect
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A 38-year-old man with schizophrenia requests to stop taking his chlorpromazine medication after hearing from another patient that it is outdated. Despite the fact that chlorpromazine has effectively managed his symptoms since he was diagnosed at age 20, the patient insists on switching to a newer and more modern medication. Which of the following atypical antipsychotics would be the least appropriate for him to start taking next?
Your Answer:
Correct Answer: Clozapine
Explanation:Before starting clozapine, it is recommended to try at least two other antipsychotic medications. However, in this particular case, the individual has only been treated with one antipsychotic.
Clozapine is an effective antipsychotic drug used in the management of treatment-resistant schizophrenia (TRS). It was reintroduced in the 1990s with mandatory blood monitoring due to the risk of agranulocyte
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This question is part of the following fields:
- General Adult Psychiatry
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Question 106
Incorrect
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What is the recommended duration for inpatient opioid detoxification according to the NICE guidelines?
Your Answer:
Correct Answer: Up to 4 weeks
Explanation:In an inpatient of residential setting, the recommended duration for opioid detoxification is typically no more than 4 weeks, while in a community setting, it can last up to 12 weeks.
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.
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This question is part of the following fields:
- Substance Misuse/Addictions
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Question 107
Incorrect
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A new drug is trialled for the treatment of heart disease. Drug A is given to 500 people with early stage heart disease and a placebo is given to 450 people with the same condition. After 5 years, 300 people who received drug A had survived compared to 225 who received the placebo. What is the number needed to treat to save one life?
Your Answer:
Correct Answer: 10
Explanation:Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 108
Incorrect
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What is a true statement about paedophilic disorder as defined by the DSM-5?
Your Answer:
Correct Answer: The individual must be at least 5 years older than the child of interest to qualify for a diagnosis
Explanation:There is a correlation between adult males with paedophilia and a history of childhood sexual abuse, but it is uncertain whether this relationship indicates that childhood sexual abuse causes adult paedophilia.
Paraphilias are intense and persistent sexual interests other than sexual interest in genital stimulation of preparatory fondling with phenotypically normal, physically mature, consenting human partners. They are divided into those relating to erotic activity and those relating to erotic target. In order to become a disorder, paraphilias must be associated with distress of impairment to the individual of with harm to others. The DSM-5 lists 8 recognised paraphilic disorder but acknowledges that there are many more. Treatment modalities for the paraphilias have limited scientific evidence to support their use. Psychological therapy (especially CBT) is often used (with extremely variable results). Pharmacological options include SSRI, Naltrexone, Antipsychotics, GnRH agonists, and Anti-androgens and progestational drugs (e.g. cyproterone acetate).
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This question is part of the following fields:
- Forensic Psychiatry
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Question 109
Incorrect
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Which statement accurately describes research variables?
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