00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - If a study has a Type I error rate of <0.05 and a...

    Incorrect

    • If a study has a Type I error rate of <0.05 and a Type II error rate of 0.2, what is the power of the study?

      Your Answer: 0.05

      Correct Answer: 0.8

      Explanation:

      A study’s ability to correctly detect a true effect of difference may be calculated as Power = 1 – Type II error rate. In the given scenario, the power can be calculated as Power = 1 – 0.2 = 0.8. Type I error refers to a false positive, while Type II error refers to a false negative.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      8.1
      Seconds
  • Question 2 - A study comparing the benefit of two surgical procedures for patients over 65...

    Incorrect

    • A study comparing the benefit of two surgical procedures for patients over 65 concludes that the two procedures are equally effective. A researcher is then asked to conduct a cost analysis of the two procedures, considering only the financial expenses.

      What is the best way to describe this approach?

      Your Answer:

      Correct Answer: Cost-minimisation analysis

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 3 - What is the preferred medication for treating alcohol withdrawal in a patient who...

    Incorrect

    • What is the preferred medication for treating alcohol withdrawal in a patient who has significant liver damage?

      Your Answer:

      Correct Answer: Lorazepam

      Explanation:

      Sedatives and Liver Disease

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 4 - You are asked to evaluate a patient who has just begun taking clozapine....

    Incorrect

    • You are asked to evaluate a patient who has just begun taking clozapine. The nurse is worried about his fever and tachycardia, which have persisted for a few hours. The patient reports experiencing some chest discomfort. What is your suspicion regarding his condition?

      Your Answer:

      Correct Answer: Myocarditis

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 5 - In a healthy right-handed man, which structure is typically larger in the left...

    Incorrect

    • In a healthy right-handed man, which structure is typically larger in the left hemisphere compared to the right hemisphere?

      Your Answer:

      Correct Answer: Planum temporale

      Explanation:

      Cerebral Asymmetry in Planum Temporale and its Implications in Language and Auditory Processing

      The planum temporale, a triangular region in the posterior superior temporal gyrus, is a highly lateralized brain structure involved in language and music processing. Studies have shown that the planum temporale is up to ten times larger in the left cerebral hemisphere than the right, with this asymmetry being more prominent in men. This asymmetry can be observed in gestation and is present in up to 70% of right-handed individuals.

      Recent research suggests that the planum temporale also plays an important role in auditory processing, specifically in representing the location of sounds in space. However, reduced planum temporale asymmetry has been observed in individuals with dyslexia, stuttering, and schizophrenia. These findings highlight the importance of cerebral asymmetry in the planum temporale and its implications in language and auditory processing.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 6 - Which of the following therapies would be most suitable for a 27 year...

    Incorrect

    • Which of the following therapies would be most suitable for a 27 year old female who struggles with maintaining stable and close relationships, managing emotions without resorting to self-harm, and experiencing intense feelings of distress, anxiety, and worthlessness?

      Your Answer:

      Correct Answer: Dialectical Behavioural Therapy

      Explanation:

      The symptoms displayed by the woman are in line with those of borderline personality disorder, which requires treatment with DBT.

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

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

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 7 - What condition of situation would make rTMS inappropriate of unsafe to use? ...

    Incorrect

    • What condition of situation would make rTMS inappropriate of unsafe to use?

      Your Answer:

      Correct Answer: Cochlear implant

      Explanation:

      Neurostimulation is a treatment that uses electromagnetic energy targeted at the brain. There are several forms of neurostimulation, including TMS, deep brain stimulation, and ECT. TMS is a non-invasive, non-convulsive technique used to stimulate neural tissue. It involves the placement of an electromagnetic coil on the patient’s scalp to deliver a short, powerful magnetic field pulse through the scalp and induce electric current in the brain. TMS is used to treat depression when standard treatments have failed. Deep brain stimulation is a neurosurgical technique that involves placing an electrode within the brain to deliver a high-frequency current in a specific subcortical of deep cortical structure. It has been used to treat Parkinson’s, dysthymia, OCD, and Tourette syndrome. There is RCT evidence to demonstrate its effectiveness in OCD, but conflicting results in depression and Tourette’s. DBS is also being trailed in other conditions such as anorexia, bipolar, and additions.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      0
      Seconds
  • Question 8 - A male patient in his 50s is admitted to hospital due to pronounced...

    Incorrect

    • A male patient in his 50s is admitted to hospital due to pronounced psychosis. He responds well to clozapine but is noted to be highly sedated on his current dose. After 6 months of therapy his plasma levels are found to be 1100 µg/L. An EEG is conducted which is found to be normal. Which of the following would be the most appropriate course of action?

      Your Answer:

      Correct Answer:

      Explanation:

      The situation requires addressing both the high levels and the potential seizure risk. It is recommended to attempt to reduce the dose to alleviate the sedation while monitoring for any negative impact on the patient’s mental state. As the levels are greater than 1000 µg/L, it is advised to add an anticonvulsant to mitigate the risk of seizures. Once the levels have decreased, the anticonvulsant can be discontinued.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 9 - What is the most probable biomarker to be increased in an individual diagnosed...

    Incorrect

    • What is the most probable biomarker to be increased in an individual diagnosed with anorexia nervosa?

      Your Answer:

      Correct Answer: Creatinine kinase

      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.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 10 - A 35 year old farmer presents with a circumscribed 4cm red lesion on...

    Incorrect

    • A 35 year old farmer presents with a circumscribed 4cm red lesion on his chest, along with general malaise and low mood. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Lyme disease

      Explanation:

      Lyme Disease: An Overview

      Lyme disease is a type of infection that is transmitted through tick bites. Its symptoms typically include fatigue, fever, malaise, and a skin rash called erythema migrans. If left untreated, it can cause complications in the heart, joints, and central nervous system (CNS).

      Lyme disease is a serious condition that can have long-term effects on a person’s health. It is important to seek medical attention if you suspect that you have been bitten by a tick and are experiencing any of the symptoms associated with Lyme disease. Early diagnosis and treatment can help prevent the development of more severe complications.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 11 - What is the estimated percentage of patients with schizophrenia who do not respond...

    Incorrect

    • What is the estimated percentage of patients with schizophrenia who do not respond to treatment?

      Your Answer:

      Correct Answer: 30%

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 12 - What environmental factor increases the risk of violence in hospitalized patients? ...

    Incorrect

    • What environmental factor increases the risk of violence in hospitalized patients?

      Your Answer:

      Correct Answer: High use of temporary staff

      Explanation:

      Risk Factors for Violence in In-Patient Settings

      In-patient settings can be prone to violence, and there are several risk factors that contribute to this issue. According to Davison (2005), patient-related risk factors include being young, having a history of violence, being compulsorily admitted, having comorbid substance misuse, and being in the acute phase of the illness. Environmental risk factors include a lack of structured activity, high use of temporary staff, low levels of staff-patient interaction, poor staffing levels, poorly defined staffing roles, unpredictable ward programmes, lack of privacy, overcrowding, poor physical facilities, and the availability of weapons. It is important for healthcare providers to be aware of these risk factors and take steps to mitigate them to ensure the safety of both patients and staff.

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 13 - What intervention has been proven to effectively decrease suicidal behavior? ...

    Incorrect

    • What intervention has been proven to effectively decrease suicidal behavior?

      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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 14 - What is a true statement about Cotard's syndrome? ...

    Incorrect

    • What is a true statement about Cotard's syndrome?

      Your Answer:

      Correct Answer: It is most commonly associated with depression

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 15 - According to Gottesman (1982), what is the risk of a child developing schizophrenia...

    Incorrect

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

      Your Answer:

      Correct Answer: 13%

      Explanation:

      Schizophrenia: Understanding the Risk Factors

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 16 - What is the name of the test that compares the variance within a...

    Incorrect

    • What is the name of the test that compares the variance within a group to the variance between groups?

      Your Answer:

      Correct Answer: ANOVA

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 17 - What is a known factor that can lead to drug-induced mania? ...

    Incorrect

    • What is a known factor that can lead to drug-induced mania?

      Your Answer:

      Correct Answer: Levodopa

      Explanation:

      Drug-Induced Mania: Evidence and Precipitating Drugs

      There is strong evidence that mania can be triggered by certain drugs, according to Peet (1995). These drugs include levodopa, corticosteroids, anabolic-androgenic steroids, and certain classes of antidepressants such as tricyclic and monoamine oxidase inhibitors.

      Additionally, Peet (2012) suggests that there is weaker evidence that mania can be induced by dopaminergic anti-Parkinsonian drugs, thyroxine, iproniazid and isoniazid, sympathomimetic drugs, chloroquine, baclofen, alprazolam, captopril, amphetamine, and phencyclidine.

      It is important for healthcare professionals to be aware of the potential for drug-induced mania and to monitor patients closely for any signs of symptoms. Patients should also be informed of the risks associated with these medications and advised to report any unusual changes in mood of behavior.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 18 - What types of conditions of situations would be considered high risk according to...

    Incorrect

    • What types of conditions of situations would be considered high risk according to the Junior MARSIPAN assessment?

      Your Answer:

      Correct Answer: Unable to get up at all from squatting

      Explanation:

      Anorexia is a serious mental health condition that can have severe physical complications. These complications can affect various systems in the body, including the cardiac, skeletal, hematologic, reproductive, metabolic, gastrointestinal, CNS, and dermatological systems. Some of the recognized physical complications of anorexia nervosa include bradycardia, hypotension, osteoporosis, anemia, amenorrhea, hypothyroidism, delayed gastric emptying, cerebral atrophy, and lanugo.

      The Royal College of Psychiatrists has issued advice on managing sick patients with anorexia nervosa, recommending hospital admission for those with high-risk items. These items include a BMI of less than 13, a pulse rate of less than 40 bpm, a SUSS test score of less than 2, a sodium level of less than 130 mmol/L, a potassium level of less than 3 mmol/L, a serum glucose level of less than 3 mmol/L, and a QTc interval of more than 450 ms. The SUSS test involves assessing the patient’s ability to sit up and squat without using their hands. A rating of 0 indicates complete inability to rise, while a rating of 3 indicates the ability to rise without difficulty. Proper management and treatment of anorexia nervosa are crucial to prevent of manage these physical complications.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 19 - Which of the following options would NOT be appropriate for rapid tranquilisation? ...

    Incorrect

    • Which of the following options would NOT be appropriate for rapid tranquilisation?

      Your Answer:

      Correct Answer: IM olanzapine 20 mg

      Explanation:

      Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 20 - What is true about the treatment of attention deficit hyperactivity disorder? ...

    Incorrect

    • What is true about the treatment of attention deficit hyperactivity disorder?

      Your Answer:

      Correct Answer: Stimulant medications should be discontinued in those with attention deficit hyperactivity disorder who develop symptoms of mania

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 21 - Prior to initiating lithium treatment for an adult with a learning disability and...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 22 - In which conditions has Cotard's syndrome been reported? ...

    Incorrect

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

      Your Answer:

      Correct Answer: All of the above

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 23 - What is the duration of time that LSD can be detected in urine...

    Incorrect

    • What is the duration of time that LSD can be detected in urine based on the presence of its metabolite (2-oxo-3-hydroxy-LSD)?

      Your Answer:

      Correct Answer: 5 days

      Explanation:

      The latest LSD immunoassays are created to detect 2-oxo-3-hydroxy-LSD, the main metabolite that can be found in higher concentrations in urine, potentially enhancing the accuracy of detection.

      Drug Screening

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 24 - The initial application of deep brain stimulation (DBS) was for the treatment of...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      0
      Seconds
  • Question 25 - What is the recommended initial treatment for insomnia that has persisted for 2...

    Incorrect

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

      Your Answer:

      Correct Answer: CBT-I

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 26 - In which condition of situation are hand wringing movements frequently observed? ...

    Incorrect

    • In which condition of situation are hand wringing movements frequently observed?

      Your Answer:

      Correct Answer: Rett syndrome

      Explanation:

      Genetic Conditions and Their Features

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 27 - Which condition has been found to have the highest prevalence throughout a person's...

    Incorrect

    • Which condition has been found to have the highest prevalence throughout a person's lifetime?

      Your Answer:

      Correct Answer: Major depression

      Explanation:

      Epidemiological surveys and prevalence estimates have been conducted to determine the prevalence of various mental health conditions. The Epidemiological Catchment Area (ECA) study was conducted in the mid-1980s using the Diagnostic Interview Schedule (DIS) based on DSM-III criteria. The National Comorbidity Survey (NCS) used the Composite International Diagnostic Interview (CIDI) and was conducted in the 1990s and repeated in 2001. The Adult Psychiatric Morbidity Survey (APMS) used the Clinical Interview Schedule (CIS-R) and was conducted in England every 7 years since 1993. The WHO World Mental Health (WMH) Survey Initiative used the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) and was conducted in close to 30 countries from 2001 onwards.

      The main findings of these studies show that major depression has a prevalence of 4-10% worldwide, with 6.7% in the past 12 months and 16.6% lifetime prevalence. Generalised anxiety disorder (GAD) has a 3.1% 12-month prevalence and 5.7% lifetime prevalence. Panic disorder has a 2.7% 12-month prevalence and 4.7% lifetime prevalence. Specific phobia has an 8.7% 12-month prevalence and 12.5% lifetime prevalence. Social anxiety disorder has a 6.8% 12-month prevalence and 12.1% lifetime prevalence. Agoraphobia without panic disorder has a 0.8% 12-month prevalence and 1.4% lifetime prevalence. Obsessive-compulsive disorder (OCD) has a 1.0% 12-month prevalence and 1.6% lifetime prevalence. Post-traumatic stress disorder (PTSD) has a 1.3-3.6% 12-month prevalence and 6.8% lifetime prevalence. Schizophrenia has a 0.33% 12-month prevalence and 0.48% lifetime prevalence. Bipolar I disorder has a 1.5% 12-month prevalence and 2.1% lifetime prevalence. Bulimia nervosa has a 0.63% lifetime prevalence, anorexia nervosa has a 0.16% lifetime prevalence, and binge eating disorder has a 1.53% lifetime prevalence.

      These prevalence estimates provide important information for policymakers, healthcare providers, and researchers to better understand the burden of mental health conditions and to develop effective prevention and treatment strategies.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 28 - One of Bion's fundamental group assumptions is: ...

    Incorrect

    • One of Bion's fundamental group assumptions is:

      Your Answer:

      Correct Answer: Pairing

      Explanation:

      Bion, a psychoanalyst, was fascinated by group dynamics and believed that groups had a collective unconscious that functioned similarly to that of an individual. He argued that this unconsciousness protected the group from the pain of reality. Bion identified two types of groups: the ‘working group’ that functioned well and achieved its goals, and the ‘basic assumption group’ that acted out primitive fantasies and prevented progress. Bion then described different types of basic assumption groups, including ‘dependency,’ where the group turns to a leader to alleviate anxiety, ‘fight-flight,’ where the group perceives an enemy and either attacks of avoids them, and ‘pairing,’ where the group believes that the solution lies in the pairing of two members. These dynamics can be observed in various settings, such as when strangers come together for the first time of when doctors in different specialties criticize one another.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 29 - The patient's presentation with a first episode psychosis, myeloneuropathy with ataxia, low B12...

    Incorrect

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

      Your Answer:

      Correct Answer: Nitrous oxide

      Explanation:

      Understanding Vitamin B12 Deficiency

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 30 - What is a true statement about antisocial personality disorder? ...

    Incorrect

    • What is a true statement about antisocial personality disorder?

      Your Answer:

      Correct Answer: In the ICD-11 it is referred to as personality disorder with dissociation

      Explanation:

      Individuals with antisocial personality disorder were more likely to have a history of aggression, unemployment, and promiscuity than to have committed serious crimes.

      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.

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 31 - What changes would be anticipated when transitioning a middle-aged man with long-term schizophrenia...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 32 - In which psychological therapy is the concept of 'rolling with resistance' utilized? ...

    Incorrect

    • In which psychological therapy is the concept of 'rolling with resistance' utilized?

      Your Answer:

      Correct Answer: Motivational interviewing

      Explanation:

      Motivational Interviewing: A Model for Resolving Ambivalence and Facilitating Change

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 33 - A 50 year old man with schizophrenia is diagnosed with HIV. The physician...

    Incorrect

    • A 50 year old man with schizophrenia is diagnosed with HIV. The physician overseeing his medical care seeks guidance on the appropriate psychotropic medication. What is the most suitable treatment option for individuals with HIV who require psychosis treatment?

      Your Answer:

      Correct Answer: Risperidone

      Explanation:

      For patients with HIV who experience psychosis, atypical antipsychotics are the preferred first-line treatment. Among these medications, risperidone has the strongest evidence base, while quetiapine, aripiprazole, and olanzapine are also viable options. However, if clozapine is used, patients must be closely monitored.

      HIV and Mental Health: Understanding the Relationship and Treatment Options

      Human immunodeficiency virus (HIV) is a blood-borne virus that causes cellular immune deficiency, resulting in a decrease in the number of CD4+ T-cells. People with severe mental illness are at increased risk of contracting and transmitting HIV, and the prevalence of HIV infection among them is higher than in the general population. Antiretroviral drugs are used to manage HIV, but they are not curative.

      Depression is the most common mental disorder in the HIV population, and it can result from HIV of the psycho-social consequences of having the condition. HIV-associated neurocognitive disorder (HAND) is the umbrella term for the spectrum of neurocognitive impairment induced by HIV, ranging from mild impairment through to dementia. Poor episodic memory is the most frequently reported cognitive difficulty in HIV-positive individuals.

      Treatment options for mental health issues in people with HIV include atypical antipsychotics for psychosis, SSRIs for depression and anxiety, valproate for bipolar disorder, and antiretroviral therapy for HAND. It is important to avoid benzodiazepines for delirium and MAOIs for depression. Understanding the relationship between HIV and mental health and providing appropriate treatment options can improve the quality of life for people living with HIV.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 34 - What is the standard deviation of the sample mean height of 100 adults...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 35 - NICE recommends which option as the first choice for children and young people...

    Incorrect

    • NICE recommends which option as the first choice for children and young people (aged 5-18) with attention deficit hyperactivity disorder?

      Your Answer:

      Correct Answer: Educational attention deficit hyperactivity disorder sessions

      Explanation:

      For individuals between the ages of 5 and 18, the initial approach is to provide education on ADHD and assist with parental strategies. This may involve a structured conversation covering topics such as adjusting the environment (e.g. shorter periods of concentration) and weighing the benefits and drawbacks of obtaining a diagnosis.

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 36 - A teacher makes regular visits to a student. During these visits she reinforces...

    Incorrect

    • A teacher makes regular visits to a student. During these visits she reinforces adaptive behaviours with praise and tries to improve the student's self-esteem. Which type of therapy is being provided?

      Your Answer:

      Correct Answer: Supportive psychotherapy

      Explanation:

      Supportive Psychotherapy: An Overview

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

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

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

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

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 37 - Which of the options below is not included in the DSM-5 criteria for...

    Incorrect

    • Which of the options below is not included in the DSM-5 criteria for diagnosing attention deficit hyperactivity disorder?

      Your Answer:

      Correct Answer: Often loses temper

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 38 - For what is Carl Jung most well-known? ...

    Incorrect

    • For what is Carl Jung most well-known?

      Your Answer:

      Correct Answer: Differentiating between the personal and collective unconscious

      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.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 39 - What is the term used to describe approaches that evaluate risk at the...

    Incorrect

    • What is the term used to describe approaches that evaluate risk at the group level?

      Your Answer:

      Correct Answer: Actuarial

      Explanation:

      There are two main types of risk assessment tools: actuarial instruments and structured clinical guides. Actuarial approaches focus on assessing risk at a group level, but are not easily adaptable to individual risk evaluations and are less accurate in detecting rare events. Clinical approaches provide personalized and contextualized assessments, but are susceptible to individual bias and poor agreement between evaluators. These approaches can be structured, unstructured, of a combination of both.

      Methods of Risk Assessment

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 40 - What are some indications on a urinalysis that suggest the sample may have...

    Incorrect

    • What are some indications on a urinalysis that suggest the sample may have been tampered with and is therefore unreliable for drug testing?

      Your Answer:

      Correct Answer: Temperature of 18 C

      Explanation:

      An 18 C temperature reading is below the typical range for urine, indicating that the sample may not be fresh and could potentially be a replacement sample.

      Drug Screening

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 41 - What is a true statement about transference? ...

    Incorrect

    • What is a true statement about transference?

      Your Answer:

      Correct Answer: It is largely an unconscious process

      Explanation:

      Transference and Countertransference

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

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

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 42 - What is a true statement about dissociative disorders? ...

    Incorrect

    • What is a true statement about dissociative disorders?

      Your Answer:

      Correct Answer: The onset is usually acute

      Explanation:

      Dissociative disorders involve an involuntary disturbance of interruption in the usual integration of various aspects such as identity, sensations, perceptions, emotions, thoughts, memories, bodily movements, of behavior. This disruption can be complete of partial and may vary in intensity over time. The condition usually develops suddenly.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 43 - Which of the following factors does not increase the risk of developing Alzheimer's...

    Incorrect

    • Which of the following factors does not increase the risk of developing Alzheimer's disease?

      Your Answer:

      Correct Answer: Aluminium exposure

      Explanation:

      In the 1960s and 1970s, there was a suspicion that aluminum could be a cause of Alzheimer’s disease. This led to concerns about exposure to aluminum in everyday items such as cooking pots, foil, beverage cans, antacids, and antiperspirants. However, subsequent studies have not found any evidence to support this theory. Today, most scientists are focused on other areas of research, and very few experts believe that everyday sources of aluminum are a risk factor for Alzheimer’s disease.

      Alzheimer’s Association: Risk Factors

      The Alzheimer’s Association has identified several risk factors for the development of Alzheimer’s disease. These include age, family history, head trauma (especially if associated with loss of consciousness), hypertension, heart disease, diabetes, CVA, high cholesterol, lower educational level, and female gender. Increasing age is a significant risk factor, as is having a family history of the disease. Head trauma, particularly if it results in loss of consciousness, can also increase the risk of developing Alzheimer’s. Other medical conditions such as hypertension, heart disease, and diabetes have also been linked to an increased risk of Alzheimer’s. Additionally, individuals with lower levels of education and females may be at higher risk. It is important to be aware of these risk factors and take steps to reduce them where possible.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 44 - On which principle does the Id operate? ...

    Incorrect

    • On which principle does the Id operate?

      Your Answer:

      Correct Answer: Pleasure

      Explanation:

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

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

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 45 - A 26-year-old male is admitted to the Emergency Department with severe abdominal pain....

    Incorrect

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

      Your Answer:

      Correct Answer: Malingering

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 46 - A 52-year-old individual with a history of hypertension and transient ischaemic attacks experiences...

    Incorrect

    • A 52-year-old individual with a history of hypertension and transient ischaemic attacks experiences sudden onset of nausea, vomiting and falls to the ground. Upon neurological examination, cerebellar signs, Horner's syndrome and sensory deficits are observed. Which region of the cerebral vasculature is the most probable site of damage?

      Your Answer:

      Correct Answer: Posterior inferior cerebellar artery

      Explanation:

      The patient has Wallenberg’s syndrome, which is caused by a blockage in the posterior inferior cerebellar artery. Symptoms typically appear suddenly and include severe dizziness, which can cause the patient to fall. Other common symptoms include nausea, vomiting, difficulty with coordination on the same side as the blockage, muscle stiffness, difficulty judging distance, and a tendency to lean to one side. The patient may also experience pain, tingling, of numbness on one side of the face, as well as involuntary eye movements, hiccups, difficulty swallowing, speaking, of breathing, and double vision. Horner’s syndrome, which affects the eye, is also common. Sensory changes may include a loss of pain and temperature sensation on one side of the face and reduced sensation on the opposite side of the body. This condition is most commonly seen in individuals over the age of 40.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 47 - Which of the following is guided by the principle of reality? ...

    Incorrect

    • Which of the following is guided by the principle of reality?

      Your Answer:

      Correct Answer: Ego

      Explanation:

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

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

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 48 - What is the recommended antidepressant for an individual with epilepsy who experiences symptoms...

    Incorrect

    • What is the recommended antidepressant for an individual with epilepsy who experiences symptoms of depression?

      Your Answer:

      Correct Answer: Mirtazapine

      Explanation:

      Psychotropics and Seizure Threshold in People with Epilepsy

      People with epilepsy are at an increased risk for various mental health conditions, including depression, anxiety, psychosis, and suicide. It is important to note that the link between epilepsy and mental illness is bidirectional, as patients with mental health conditions also have an increased risk of developing new-onset epilepsy. Psychotropic drugs are often necessary for people with epilepsy, but they can reduce the seizure threshold and increase the risk of seizures. The following tables provide guidance on the seizure risk associated with different classes of antidepressants, antipsychotics, and ADHD medications. It is important to use caution and carefully consider the risks and benefits of these medications when treating people with epilepsy.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 49 - Which of the options below is not a factor that can be reversed...

    Incorrect

    • Which of the options below is not a factor that can be reversed and may lead to dementia?

      Your Answer:

      Correct Answer: Pick's disease

      Explanation:

      Frontotemporal dementia, also referred to as Pick’s disease, is a type of dementia that worsens over time and is caused by tauopathy. Unfortunately, it is irreversible.

      Reversible causes of dementia should be screened for in all cases of dementia. The mnemonic DEMENTIA can help remember the most common causes, including drugs and alcohol (especially those with anticholinergic activity), emotions such as depression, metabolic disorders like hypo and hyperthyroidism, decline in eyes and ears, normal pressure hydrocephalus, tumors of space-occupying lesions, infections like syphilis and AIDS, and anemia due to vitamin B12 of folate deficiency. Other notable metabolic causes include Wilson’s disease, Hashimoto’s encephalitis, hypo and hyperparathyroidism, Cushing’s disease, and Addison’s disease. Additional infectious causes include Whipple’s disease, sarcoidosis, and meningitis. The most common causes are alcohol and medication-related dementia, depression, brain lesions such as normal pressure hydrocephalus, tumors and chronic subdural hematomas, metabolic disorders such as hypothyroidism, hypoparathyroidism, vitamin B12 deficiency, and central nervous system infections such as neurosyphilis and HIV.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 50 - What are the endocrine changes observed in individuals with Anorexia nervosa? ...

    Incorrect

    • What are the endocrine changes observed in individuals with Anorexia nervosa?

      Your Answer:

      Correct Answer: Increased cortisol levels

      Explanation:

      Eating Disorders: Lab Findings and Medical Complications

      Eating disorders can lead to a range of medical complications, including renal failure, peripheral edema, sinus bradycardia, QT-prolongation, pericardial effusion, and slowed GI motility. Other complications include constipation, cathartic colon, esophageal esophagitis, hair loss, and dental erosion. Blood abnormalities are also common in patients with eating disorders, including hyponatremia, hypokalemia, hypophosphatemia, and hypoglycemia. Additionally, patients may experience leucopenia, anemia, low albumin, elevated liver enzymes, and vitamin deficiencies. These complications can cause significant morbidity and mortality in patients with eating disorders. It is important for healthcare providers to monitor patients for these complications and provide appropriate treatment.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 51 - Which category does social class fall under in terms of variable types? ...

    Incorrect

    • Which category does social class fall under in terms of variable types?

      Your Answer:

      Correct Answer: Ordinal

      Explanation:

      Ordinal variables are a form of qualitative variable that follows a specific sequence in its values. Additional instances may include exam scores and tax brackets based on income.

      Scales of Measurement in Statistics

      In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.

      Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.

      Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.

      Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 52 - A 38-year-old female patient presents with a 2-year history of low mood. She...

    Incorrect

    • A 38-year-old female patient presents with a 2-year history of low mood. She reports feeling intermittently low for approximately half of the days each month and during this time she feels tired and disinterested in life but manages to keep going albeit with tremendous effort. When low she says that it can be a bit difficult to control her worrying thoughts and that she feels ‘on edge’, but denies sympathetic autonomic symptoms. She is tearful during interview but shows mood reactivity. She is passively but not actively suicidal.

      She denies any history of mania or hypomania and there is no family history of mood disturbance. Aside from having hypertension and gout she is medically fit.

      She reports that her symptoms have been quite consistent throughout the preceding 2-year period and denies any previous history of low mood. She denies insomnia, significant issues with concentration, and appetite disturbance.

      Which of the following ICD-11 diagnoses would best apply?:

      Your Answer:

      Correct Answer: Mixed depressive and anxiety disorder

      Explanation:

      The most appropriate diagnosis according to ICD-11 would be mixed depressive and anxiety disorder due to the presence of symptoms related to both anxiety and depression. The evidence is insufficient to diagnose either a depressive episode of generalised anxiety disorder. The symptoms in this case are limited to half the days of each month, which is not pervasive enough for a diagnosis of generalised anxiety disorder of a depressive episode. Dysthymic disorder is not applicable as the duration of symptoms is less than two years. If anxiety symptoms were absent, the diagnosis would be ‘other specified depressive disorders’ until the two-year duration criterion is met.

      Depression is diagnosed using different criteria in the ICD-11 and DSM-5. The ICD-11 recognizes single depressive episodes, recurrent depressive disorder, dysthymic disorder, and mixed depressive and anxiety disorder. The DSM-5 recognizes disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder, and premenstrual dysphoric disorder.

      For a diagnosis of a single depressive episode, the ICD-11 requires the presence of at least five characteristic symptoms occurring most of the day, nearly every day during a period lasting at least 2 weeks. The DSM-5 requires the presence of at least five symptoms during the same 2-week period, with at least one of the symptoms being either depressed mood of loss of interest of pleasure.

      Recurrent depressive disorder is characterized by a history of at least two depressive episodes separated by at least several months without significant mood disturbance, according to the ICD-11. The DSM-5 requires at least two episodes with an interval of at least 2 consecutive months between separate episodes in which criteria are not met for a major depressive episode.

      Dysthymic disorder is diagnosed when a person experiences persistent depressed mood lasting 2 years of more, according to the ICD-11. The DSM-5 requires depressed mood for most of the day, for more days than not, for at least 2 years, along with the presence of two or more additional symptoms.

      Mixed depressive and anxiety disorder is recognized as a separate code in the ICD-11, while the DSM-5 uses the ‘with anxious distress’ qualifier. The ICD-11 requires the presence of both depressive and anxiety symptoms for most of the time during a period of 2 weeks of more, while the DSM-5 requires the presence of both depressive and anxious symptoms during the same 2-week period.

      Overall, the criteria for diagnosing depression vary between the ICD-11 and DSM-5, but both require the presence of characteristic symptoms that cause significant distress of impairment in functioning.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 53 - The research team is studying the effectiveness of a new treatment for a...

    Incorrect

    • The research team is studying the effectiveness of a new treatment for a certain medical condition. They have found that the brand name medication Y and its generic version Y1 have similar efficacy. They approach you for guidance on what type of analysis to conduct next. What would you suggest?

      Your Answer:

      Correct Answer: Cost minimisation analysis

      Explanation:

      Cost minimisation analysis is employed to compare net costs when the observed effects of health care interventions are similar. To conduct this analysis, it is necessary to have clinical evidence that demonstrates the differences in health effects between alternatives are negligible of insignificant. This approach is commonly used by institutions like the National Institute for Health and Care Excellence (NICE).

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 54 - A 48 year old man with a long history of alcohol dependence presents...

    Incorrect

    • A 48 year old man with a long history of alcohol dependence presents to A&E with confusion and ataxia. Further enquiry reveals several weeks of diarrhoea and low mood. On examination you note a symmetrical rash limited to sun-exposed sites.

      What vitamin deficiency is suggested by these symptoms?

      Your Answer:

      Correct Answer: Vitamin B3

      Explanation:

      The symptoms indicate a possible case of pellagra, a condition caused by a deficiency in vitamin B3 (niacin). Pellagra can also cause ataxia. It is important to note that vitamin B1 is thiamine, and vitamin B2 is riboflavin.

      Pellagra: A Vitamin B3 Deficiency Disease

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 55 - A study which aims to see if women over 40 years old have...

    Incorrect

    • A study which aims to see if women over 40 years old have a different length of pregnancy, compare the mean in a group of women of this age against the population mean. Which of the following tests would you use to compare the means?

      Your Answer:

      Correct Answer: One sample t-test

      Explanation:

      The appropriate statistical test for the study is a one-sample t-test as it involves the calculation of a single mean.

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 56 - What symptom is commonly observed in individuals with bipolar disorder and psychosis? ...

    Incorrect

    • What symptom is commonly observed in individuals with bipolar disorder and psychosis?

      Your Answer:

      Correct Answer: Prominent affective symptoms and mood congruent delusions

      Explanation:

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 57 - What does the standardized mortality ratio indicate for individuals with schizophrenia? ...

    Incorrect

    • What does the standardized mortality ratio indicate for individuals with schizophrenia?

      Your Answer:

      Correct Answer: 2-Mar

      Explanation:

      Schizophrenia and Mortality

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 58 - What level of intellectual disability is indicated by an IQ range of 35-49?...

    Incorrect

    • What level of intellectual disability is indicated by an IQ range of 35-49?

      Your Answer:

      Correct Answer: Moderate

      Explanation:

      Classification of Intellectual Disability

      Intellectual disability affects approximately 2% of the general population, with an estimated 828,000 adults aged 18 of older affected in England alone. Those with an IQ below 70 are considered to have an intellectual disability, with the average IQ being 100. The severity of intellectual disability is categorized based on IQ scores, with mild intellectual disability being the most common (85% of cases) and profound intellectual disability being the least common (1-2% of cases). People with intellectual disability may require varying levels of support in their daily lives, depending on their individual needs. It is important to use the preferred term ‘people with intellectual disability’ when referring to individuals with this condition.

    • This question is part of the following fields:

      • Learning Disability
      0
      Seconds
  • Question 59 - A 14 year old boy is brought to clinic by his father. He...

    Incorrect

    • A 14 year old boy is brought to clinic by his father. He is struggling with both obsessive compulsive disorder and depression. Despite trying psychological approaches, he has not found relief and is interested in trying medication. What is the most suitable medication to consider?

      Your Answer:

      Correct Answer: Fluoxetine

      Explanation:

      According to NICE, when a patient has both depression and OCD, the preferred treatment is fluoxetine.

      OCD and BDD are two mental health disorders that can affect children. OCD is characterized by obsessions and compulsions, while BDD is characterized by a preoccupation with an imagined defect in one’s appearance. Both disorders can cause significant distress and impairment in daily functioning.

      For mild cases of OCD, guided self-help may be considered along with support and information for the family of caregivers. For moderate to severe cases of OCD, cognitive-behavioral therapy (CBT) that involves the family of caregivers and is adapted to suit the child’s developmental age is recommended. For all children and young people with BDD, CBT (including exposure and response prevention) is recommended.

      If a child declines psychological treatment, a selective serotonin reuptake inhibitor (SSRI) may be prescribed. However, a licensed medication (sertraline of fluvoxamine) should be used for children and young people with OCD, while fluoxetine should be used for those with BDD. If an SSRI is ineffective of not tolerated, another SSRI of clomipramine may be tried. Tricyclic antidepressants other than clomipramine should not be used to treat OCD of BDD in children and young people. Other antidepressants (MAOIs, SNRIs) and antipsychotics should not be used alone in the routine treatment of OCD of BDD in children of young people, but may be considered as an augmentation strategy.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 60 - What is the accurate statement about the levels of clozapine? ...

    Incorrect

    • What is the accurate statement about the levels of clozapine?

      Your Answer:

      Correct Answer: Clozapine induced constipation is dose related

      Explanation:

      The occurrence of constipation caused by clozapine is dependent on the dosage.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 61 - Which of the following factors would be the least useful in determining a...

    Incorrect

    • Which of the following factors would be the least useful in determining a diagnosis of pathological intoxication?

      Your Answer:

      Correct Answer: Presence of liver cirrhosis

      Explanation:

      Pathological Intoxication: A Rare Legal Defence

      Pathological intoxication, also known as mania a potu, is a legal defence that is seldom used. It refers to a sudden onset of aggressive and violent behaviour that is not typical of the individual when sober. This behaviour occurs shortly after consuming small amounts of alcohol that would not typically cause intoxication in most people. The individual may experience complete of partial amnesia following the episode. Unlike regular alcohol intoxication, there is no motor incoordination, slurred speech, of diplopia present in pathological intoxication.

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 62 - What is a true statement about Charles Bonnet syndrome? ...

    Incorrect

    • What is a true statement about Charles Bonnet syndrome?

      Your Answer:

      Correct Answer: Visual hallucinations are not normally associated with an auditory component

      Explanation:

      While Charles Bonnet Syndrome (CBS) typically only presents with visual hallucinations, some experts have proposed diagnostic criteria that require the absence of hallucinations in other sensory modalities. However, there have been documented cases of CBS with auditory hallucinations, so the presence of such hallucinations should not necessarily exclude a diagnosis of CBS.

      Charles Bonnet Syndrome: A Condition of Complex Visual Hallucinations

      Charles Bonnet Syndrome (CBS) is a condition characterized by persistent of recurrent complex visual hallucinations that occur in clear consciousness. This condition is observed in individuals who have suffered damage to the visual pathway, which can be caused by damage to any part of the pathway from the eye to the cortex. The hallucinations are thought to result from a release phenomenon secondary to the deafferentation of the cerebral cortex. CBS is equally distributed between sexes and does not show any familial predisposition. The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.

      Risk factors for CBS include advanced age, peripheral visual impairment, social isolation, sensory deprivation, and early cognitive impairment. Well-formed complex visual hallucinations are thought to occur in 10-30 percent of individuals with severe visual impairment. Only around a third of individuals find the hallucinations themselves an unpleasant or disturbing experience. The most effective treatment is reversal of the visual impairment. Antipsychotic drugs are commonly prescribed but are largely ineffective. CBS is a long-lasting condition, with 88% of individuals experiencing it for two years of more, and only 25% resolving at nine years.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 63 - Which statement accurately describes autism spectrum disorder? ...

    Incorrect

    • Which statement accurately describes autism spectrum disorder?

      Your Answer:

      Correct Answer: Cognitive but not affective empathy is typically impaired

      Explanation:

      The genetics involved in this condition are complex and do not adhere to a straightforward Mendelian pattern of inheritance. Individuals with this condition typically have limited social play skills and may experience difficulties with language. Despite a desire to form friendships, they may face challenges in doing so.

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 64 - A 56 year-old man attends the out-patient clinic. He was started on fluoxetine...

    Incorrect

    • A 56 year-old man attends the out-patient clinic. He was started on fluoxetine eight weeks ago for depression and is now requesting to stop his medication as he feels so well. Your assessment indicates that he is now in remission. What should be recommended regarding his treatment?

      Your Answer:

      Correct Answer: It should be continued for at least another 6 months

      Explanation:

      To minimize the likelihood of relapse, it is recommended to maintain treatment for at least 6 months after achieving remission. It is important to note that antidepressants are not habit-forming, and patients should be reassured of this fact.

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 65 - What term is used to describe an association between two variables that is...

    Incorrect

    • What term is used to describe an association between two variables that is influenced by a confounding factor?

      Your Answer:

      Correct Answer: Indirect

      Explanation:

      Stats Association and Causation

      When two variables are found to be more commonly present together, they are said to be associated. However, this association can be of three types: spurious, indirect, of direct. Spurious association is one that has arisen by chance and is not real, while indirect association is due to the presence of another factor, known as a confounding variable. Direct association, on the other hand, is a true association not linked by a third variable.

      Once an association has been established, the next question is whether it is causal. To determine causation, the Bradford Hill Causal Criteria are used. These criteria include strength, temporality, specificity, coherence, and consistency. The stronger the association, the more likely it is to be truly causal. Temporality refers to whether the exposure precedes the outcome. Specificity asks whether the suspected cause is associated with a specific outcome of disease. Coherence refers to whether the association fits with other biological knowledge. Finally, consistency asks whether the same association is found in many studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 66 - In the context of Criminal law, what is the age at which an...

    Incorrect

    • In the context of Criminal law, what is the age at which an individual is considered an adult in England?

      Your Answer:

      Correct Answer: 18

      Explanation:

      Criminal Responsibility and Age Limits

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

      Not Guilty by Reason of Insanity and Other Defenses

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 67 - What are the accurate statements about the risk factors associated with schizophrenia? ...

    Incorrect

    • What are the accurate statements about the risk factors associated with schizophrenia?

      Your Answer:

      Correct Answer: Winter birth is a risk factor for schizophrenia

      Explanation:

      Studies have indicated that belonging to an ethnic minority group increases the likelihood of being at risk. However, it is important to note that race alone is not a determining factor. The correlation is believed to be influenced by various factors, including social stress and discrimination. It is noteworthy that this trend appears to persist across multiple generations.

      Schizophrenia: Understanding the Risk Factors

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 68 - A child with a fear of dogs is encouraged to pet a friendly...

    Incorrect

    • A child with a fear of dogs is encouraged to pet a friendly one. At first, the child is very scared but eventually becomes comfortable and enjoys playing with the dog. What type of therapeutic approach does this demonstrate?

      Your Answer:

      Correct Answer: Flooding

      Explanation:

      Flooding as a Treatment for Phobias

      Flooding is a treatment method for phobias that involves directly confronting the fear and remaining in the situation until the anxiety subsides. This process is called habituation and is different from systematic desensitization. However, flooding can be challenging for patients as it produces high levels of anxiety, which can cause them to leave the situation before the fear response is extinguished. As a result, desensitization is generally preferred over flooding as a treatment method for phobias.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 69 - What symptom is more frequently observed in individuals experiencing mania compared to those...

    Incorrect

    • What symptom is more frequently observed in individuals experiencing mania compared to those with schizophrenia?

      Your Answer:

      Correct Answer: Grandiose delusions

      Explanation:

      Schizophrenia typically presents with delusions that are not consistent with the individual’s mood, while grandiose delusions that align with a manic state are an example of mood congruent delusions.

      Mania: Features and Characteristics

      Mania is a mental state characterized by a range of symptoms that can significantly impact an individual’s behavior, thoughts, and emotions. Some of the key features of mania include an elated of irritable mood, restlessness, and overactivity. People experiencing mania may also exhibit disinhibited and reckless behavior, such as excessive spending of engaging in risky activities. They may have over-ambitious plans for the future and experience a flight of ideas and pressured speech. Additionally, mania can involve mood congruent delusions, increased libido, and a decreased need for sleep. Overall, mania can be a challenging and disruptive condition that requires professional treatment and support.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 70 - What is the most frequently observed defence mechanism in individuals with borderline personality...

    Incorrect

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

      Your Answer:

      Correct Answer: Projection

      Explanation:

      Defense Mechanisms in Specific Conditions

      Certain psychiatric conditions are characterized by specific defense mechanisms. These mechanisms are used by individuals to protect themselves from anxiety and other negative emotions. The following conditions and the associated defenses tend to come up on membership exams.

      Phobias are characterized by intense and irrational fears of specific objects of situations. The defense mechanisms commonly used in phobias are repression and displacement. Repression involves pushing the anxiety-provoking thoughts of memories out of conscious awareness. Displacement involves redirecting the anxiety onto a less threatening object of situation.

      Obsessive-compulsive disorder (OCD) is characterized by intrusive and repetitive thoughts (obsessions) and/of repetitive behaviors (compulsions). The defense mechanisms commonly used in OCD are isolation, undoing, and reaction formation. Isolation involves separating the anxiety-provoking thought from the associated emotion. Undoing involves performing a ritual of action to undo the anxiety-provoking thought. Reaction formation involves expressing the opposite emotion of the anxiety-provoking thought.

      Borderline personality disorder (BPD) is characterized by unstable moods, relationships, and self-image. The defense mechanisms commonly used in BPD are projection and splitting. Projection involves attributing one’s own unacceptable thoughts of feelings onto another person. Splitting involves seeing people of situations as either all good of all bad.

      Narcissistic personality disorder (NPD) is characterized by a grandiose sense of self-importance, a need for admiration, and a lack of empathy. The defense mechanisms commonly used in NPD are projection and splitting, similar to BPD.

      Agoraphobia is characterized by a fear of being in situations where escape may be difficult of embarrassing. The defense mechanism commonly used in agoraphobia is displacement, which involves redirecting the anxiety onto a less threatening object of situation.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 71 - Which treatment option is not suggested by the Maudsley Guidelines to enhance the...

    Incorrect

    • Which treatment option is not suggested by the Maudsley Guidelines to enhance the effectiveness of clozapine?

      Your Answer:

      Correct Answer: Olanzapine

      Explanation:

      According to the Maudsley Guidelines, there is insufficient evidence to support the use of olanzapine as an addition to treatment, and it may worsen metabolic side effects.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 72 - What is true about dementia that occurs at an early age? ...

    Incorrect

    • What is true about dementia that occurs at an early age?

      Your Answer:

      Correct Answer: The majority of early onset Alzheimer's cases are sporadic rather than inherited

      Explanation:

      While inherited causes of Alzheimer’s are prevalent among younger individuals, the majority of cases are attributed to sporadic causes.

      Early-Onset Dementia: A Less Common but Broader Differential Diagnosis

      Early-onset dementia refers to the occurrence of dementia before the age of 65, which accounts for only 2% of all people with dementia in the UK. However, the differential diagnosis for early-onset dementia is broader, and younger people are more likely to have a rarer form of dementia. The distribution of diagnoses of dementia differs dramatically between older and younger patients, with Alzheimer’s disease being the most common cause of dementia in both groups. However, it only accounts for a third of cases in younger people, while frontotemporal dementia occurs much more commonly in younger populations. Rarer causes of dementia also occur with greater frequency in the younger population.

      It is worth noting that the majority of Alzheimer’s cases are sporadic in early-onset, but inherited cases are more common. Vascular dementia is the second most common dementia in those under 65, and frontotemporal dementias occur more frequently in the younger population, with up to 50% of patients having a positive family history.

      In summary, early-onset dementia is a less common but important condition to consider, as it presents a broader differential diagnosis and may have a genetic component. Understanding the distribution of diagnoses in younger populations can aid in early detection and appropriate management of the condition.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 73 - What is a distinguishing characteristic of normal pressure hydrocephalus? ...

    Incorrect

    • What is a distinguishing characteristic of normal pressure hydrocephalus?

      Your Answer:

      Correct Answer: Incontinence

      Explanation:

      Understanding Normal Pressure Hydrocephalus

      Normal pressure hydrocephalus is a type of communicating hydrocephalus that is chronic in nature. It occurs when there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain due to impaired reabsorption by the arachnoid villi. Unlike other types of hydrocephalus, the CSF pressure in normal pressure hydrocephalus is typically high but still within the normal range. Therefore, patients do not experience symptoms of high intracranial pressure such as headache and nausea. Instead, they present with a classic triad of incontinence, gait ataxia, and dementia, which is often referred to as wet, wobbly, wacky. Unfortunately, this condition is often misdiagnosed as Parkinson’s of Alzheimer’s disease.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 74 - In which situations might lower doses of clozapine be necessary? ...

    Incorrect

    • In which situations might lower doses of clozapine be necessary?

      Your Answer:

      Correct Answer: Patients on fluoxetine

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 75 - What percentage of individuals with Munchausen's syndrome by proxy are younger than 6...

    Incorrect

    • What percentage of individuals with Munchausen's syndrome by proxy are younger than 6 years old?

      Your Answer:

      Correct Answer: 75%

      Explanation:

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 76 - What alternative treatment options are available for schizophrenia if clozapine proves to be...

    Incorrect

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

      Your Answer:

      Correct Answer: Olanzapine and allopurinol

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 77 - What is a true statement about obsessional neurosis? ...

    Incorrect

    • What is a true statement about obsessional neurosis?

      Your Answer:

      Correct Answer: Those affected tend to have good insight

      Explanation:

      Obsessional Neurosis: A Term Coined by Freud for Obsessive Compulsive Disorder

      Obsessional neurosis is a term coined by Sigmund Freud to describe what is now commonly known as obsessive compulsive disorder. This condition typically begins in early adulthood and is often observed in individuals with average of above-average intelligence.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 78 - What is the most accurate approximation of the 1 year prevalence of late...

    Incorrect

    • What is the most accurate approximation of the 1 year prevalence of late onset schizophrenia?

      Your Answer:

      Correct Answer: 0.40%

      Explanation:

      Epidemiology of Mental Disorders Among the Elderly

      Depression:
      Contrary to popular belief, studies have shown that rates of depression among the elderly in the general population are lower than in younger adults. However, elderly individuals who seek medical attention have a higher prevalence of depressive symptoms, with one study in London reporting a point prevalence of around 30%. Suicide risk factors in the elderly include a history of attempts, depressive disorder, access to lethal means, physical illness of disability, chronic pain, recent losses, and social isolation. Physician education in recognizing and treating depression and restricting access to lethal means have been found to reduce suicide rates.

      Personality Disorder:
      There is limited information on the prevalence of personality disorders in the general population, but rates tend to decrease with age.

      Psychosis:
      Very late-onset schizophrenia, with onset after the age of 60, has a 1-year prevalence of 0.1 to 0.5%. It is more common in women and has been associated with sensory impairment. Genetic factors appear to be less important than in earlier onset schizophrenia.

      Alcohol Misuse:
      Studies have shown that men have higher rates of alcohol misuse than women in the elderly population. However, precise figures and prevalence rates are unreliable, and standard assessment tools may not be valid in this group.

      Dementia:
      Dementia incidence is similar across all continents and regions of the world, with Alzheimer’s accounting for 60-70% and vascular dementia accounting for 15-20% of all dementia cases. Age is the strongest risk factor for dementia, with approximately 48% of people aged 95 and over having dementia.

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 79 - A new clinical trial has found a correlation between alcohol consumption and lung...

    Incorrect

    • A new clinical trial has found a correlation between alcohol consumption and lung cancer. Considering the well-known link between alcohol consumption and smoking, what is the most probable explanation for this new association?

      Your Answer:

      Correct Answer: Confounding

      Explanation:

      The observed link between alcohol consumption and lung cancer is likely due to confounding factors, such as cigarette smoking. Confounding variables are those that are associated with both the independent and dependent variables, in this case, alcohol consumption and lung cancer.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 80 - What is accurate about the immediate management of self-harm in adolescents? ...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 81 - For what purpose is the Gudjonsson Scale primarily used in assessment? ...

    Incorrect

    • For what purpose is the Gudjonsson Scale primarily used in assessment?

      Your Answer:

      Correct Answer: Suggestibility

      Explanation:

      The Gudjonsson Suggestibility Scale

      The Gudjonsson Suggestibility Scale is a tool used to measure suggestibility in individuals. It involves reading a story to participants, who are then asked to recall as much as they can remember. Afterward, participants are asked 20 questions related to the story, 15 of which are misleading. Once the questions have been answered, participants are given negative feedback on their performance and told that they made several errors. They are then asked to repeat the questions to obtain more accurate answers. Based on the participants’ responses to the misleading questions, a total suggestibility score can be calculated. This scale is useful in understanding how easily individuals can be influenced of manipulated by external factors.

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 82 - What factor is most likely to cause difficulty with swallowing in an individual...

    Incorrect

    • What factor is most likely to cause difficulty with swallowing in an individual with a learning disability?

      Your Answer:

      Correct Answer: Clonazepam

      Explanation:

      While this question may not be ideal, it does occasionally appear on exams. If you encounter it, choose clonazepam and disregard the possibility that other choices may also cause dysphagia.

      Swallowing Difficulties Caused by Certain Medications

      Swallowing difficulties, also known as dysphagia, can be caused by various factors, including certain medications. Benzodiazepines, commonly used to treat anxiety and sleep disorders, have been found to cause swallowing problems in patients with learning difficulties. Additionally, other drugs such as metoclopramide, haloperidol, and phenothiazines have also been linked to dysphagia.

      Diagnosis and management of dysphagia is crucial to prevent complications such as aspiration pneumonia and malnutrition. Patients experiencing swallowing difficulties should undergo a thorough evaluation by a healthcare professional, including a clinical examination and imaging studies. Treatment options may include modifying the consistency of food and liquids, swallowing exercises, and medication adjustments. It is important for healthcare providers to be aware of the potential side effects of certain medications and to monitor patients for any signs of dysphagia.

    • This question is part of the following fields:

      • Learning Disability
      0
      Seconds
  • Question 83 - An older adult with Lewy body dementia who is prescribed donepezil, develops distressing...

    Incorrect

    • An older adult with Lewy body dementia who is prescribed donepezil, develops distressing visual hallucinations and delusions and has begun to attack members of his care team. Non-pharmacological attempts to manage him have been exhausted.
      What would be the most effective approach in managing this individual?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      Cholinesterase Inhibitors are the preferred medication for treating visual hallucinations in LBD, but if they don’t work, antipsychotic drugs may be necessary. For Lewy Body psychosis, clozapine is the most effective option, although quetiapine is also a viable alternative. In Parkinson’s disease dementia with psychosis, a review by the Movement Disorder Society found that clozapine was effective and had an acceptable risk with proper monitoring. Quetiapine was considered investigational due to a lack of supporting evidence, while olanzapine was deemed unlikely to be effective and had an unacceptable risk due to its demonstrated worsening of motor function.

      Management of Non-Cognitive Symptoms in Dementia

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 84 - Which of the following is an atypical characteristic of avoidant personality disorder? ...

    Incorrect

    • Which of the following is an atypical characteristic of avoidant personality disorder?

      Your Answer:

      Correct Answer: Urgent search for another relationship as a source of care and support when a close relationship ends

      Explanation:

      Dependent personality disorder is characterized by an immediate and desperate search for a new relationship to provide care and support after the end of a close relationship.

      Personality Disorder: Avoidant

      Avoidant Personality Disorder (AVPD) is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. According to the DSM-5, individuals with AVPD exhibit at least four of the following symptoms: avoidance of occupational activities that involve interpersonal contact, unwillingness to be involved unless certain of being liked, restraint in intimate relationships due to fear of ridicule, preoccupation with being criticized of rejected in social situations, inhibition in new interpersonal situations due to feelings of inadequacy, viewing oneself as inept and inferior to others, and reluctance to take personal risks of engage in new activities due to potential embarrassment.

      In contrast, the ICD-11 does not have a specific category for AVPD but instead uses the qualifier of detachment trait. The Detachment trait domain is characterized by a tendency to maintain interpersonal and emotional distance. Common manifestations of Detachment include social detachment (avoidance of social interactions, lack of friendships, and avoidance of intimacy) and emotional detachment (reserve, aloofness, and limited emotional expression and experience). It is important to note that not all individuals with Detachment will exhibit all of these symptoms at all times.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 85 - What is the percentage of completed suicides that occur in individuals aged 65...

    Incorrect

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

      Your Answer:

      Correct Answer: 20%

      Explanation:

      Suicide in the Elderly

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 86 - What condition is linked to a deficiency in hypoxanthine phosphoribosyltransferase? ...

    Incorrect

    • What condition is linked to a deficiency in hypoxanthine phosphoribosyltransferase?

      Your Answer:

      Correct Answer: Lesch-Nyhan syndrome

      Explanation:

      Lesch-Nyhan Syndrome: A Rare Genetic Disorder

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

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

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

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

    • This question is part of the following fields:

      • Learning Disability
      0
      Seconds
  • Question 87 - What is a distinguishing trait of being intoxicated with phencyclidine? ...

    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.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 88 - At what age can a person be diagnosed with the personality disorder that...

    Incorrect

    • At what age can a person be diagnosed with the personality disorder that is specified in DSM-5 as requiring the individual to be at least 18 years old?

      Your Answer:

      Correct Answer: Antisocial

      Explanation:

      Personality Disorder: Understanding the Clinical Diagnosis

      A personality disorder is a long-standing pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, clinicians must first establish that the general diagnostic threshold is met before identifying the subtype(s) present. The course of personality disorders varies, with some becoming less evident of remitting with age, while others persist.

      DSM-5 and ICD-11 have different classification systems for personality disorders. DSM-5 divides them into three clusters (A, B, and C), while ICD-11 has a general category with six trait domains that can be added. The prevalence of personality disorders in Great Britain is 4.4%, with Cluster C being the most common. Clinicians are advised to avoid diagnosing personality disorders in children, although a diagnosis can be made in someone under 18 if the features have been present for at least a year (except for antisocial personality disorder).

      Overall, understanding the clinical diagnosis of personality disorders is important for effective treatment and management of these conditions.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 89 - What is the estimated percentage of 10 year olds affected by encopresis? ...

    Incorrect

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

      Your Answer:

      Correct Answer: 1.60%

      Explanation:

      Elimination Disorders

      Elimination disorders refer to conditions that affect a child’s ability to control their bladder of bowel movements. Enuresis, of lack of control over the bladder, typically occurs between the ages of 1-3, while control over the bowel usually occurs before that of the bladder for most toddlers. Toilet training can be influenced by various factors, including intellectual capacity, cultural determinants, and psychological interactions between the child and their parents.

      Enuresis is characterized by involuntary voiding of urine, by day and/of by night, which is abnormal in relation to the individual’s age and is not a result of any physical abnormality. It is not normally diagnosed before age 5 and may be primary (the child never having achieved continence) of secondary. Treatment options include reassurance, enuresis alarms, and medication.

      Encopresis refers to repeated stool evacuation in inappropriate places in children over the age of four. The behavior can be either involuntary of intentional and may be due to unsuccessful toilet training (primary encopresis) of occur after a period of normal bowel control (secondary encopresis). Treatment generally involves bowel clearance, prevention of impaction, and behavioral therapy.

      Before a diagnosis of encopresis is made, organic causes must be excluded. Hirschsprung’s disease is a condition that results from an absence of parasympathetic ganglion cells in the rectum, colon, and sometimes the small intestine. It leads to a colonic obstruction and is diagnosed in at least half of all cases in the first year of life. It is twice as common in boys than in girls.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 90 - Which type of variable does the measurement of temperature on the Kelvin scale...

    Incorrect

    • Which type of variable does the measurement of temperature on the Kelvin scale represent?

      Your Answer:

      Correct Answer: Ratio

      Explanation:

      The distinction between interval and ratio scales is illustrated by the fact that ratio scales have a non-arbitrary zero point and meaningful ratios between values. Celsius and Fahrenheit temperature measurements are examples of interval scales, while the Kelvin scale is a ratio scale due to its zero point representing the complete absence of heat and the meaningful ratios between its values.

      Scales of Measurement in Statistics

      In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.

      Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.

      Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.

      Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 91 - Which statement accurately reflects the standard mortality ratio of a disease in a...

    Incorrect

    • Which statement accurately reflects the standard mortality ratio of a disease in a sampled population that is determined to be 1.4?

      Your Answer:

      Correct Answer: There were 40% more fatalities from the disease in this population compared to the reference population

      Explanation:

      Calculation of Standardised Mortality Ratio (SMR)

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 92 - Circular questioning is commonly utilized in which type of family therapy? ...

    Incorrect

    • Circular questioning is commonly utilized in which type of family therapy?

      Your Answer:

      Correct Answer: Systemic

      Explanation:

      Linear question: When did your brother start using drugs?
      Circular question: How does your brother’s drug use affect the dynamics within your family?

      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.

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 93 - A woman in her 30s frequently washes her hands due to unfounded concerns...

    Incorrect

    • A woman in her 30s frequently washes her hands due to unfounded concerns about germs. What would be the most effective solution?

      Your Answer:

      Correct Answer: Exposure and response prevention

      Explanation:

      Maudsley Guidelines

      First choice: SSRI of clomipramine (SSRI preferred due to tolerability issues with clomipramine)

      Second line:

      – SSRI + antipsychotic
      – Citalopram + clomipramine
      – Acetylcysteine + (SSRI of clomipramine)
      – Lamotrigine + SSRI
      – Topiramate + SSRI

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 94 - A 45-year-old man is referred to you by his primary care physician. He...

    Incorrect

    • A 45-year-old man is referred to you by his primary care physician. He has a history of anxiety and is currently experiencing symptoms of low mood and difficulty sleeping. The physician is concerned about the possibility of depression.
      During your assessment, you note evidence of low mood, initial insomnia, and some feelings of hopelessness. The patient denies any suicidal thoughts.
      What treatment approach would you avoid as part of his management plan?

      Your Answer:

      Correct Answer: Paroxetine

      Explanation:

      The patient’s symptoms suggest a moderate depressive episode, which can be treated with cognitive behavioural therapy (CBT) if it is easily accessible. During pregnancy, amitriptyline, imipramine, and fluoxetine are commonly used antidepressants. However, paroxetine should be avoided due to its short half-life, which can lead to neonatal irritability and withdrawal.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 95 - What PET scan result would strongly suggest the presence of Alzheimer's dementia? ...

    Incorrect

    • What PET scan result would strongly suggest the presence of Alzheimer's dementia?

      Your Answer:

      Correct Answer: Temporoparietal hypometabolism

      Explanation:

      PET scans reveal the level of metabolic activity in different parts of the brain. In individuals with Alzheimer’s disease, the temporoparietal cortices exhibit decreased metabolic activity as a result of the atrophy in those regions.

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      0
      Seconds
  • Question 96 - A 45-year-old individual with a long-standing history of bipolar disorder has been an...

    Incorrect

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

      Your Answer:

      Correct Answer: Transfer to rehabilitation unit

      Explanation:

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

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      0
      Seconds
  • Question 97 - Which medication is recommended as the initial treatment option for opioid detoxification based...

    Incorrect

    • Which medication is recommended as the initial treatment option for opioid detoxification based on NICE guidelines?

      Your Answer:

      Correct Answer: Buprenorphine of methadone

      Explanation:

      Opioid Maintenance Therapy and Detoxification

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

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 98 - What is the term used in psychodynamic theory to describe the process of...

    Incorrect

    • What is the term used in psychodynamic theory to describe the process of internalizing cultural norms and values primarily acquired from parents?

      Your Answer:

      Correct Answer: Superego

      Explanation:

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

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

    • This question is part of the following fields:

      • Psychotherapy
      0
      Seconds
  • Question 99 - Which of the following is an example of primary evidence? ...

    Incorrect

    • Which of the following is an example of primary evidence?

      Your Answer:

      Correct Answer: A case-series of chronic leukocytosis associated with clozapine

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 100 - How common is attempted suicide among individuals who identify with the goth subculture...

    Incorrect

    • How common is attempted suicide among individuals who identify with the goth subculture over their lifetime?

      Your Answer:

      Correct Answer: 47%

      Explanation:

      Suicide and Self-Harm in the Goth Community

      Deliberate self-harm is a common issue among young people, with rates ranging from 7% to 14% in the UK. This behavior is often used as a maladaptive coping mechanism to alleviate negative emotions such as anxiety, anger, guilt, of frustration. However, it is usually not associated with an immediate suicide attempt.

      A large study has found that individuals who identify with the Goth community have a higher prevalence of self-harm and attempted suicide. The study reported a lifetime prevalence of 53% for self-harm (using any method) and 47% for attempted suicide. These findings suggest that the Goth community may be at a higher risk for suicidal behavior and self-harm. It is important to address this issue and provide support for those who may be struggling with these challenges.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds
  • Question 101 - A case-control study was conducted to determine if exposure to passive smoking during...

    Incorrect

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

      Your Answer:

      Correct Answer: 2.25

      Explanation:

      Measures of Effect in Clinical Studies

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 102 - How can bipolar disorder be distinguished from borderline personality disorder? ...

    Incorrect

    • How can bipolar disorder be distinguished from borderline personality disorder?

      Your Answer:

      Correct Answer: Episodic psychomotor activation

      Explanation:

      Psychomotor activation, also known as psychomotor agitation, is characterized by increased speed of thinking, difficulty focusing, excessive energy, and a sense of restlessness. These terms can be used interchangeably.

      Bipolar Disorder Versus BPD

      Bipolar disorder and borderline personality disorder (BPD) can be distinguished from each other based on several factors. Bipolar disorder is characterized by psychomotor activation, which is not typically seen in BPD. Additionally, self-destructive cutting behavior is rare in bipolar disorder but common in BPD. BPD is often associated with sexual trauma, while bipolar disorder has a lower prevalence of sexual trauma. Other BPD features such as identity disturbance and dissociative symptoms are not typically seen in bipolar disorder. Finally, bipolar disorder is highly heritable, while BPD has a lower genetic loading. Understanding these differences is important for accurate diagnosis and treatment.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 103 - A 50-year-old man presents in the early hours of the morning with a...

    Incorrect

    • A 50-year-old man presents in the early hours of the morning with a high fever of 39.5°C. He complains of a stiff neck and headache. He quickly becomes confused and there is evidence of hallucinations in both taste and smell. He then begins to have frequent seizures.
      He has a history of good health except for a pacemaker implanted when he was 40 years old. He has not traveled outside of the United States recently. The medical team requests your assistance as the consulting psychiatrist.
      What would you suggest as the initial investigation to assist with the diagnosis?

      Your Answer:

      Correct Answer: CT scan of the head

      Explanation:

      The patient’s symptoms indicate possible viral encephalitis, likely caused by herpes. To confirm the diagnosis and rule out other infections, a diagnostic examination of the cerebrospinal fluid (CSF) is necessary. However, it is important to ensure the safety of the patient before performing the CSF examination, as there is a risk of herniation. Therefore, a CT scan of the head should be the initial investigation to be carried out, as it can also detect any abscesses that may be present.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 104 - What is a risk management factor included in the HCR-20? ...

    Incorrect

    • What is a risk management factor included in the HCR-20?

      Your Answer:

      Correct Answer: Exposure to destabilizers

      Explanation:

      The HCR-20 is a comprehensive tool used to assess the risk of violence in adults. It takes into account various factors from the past, present, and future to provide a holistic view of the individual’s risk. The tool consists of 20 items, which are divided into three domains: historical, clinical, and risk management.

      The historical domain includes factors such as previous violence, young age at first violent incident, relationship instability, employment problems, substance use problems, major mental illness, psychopathy, early maladjustment, personality disorder, and prior supervision failure. These factors are important to consider as they provide insight into the individual’s past behavior and potential risk for future violence.

      The clinical domain includes factors such as lack of insight, negative attitudes, active symptoms of major mental illness, impulsivity, and unresponsiveness to treatment. These factors are important to consider as they provide insight into the individual’s current mental state and potential risk for future violence.

      The risk management domain includes factors such as plans lack feasibility, exposure to destabilizers, lack of personal support, noncompliance with remediation attempts, and stress. These factors are important to consider as they provide insight into the individual’s ability to manage their risk and potential for future violence.

      Overall, the HCR-20 is a valuable tool for assessing the risk of violence in adults. It provides a comprehensive view of the individual’s risk and can be used to inform treatment and risk management strategies.

    • This question is part of the following fields:

      • Forensic Psychiatry
      0
      Seconds
  • Question 105 - How can you identify advanced heroin withdrawal in a young man who presents...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      0
      Seconds
  • Question 106 - What study method would be most suitable for a researcher tasked with comparing...

    Incorrect

    • What study method would be most suitable for a researcher tasked with comparing the cost-effectiveness of olanzapine and haloperidol in reducing symptom severity of schizophrenia, as measured by the Positive and Negative Syndrome Scale?

      Your Answer:

      Correct Answer: Cost-effectiveness analysis

      Explanation:

      The task assigned to the researcher is to conduct a cost-effectiveness analysis, which involves comparing two interventions based on their costs and their impact on a single clinical measure of effectiveness, specifically the reduction in symptom severity as measured by the PANSS.

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 107 - A colleague in primary care contacts you for advice regarding a case of...

    Incorrect

    • A colleague in primary care contacts you for advice regarding a case of mild panic disorder in a 35-year-old woman. Medical causes have been ruled out.

      According to NICE guidelines, what would be the most appropriate course of action in this case?

      Your Answer:

      Correct Answer: Individual self-help

      Explanation:

      Understanding Panic Disorder: Key Facts, Diagnosis, and Treatment Recommendations

      Panic disorder is a mental health condition characterized by recurrent unexpected panic attacks, which are sudden surges of intense fear of discomfort that reach a peak within minutes. Females are more commonly affected than males, and the disorder typically onsets during the early 20s. Panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.

      To diagnose panic disorder, the individual must experience recurrent panic attacks that are not restricted to particular stimuli of situations and are unexpected. The panic attacks are followed by persistent concern of worry about their recurrence of negative significance, of behaviors intended to avoid their recurrence. The symptoms are not a manifestation of another medical condition of substance use, and they result in significant impairment in functioning.

      Panic disorder is differentiated from normal fear reactions by the frequent recurrence of panic attacks, persistent worry of concern about the panic attacks of their meaning, and associated significant impairment in functioning. Treatment recommendations vary based on the severity of the disorder, with mild to moderate cases recommended for individual self-help and moderate to severe cases recommended for cognitive-behavioral therapy of antidepressant medication. The classes of antidepressants that have an evidence base for effectiveness are SSRIs, SNRIs, and TCAs. Benzodiazepines are not recommended for the treatment of panic disorder due to their association with a less favorable long-term outcome. Sedating antihistamines of antipsychotics should also not be prescribed for the treatment of panic disorder.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 108 - A patient in their late 50s with a history of schizophrenia attends the...

    Incorrect

    • A patient in their late 50s with a history of schizophrenia attends the out-patient clinic. They were discharged from hospital 9 months ago following a relapse of their psychotic illness. They report sustained improvement in their psychotic symptoms. During the clinic they complain that they are feeling very low, and lacking energy and they have felt this way for the past month. Their carer also comments that they are not attending to their self care as they usually do. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Post-schizophrenic depression

      Explanation:

      If an individual experiences depression within a year of a relapse of schizophrenia, it should be classified as post-schizophrenic depression.

      Understanding Post-Psychotic Depression

      The term post-psychotic depression refers to three distinct groups of patients who experience depressive symptoms after an acute psychotic episode. The first group experiences depressive symptoms during the acute episode, which only become apparent as the positive psychotic symptoms resolve. The second group develops depressive symptoms as their positive psychotic symptoms resolve, while the third group experiences significant depressive symptoms after the acute episode has resolved.

      The timing of the onset of depressive symptoms is not important for diagnostic purposes. The ICD 10 diagnostic guidelines for post-schizophrenic depression require that the patient has met general criteria for schizophrenia within the past 12 months, with some schizophrenic symptoms still present but no longer dominating the clinical picture. The depressive symptoms must be prominent and distressing, fulfilling at least the criteria for a depressive episode, and have been present for at least two weeks. While they are rarely severe enough to meet the criteria for a severe depressive episode, they can still be debilitating for the patient.

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 109 - An endocrinologist conducts a study to determine if there is a correlation between...

    Incorrect

    • An endocrinologist conducts a study to determine if there is a correlation between a patient's age and their blood pressure. Assuming both age and blood pressure are normally distributed, what statistical test would be most suitable to use?

      Your Answer:

      Correct Answer: Pearson's product-moment coefficient

      Explanation:

      Since the data is normally distributed and the study aims to evaluate the correlation between two variables, the most suitable test to use is Pearson’s product-moment coefficient. On the other hand, if the data is non-parametric, Spearman’s coefficient would be more appropriate.

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
      Seconds
  • Question 110 - A 25-year-old woman is brought to the GP by her mother. The mother...

    Incorrect

    • A 25-year-old woman is brought to the GP by her mother. The mother reports that she has noticed a change in her daughter's behavior over the past week. She has been more irritable and talkative than usual, and her thoughts seem to be racing. However, the daughter denies any problems and insists that she feels great, despite getting very little sleep. There is no evidence of psychosis, and she has not missed any work. The mother reports a similar episode last year and a history of depression when her daughter was 14. Additionally, the mother's sister was hospitalized and given ECT many years ago. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Bipolar II disorder

      Explanation:

      Based on the symptoms presented, it appears that the individual is experiencing either mania or hypomania. However, as there are no psychotic symptoms and the impairment is not severe, it is more likely that this is hypomania rather than mania. Therefore, the individual may be diagnosed with bipolar II disorder.

      Bipolar Disorder Diagnosis

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      0
      Seconds
  • Question 111 - What traits of conditions can be passed down through autosomal dominant inheritance? ...

    Incorrect

    • What traits of conditions can be passed down through autosomal dominant inheritance?

      Your Answer:

      Correct Answer: Velocardiofacial syndrome

      Explanation:

      Inheritance Patterns and Examples

      Autosomal Dominant:
      Neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, and Noonan’s syndrome are all examples of conditions that follow an autosomal dominant inheritance pattern. This means that only one copy of the mutated gene is needed to cause the condition.

      Autosomal Recessive:
      Phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, and cystic fibrosis are all examples of conditions that follow an autosomal recessive inheritance pattern. This means that two copies of the mutated gene are needed to cause the condition.

      X-Linked Dominant:
      Vitamin D resistant rickets and Rett syndrome are examples of conditions that follow an X-linked dominant inheritance pattern. This means that the mutated gene is located on the X chromosome and only one copy of the gene is needed to cause the condition.

      X-Linked Recessive:
      Cerebellar ataxia, Hunter’s syndrome, and Lesch-Nyhan are examples of conditions that follow an X-linked recessive inheritance pattern. This means that the mutated gene is located on the X chromosome and two copies of the gene are needed to cause the condition.

      Mitochondrial:
      Leber’s hereditary optic neuropathy and Kearns-Sayre syndrome are examples of conditions that follow a mitochondrial inheritance pattern. This means that the mutated gene is located in the mitochondria and is passed down from the mother to her offspring.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      0
      Seconds