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  • Question 1 - What is the statistical test that is represented by the F statistic? ...

    Correct

    • What is the statistical test that is represented by the F statistic?

      Your 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
      5
      Seconds
  • Question 2 - A teenager is referred after experiencing a traumatic event that has caused a...

    Incorrect

    • A teenager is referred after experiencing a traumatic event that has caused a decline in their mental well-being. What would be the most helpful in distinguishing between a diagnosis of post traumatic stress disorder and adjustment disorder?

      Your Answer: The symptoms have persisted for over three months

      Correct Answer: The patient reports flashbacks

      Explanation:

      If an individual experiences symptoms that meet the criteria for Post-Traumatic Stress Disorder but the event of situation is not considered serious, they should be diagnosed with adjustment disorder instead. Additionally, it is common for individuals who have experienced a highly traumatic event to develop adjustment disorder rather than Post-Traumatic Stress Disorder. The diagnosis should be based on meeting the full diagnostic criteria for either disorder, rather than solely on the type of stressor experienced.

      Stress disorders, such as Post Traumatic Stress Disorder (PTSD), are emotional reactions to traumatic events. The diagnosis of PTSD requires exposure to an extremely threatening of horrific event, followed by the development of a characteristic syndrome lasting for at least several weeks, consisting of re-experiencing the traumatic event, deliberate avoidance of reminders likely to produce re-experiencing, and persistent perceptions of heightened current threat. Additional clinical features may include general dysphoria, dissociative symptoms, somatic complaints, suicidal ideation and behaviour, social withdrawal, excessive alcohol of drug use, anxiety symptoms, and obsessions of compulsions. The emotional experience of individuals with PTSD commonly includes anger, shame, sadness, humiliation, of guilt. The onset of PTSD symptoms can occur at any time during the lifespan following exposure to a traumatic event, and the symptoms and course of PTSD can vary significantly over time and individuals. Key differentials include acute stress reaction, adjustment disorder, and complex PTSD. Management of PTSD includes trauma-focused cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and supported trauma-focused computerized CBT interventions. Drug treatments, including benzodiazepines, are not recommended for the prevention of treatment of PTSD in adults, but venlafaxine of a selective serotonin reuptake inhibitor (SSRI) may be considered for adults with a diagnosis of PTSD if the person has a preference for drug treatment. Antipsychotics such as risperidone may be considered in addition if disabling symptoms and behaviors are present and have not responded to other treatments. Psychological debriefing is not recommended for the prevention of treatment of PTSD. For children and young people, individual trauma-focused CBT interventions of EMDR may be considered, but drug treatments are not recommended.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 3 - What is the most prevalent type of disorder among secondary school children residing...

    Correct

    • What is the most prevalent type of disorder among secondary school children residing in England, based on the 2017 survey data?

      Your Answer: Emotional disorders

      Explanation:

      Conduct disorder is prevalent among children aged 5-15, while emotional problems are the primary concern for secondary school-aged children. Conversely, primary-aged children are more likely to exhibit behavioural problems.

      Epidemiology of Mental Health Disorders in Children and Adolescents

      The Department of Health (DoH) survey titled The Mental Health of Children and Young People in England is the primary source of epidemiological data on children and adolescents aged 2-19. The latest survey was conducted in 2017 and involved over 9000 participants. The data was collected through interviews with the child, their parent, and their teacher (if school-aged).

      The survey found that 1 in 8 children aged 5-19 had a mental disorder, with emotional disorders being the most common, followed by behavioural, hyperactivity, and other disorders such as ASD, eating disorders, and tic disorders. The prevalence of mental disorders has slightly increased over recent decades, with a rise in emotional problems since 2004.

      Rates of mental disorders tend to be higher in older age groups, but there is some inconsistency with behavioural and hyperactivity types. For preschool children, 1 in 18 had at least one mental disorder, while for primary school children, 1 in 10 had at least one mental disorder, with behavioural and emotional disorders being the most common. Rates of emotional disorders were similar in boys and girls, while other types of disorders were more common in boys.

      For secondary school children, 1 in 7 had at least one mental disorder, with emotional disorders being the most common. Among those aged 17-19, 1 in 6 had at least one mental disorder, with emotional disorders being the most common, mainly anxiety. Girls aged 17-19 had the highest likelihood of having a mental disorder, with nearly one in four having a mental disorder and 22.4% having an emotional disorder.

      In summary, the epidemiology of mental health disorders in children and adolescents in England highlights the need for early intervention and support for emotional and behavioural problems, particularly in older age groups and among girls.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 4 - What is the name of the harmful substance produced by the body when...

    Correct

    • What is the name of the harmful substance produced by the body when someone takes too much paracetamol, leading to liver damage?

      Your Answer: Benzoquinoneimine

      Explanation:

      Paracetamol’s main byproduct is benzoquinoneimine, a highly reactive substance that typically binds with glutathione. However, when glutathione levels are low, it can bind to liver protein and result in liver damage.

      Self-Harm and its Management

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 5 - In the initial phases of Parkinson's disease, what type of hallucinations are more...

    Incorrect

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

      Your Answer: Pareidolic illusions

      Correct Answer: Passage hallucinations

      Explanation:

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 6 - A stable postpartum patient, with a history of depression, has just given birth....

    Incorrect

    • A stable postpartum patient, with a history of depression, has just given birth. She asks for your advice about breastfeeding. She has been stable on her current antidepressant medication for several years, although had multiple episodes of depression in the past.
      Which of the following prescribed medications would lead you to advise against breastfeeding?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      In the scenario described, the patient has treatment-resistant schizophrenia and is currently stable. Therefore, it may not be necessary to change their antipsychotic medication, as the benefits of continuing their current medication may outweigh the potential risks to the baby if they choose to breastfeed. However, it is important to consider the specific medication being taken and consult with a healthcare professional to determine the best course of action.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 7 - How can you differentiate between a tic and a stereotypy in a child...

    Incorrect

    • How can you differentiate between a tic and a stereotypy in a child who exhibits repetitive leg tapping with their hand?

      Your Answer:

      Correct Answer: The movement lacks rhythmicity

      Explanation:

      Stereotypies are generally not inhibited and do not cause discomfort to those who exhibit them. On the contrary, they seem to have a calming effect.

      Tourette’s Syndrome: Understanding the Disorder and Management Options

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 8 - The patient inquires about the potential memory impairment caused by ECT. Which specific...

    Incorrect

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

      Your Answer:

      Correct Answer: Retrograde and anterograde

      Explanation:

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

      ECT (Treatment) – Summary of Effectiveness and Recommendations

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

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

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

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

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 9 - What is the recommended duration for a therapeutic trial of methylphenidate of lisdexamfetamine?...

    Incorrect

    • What is the recommended duration for a therapeutic trial of methylphenidate of lisdexamfetamine?

      Your Answer:

      Correct Answer: 6 weeks

      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
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  • Question 10 - 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
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  • Question 11 - What factor is most likely to trigger a seizure in a patient with...

    Incorrect

    • What factor is most likely to trigger a seizure in a patient with epilepsy?

      Your Answer:

      Correct Answer: Amitriptyline

      Explanation:

      Out of the given options, Amitriptyline (TCA) is classified as high risk while the others are categorized as either moderate of low risk.

      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
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  • Question 12 - A young adult with recurrent depression achieves remission with the use of sertraline....

    Incorrect

    • A young adult with recurrent depression achieves remission with the use of sertraline. How long should drug treatment be continued to prevent relapse?

      Your Answer:

      Correct Answer: 2 years

      Explanation:

      Depression Treatment Guidelines by NICE

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

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

      The stepped care approach involves the following steps:

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 13 - What is the recommended approach by NICE for managing distress in patients with...

    Incorrect

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

      Your Answer:

      Correct Answer: Haloperidol

      Explanation:

      Delirium Management

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 14 - How should a patient with anorexia nervosa and a BMI of 14 be...

    Incorrect

    • How should a patient with anorexia nervosa and a BMI of 14 be managed appropriately?

      Your Answer:

      Correct Answer: Unsupervised use of toilet facilities

      Explanation:

      The MARSIPAN group has provided specific recommendations for managing the physical health issues of patients with anorexia nervosa. These recommendations vary depending on the patient’s BMI, with different management plans suggested for those with a BMI below 15 and those with a BMI below 13. For patients with a BMI below 15, the group suggests allowing unsupervised use of the toilet, but advises that fluid balance monitoring may be necessary. The other options mentioned in the question are relevant for patients with a BMI below 13. The MARSIPAN guidelines were published in October 2010 as the College Report CR162 by the Royal College of Psychiatrists and Royal College of Physicians in London.

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 15 - What is the purpose of using bracketing as a method in qualitative research?...

    Incorrect

    • What is the purpose of using bracketing as a method in qualitative research?

      Your Answer:

      Correct Answer: Assessing validity

      Explanation:

      Qualitative research is a method of inquiry that seeks to understand the meaning and experience dimensions of human lives and social worlds. There are different approaches to qualitative research, such as ethnography, phenomenology, and grounded theory, each with its own purpose, role of the researcher, stages of research, and method of data analysis. The most common methods used in healthcare research are interviews and focus groups. Sampling techniques include convenience sampling, purposive sampling, quota sampling, snowball sampling, and case study sampling. Sample size can be determined by data saturation, which occurs when new categories, themes, of explanations stop emerging from the data. Validity can be assessed through triangulation, respondent validation, bracketing, and reflexivity. Analytical approaches include content analysis and constant comparison.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      0
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  • Question 16 - What is the most prevalent personality disorder among individuals in Great Britain? ...

    Incorrect

    • What is the most prevalent personality disorder among individuals in Great Britain?

      Your Answer:

      Correct Answer: Anankastic

      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
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  • Question 17 - To address the increasing suicidal tendencies of a patient with bipolar disorder, what...

    Incorrect

    • To address the increasing suicidal tendencies of a patient with bipolar disorder, what would be the most suitable medication for stabilizing their mood?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      Among mood stabilizers, lithium has the most notable impact on decreasing suicidal tendencies in individuals diagnosed with bipolar disorder.

      Lithium’s Effectiveness in Reducing Suicide in Bipolar Disorder Patients

      Lithium has been found to be more effective than other mood stabilizers in reducing completed suicide in individuals with bipolar disorder. This effect is significant, with estimates suggesting that lithium can reduce both attempted and completed suicide by 80% in this patient population.

      According to the Maudsley Guidelines 10th Edition, lithium is a highly effective treatment option for bipolar disorder patients who are at risk of suicide. Its ability to reduce suicidal behavior is a crucial factor in its use as a mood stabilizer. The guidelines recommend that lithium be considered as a first-line treatment option for patients with bipolar disorder who are at high risk of suicide.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 18 - What statistical test would be appropriate to compare the mean cholesterol levels of...

    Incorrect

    • What statistical test would be appropriate to compare the mean cholesterol levels of individuals who were given antipsychotics versus those who were given a placebo in a study with a sample size of 100 participants divided into two groups?

      Your Answer:

      Correct Answer: Independent t-test

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 19 - What is the correct approach to treating tardive dyskinesia? ...

    Incorrect

    • What is the correct approach to treating tardive dyskinesia?

      Your Answer:

      Correct Answer: Reduction of the antipsychotic may worsen tardive dyskinesia

      Explanation:

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 20 - What is true about the 2014 Adult Psychiatric Morbidity Survey? ...

    Incorrect

    • What is true about the 2014 Adult Psychiatric Morbidity Survey?

      Your Answer:

      Correct Answer: People in prisons were not included in the sample

      Explanation:

      The APMS has a significant drawback in that it solely relies on household data and does not incorporate data from institutions like prisons.

      Adult Psychiatric Morbidity Survey

      The Adult Psychiatric Morbidity Survey (APMS), also known as the National Psychiatric Morbidity Survey, is conducted every 7 years to monitor the prevalence of mental illness and access to treatment in the general population of England. The survey obtains a stratified random sample representative of the population living in private households by using postcodes. The information is gathered through questionnaires and interviews to screen for a range of mental disorders and risk factors. However, the survey does not collect data on individuals under the age of 16. The study does not include people living in institutional settings such as prisons of care homes, of those who are homeless of living in temporary housing.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 21 - What is a physical symptom commonly associated with anxiety? ...

    Incorrect

    • What is a physical symptom commonly associated with anxiety?

      Your Answer:

      Correct Answer: Dry mouth

      Explanation:

      The question is specifically inquiring about the physical symptom, which is also known as the somatic symptom. The term ‘somatic’ pertains to bodily sensations of experiences, rather than mental of emotional ones.

      Generalised Anxiety Disorder: Symptoms and Diagnosis

      Generalised anxiety disorder is a condition characterized by persistent symptoms of anxiety that last for several months and occur on most days. The symptoms can be either general apprehension of excessive worry about multiple everyday events, such as family, health, finances, and work of school. In addition to these symptoms, individuals with generalised anxiety disorder may experience muscular tension, motor restlessness, sympathetic autonomic overactivity, nervousness, difficulty concentrating, irritability, of sleep disturbance.

      To diagnose generalised anxiety disorder, healthcare professionals look for specific essential features. These include marked symptoms of anxiety that are not restricted to any particular environmental circumstance, and are accompanied by additional characteristic symptoms such as muscle tension, autonomic overactivity, nervousness, difficulty concentrating, irritability, and sleep disturbances. The symptoms must persist for at least several months, for more days than not, and cannot be better accounted for by another mental disorder of medical condition. The symptoms must also result in significant distress of impairment in personal, family, social, educational, occupational, of other important areas of functioning.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 22 - After discovering that a child with attention deficit hyperactivity disorder has developed tics...

    Incorrect

    • After discovering that a child with attention deficit hyperactivity disorder has developed tics while taking lisdexamfetamine, and having previously experienced similar results with methylphenidate, a discussion with the parents leads to the decision to try a different medication. Which of the following options would be the most suitable choice?

      Your Answer:

      Correct Answer: Atomoxetine

      Explanation:

      A long-acting version of methylphenidate is Medikinet XL, which is recommended for ADHD cases where stimulant use leads to complications with tics.

      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
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  • Question 23 - A 75 year old woman admitted to hospital with a broken hip develops...

    Incorrect

    • A 75 year old woman admitted to hospital with a broken hip develops depression whilst on the ward. She is on a beta blocker for atrial fibrillation and ibuprofen for osteoarthritis. What would be the most suitable antidepressant for her?

      Your Answer:

      Correct Answer: Mirtazapine

      Explanation:

      Choosing an antidepressant for older individuals can be challenging as there is no perfect option. TCAs, particularly older ones, are not recommended due to the risk of cardiac conduction abnormalities and anticholinergic effects. While SSRIs are generally better tolerated, they do carry an increased risk of bleeding, which is a concern in this case. Additionally, older individuals are more prone to developing hyponatremia, postural hypotension, and falls with SSRIs. NICE recommends considering mirtazapine as it has less serotonin reuptake inhibition, making it a potentially suitable option. Ultimately, the decision must balance the risks of bleeding from SSRIs with the risks of arrhythmia from TCAs.

      SSRI and Bleeding Risk: Management Strategies

      SSRIs have been linked to an increased risk of bleeding, particularly in vulnerable populations such as the elderly, those with a history of bleeding, and those taking medications that predispose them to bleeding. The risk of bleeding is further elevated in patients with comorbidities such as liver of renal disease, smoking, and alcohol of drug misuse.

      To manage this risk, the Maudsley recommends avoiding SSRIs in patients receiving NSAIDs, aspirin, of oral anticoagulants, of those with a history of cerebral of GI bleeds. If SSRI use cannot be avoided, close monitoring and prescription of gastroprotective proton pump inhibitors are recommended. The degree of serotonin reuptake inhibition varies among antidepressants, with some having weaker of no inhibition, which may be associated with a lower risk of bleeding.

      NICE recommends caution when using SSRIs in patients taking aspirin and suggests considering alternative antidepressants such as trazodone, mianserin, of reboxetine. In patients taking warfarin of heparin, SSRIs are not recommended, but mirtazapine may be considered with caution.

      Overall, healthcare providers should carefully weigh the risks and benefits of SSRI use in patients at risk of bleeding and consider alternative antidepressants of gastroprotective measures when appropriate.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 24 - You are asked to assess a teenage girl with borderline personality disorder who...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

      Self-Harm and its Management

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 25 - What is the initial medication prescribed for a 9 year old boy with...

    Incorrect

    • What is the initial medication prescribed for a 9 year old boy with ADHD and no other medical conditions?

      Your Answer:

      Correct Answer: Methylphenidate

      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
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  • Question 26 - What is a commonly used tool for predicting the likelihood of someone committing...

    Incorrect

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

      Your Answer:

      Correct Answer: RRASOR

      Explanation:

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

      Methods of Risk Assessment

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 27 - What is the accurate formula for determining the pre-test odds? ...

    Incorrect

    • What is the accurate formula for determining the pre-test odds?

      Your Answer:

      Correct Answer: Pre-test probability/ (1 - pre-test probability)

      Explanation:

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 28 - What is the most accurate approximation of the occurrence rate of schizophrenia among...

    Incorrect

    • What is the most accurate approximation of the occurrence rate of schizophrenia among adults who have a learning disability?

      Your Answer:

      Correct Answer: 3%

      Explanation:

      As mentioned in previous questions, the number found in the general population is one-third of what is found here.

      Learning Disability and comorbid Psychiatric Illness

      It is estimated that 30-50% of adults with learning disabilities also experience mental health problems, including problem behavior. Specific prevalence rates for various mental health disorders in this population have been identified through research. For example, psychotic disorders are present in 4% of adults with learning disabilities, while affective disorders are present in 6%. Autism is the most prevalent disorder, affecting 7.5% of this population.

      It is important to note that major depressive disorder can occur at all IQ levels in people with learning disabilities, but may be missed of misinterpreted as challenging behavior. Additionally, individuals with learning disabilities are more susceptible to the negative effects of life events and may develop adjustment disorder. Post-traumatic stress disorder is also common in this population.

      Stimulant drugs may be less effective in children with learning disabilities and should be used with caution in individuals with Tourette’s of autism, as they may trigger tics. Overall, it is crucial to recognize and address comorbid psychiatric illness in individuals with learning disabilities to ensure appropriate treatment and support.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 29 - What is a true statement about night terrors? ...

    Incorrect

    • What is a true statement about night terrors?

      Your Answer:

      Correct Answer: Amnesia following a night terror is normal

      Explanation:

      Night Terrors: Understanding the Condition

      Night terrors, also known as pavor nocturnus of sleep terrors, are a common occurrence in children aged 3-12, with the majority of cases happening when a child is 3-4 years old. Both boys and girls are equally affected, and the condition usually resolves on its own during adolescence, although it can still occur in adults. These episodes typically last between 1 to 15 minutes and occur 1 to 3 hours after sleep has begun.

      Night terrors are different from nightmares, which occur during REM sleep. Night terrors happen during the transition from stage 3 to stage 4 sleep, and children have no memory of the event the next morning. During a night terror, a child experiences intense crying and distress while asleep, usually around 90 minutes after falling asleep. They are unresponsive to external stimuli during this time.

      Night terrors are distinct from nightmares in several ways. For example, there is no recall of the event with night terrors, while there may be partial recall with nightmares. Night terrors occur early in sleep, while nightmares occur later. Additionally, night terrors are associated with significant autonomic arousal, while nightmares have minimal arousal.

      It is important to note that the information presented here is based on the Rechtschaffen and Kales sleep classification model developed in 1968, which is the classification used in the Royal College questions. However, in 2004, the American Academy of Sleep Medicine (AASM) reclassified NREM (non-REM) sleep into three stages, the last of which is also called delta sleep of slow-wave sleep.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 30 - In what specific area of psychiatry is the DUNDRUM toolkit utilized? ...

    Incorrect

    • In what specific area of psychiatry is the DUNDRUM toolkit utilized?

      Your Answer:

      Correct Answer: Forensic

      Explanation:

      DUNDRUM-4 Recovery Items

      The DUNDRUM-4 Recovery Items is a structured professional judgement instrument that assesses a patient’s progress towards recovery and their readiness for discharge from a secure mental health facility. It consists of 17 items that cover various aspects of recovery, such as symptom management, social functioning, and engagement in therapeutic activities.

      The instrument is designed to be used by mental health professionals to monitor a patient’s progress over time and to identify areas where additional support of interventions may be needed. It can also be used to inform discharge planning and to ensure that patients are discharged safely and with appropriate follow-up care.

      Overall, the DUNDRUM toolkit provides a comprehensive approach to assessing and managing patients in secure mental health facilities, with a focus on promoting recovery and ensuring that patients receive the appropriate level of care and support.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 31 - What proportion of individuals with severe mental illness are responsible for committing violent...

    Incorrect

    • What proportion of individuals with severe mental illness are responsible for committing violent crimes?

      Your Answer:

      Correct Answer: 1 in 20

      Explanation:

      Mental Health Risk in Sweden: Data on Violent Crimes Committed by People with Severe Mental Illness

      According to data from Sweden’s national register, 2.4% of violent crimes were committed by individuals with severe mental illness. This suggests that there is a mental health risk associated with violent crime in Sweden. However, it is important to note that this percentage only accounts for a small portion of all violent crimes.

      The population attributable risk fraction of patients was found to be 5%, indicating that patients with severe mental illness are responsible for 1 in 20 violent crimes. This highlights the need for effective mental health treatment and support for individuals with severe mental illness to reduce the risk of violent behavior.

      Overall, the data from Sweden’s national register provides important insights into the relationship between mental illness and violent crime. While the percentage of violent crimes committed by individuals with severe mental illness is relatively low, it is still a significant concern that requires attention and action from mental health professionals and policymakers.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 32 - What is one of the diagnostic criteria for conduct disorder according to DSM-5?...

    Incorrect

    • What is one of the diagnostic criteria for conduct disorder according to DSM-5?

      Your Answer:

      Correct Answer: Often bullies, threatens, of intimidates others

      Explanation:

      Individuals diagnosed with conduct disorder typically engage in bullying, intimidation, and threats towards others, with a primary emphasis on their behavior. In contrast, oppositional defiant disorder can be viewed as a milder form of conduct disorder, as it encompasses both behavior and emotions.

      Disruptive Behaviour of Dissocial Disorders

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

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

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 33 - A woman in her 50s who has a lengthy history of schizophrenia has...

    Incorrect

    • A woman in her 50s who has a lengthy history of schizophrenia has experimented with various antipsychotics before and is now interested in trying a new one. She cannot remember the names of the ones she has taken in the past but remembers being informed that she experienced anticholinergic side-effects and wants to avoid them at all costs. Which of the following choices is most probable to lead to anticholinergic side-effects?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      Clozapine exhibits significant anticholinergic effects, resulting in both xerostomia and excessive salivation.

      Antipsychotics: Common Side Effects and Relative Adverse Effects

      Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.

      Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.

      Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.

      Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.

      Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.

      The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.

      Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
      Amisulpride – + + + – – +++
      Aripiprazole – +/- – +/- – – –
      Asenapine + + +/- +/- – – +/-
      Clozapine +++ +++ +++ – +++ +++ –
      Flupentixol + ++ + ++ ++ + +++
      Fluphenazine + + + +++ ++ + +++
      Haloperidol + + +/- +++ + + +++
      Olanzapine ++ +++ +++ +/- + + +
      Paliperidone + ++ + + + ++ +++
      Pimozide + + – + + + +++
      Quetiapine ++ ++ ++ – + ++ –
      Risperidone + ++ + + + ++ +++
      Zuclopenthixol ++ ++ + ++ ++ + +++

      Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 34 - How does the suicide rate in patients with epilepsy compare to the general...

    Incorrect

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

      Your Answer:

      Correct Answer: 3 times higher

      Explanation:

      Suicide Risk in Epilepsy

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 35 - What is the expected duration of detectability in urine after a one-time use...

    Incorrect

    • What is the expected duration of detectability in urine after a one-time use of cannabis?

      Your Answer:

      Correct Answer: 3 days

      Explanation:

      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
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  • Question 36 - Compared to other research models, which one yields the most robust and reliable...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 37 - What statement accurately describes the mean? ...

    Incorrect

    • What statement accurately describes the mean?

      Your Answer:

      Correct Answer: Is sensitive to a change in any value in the data set

      Explanation:

      Measures of Central Tendency

      Measures of central tendency are used in descriptive statistics to summarize the middle of typical value of a data set. There are three common measures of central tendency: the mean, median, and mode.

      The median is the middle value in a data set that has been arranged in numerical order. It is not affected by outliers and is used for ordinal data. The mode is the most frequent value in a data set and is used for categorical data. The mean is calculated by adding all the values in a data set and dividing by the number of values. It is sensitive to outliers and is used for interval and ratio data.

      The appropriate measure of central tendency depends on the measurement scale of the data. For nominal and categorical data, the mode is used. For ordinal data, the median of mode is used. For interval data with a normal distribution, the mean is preferable, but the median of mode can also be used. For interval data with skewed distribution, the median is used. For ratio data, the mean is preferable, but the median of mode can also be used for skewed data.

      In addition to measures of central tendency, the range is also used to describe the spread of a data set. It is calculated by subtracting the smallest value from the largest value.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 38 - What is the classification of the prevention strategy being used for a group...

    Incorrect

    • What is the classification of the prevention strategy being used for a group of children who are identified as at risk of self-harm due to factors such as parental divorce and academic attainment, and are referred to a support program to prevent self-harm?

      Your Answer:

      Correct Answer: Selective

      Explanation:

      Prevention measures can be classified into different levels, depending on the stage at which they are implemented. The first model, developed in the 1960s, includes primary, secondary, and tertiary prevention. Primary prevention aims to intervene before a disease of problem begins, and can be universal (targeted to the general public), selective (targeted to a high-risk population), of indicated (targeted to individuals with minimal but detectable signs of a disorder). Secondary prevention aims to detect and treat disease that has not yet become symptomatic, while tertiary prevention involves the care of established disease.

      A newer model, developed in 1992, focuses on prevention interventions used before the initial onset of a disorder. This model also includes three levels: universal prevention (targeted to the general population), selective prevention (targeted to a high-risk population), and indicated prevention (targeted to individuals with minimal but detectable signs of a disorder). Examples of prevention measures include cognitive interventions for adolescents with cognitive deficits to prevent the later phases of schizophrenia, screening procedures for early detection and treatment of disease, and the use of low-dose atypical antipsychotics and CBT for patients with prodromal symptoms of schizophrenia to delay of prevent disease onset.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 39 - Which offense is classified as a summary offense? ...

    Incorrect

    • Which offense is classified as a summary offense?

      Your Answer:

      Correct Answer: Soliciting in a public place

      Explanation:

      While prostitution is not illegal in the UK, certain activities related to it are considered criminal offenses. These include soliciting in public, managing a brothel, and pimping. Most of these offenses are considered summary offenses, but more serious offenses, such as rape, murder, and piracy, are considered indictable offenses and are tried in the Crown Court.

      Court Structure in England and Wales

      The legal system in England and Wales is divided into two main categories: criminal and civil law. Criminal law governs the rules set by the state for citizens, while civil law regulates the relationships and transactions between citizens.

      All criminal cases begin in the Magistrates’ Court. Criminal offenses are classified into three main categories: summary offenses, triable either way offenses, and indictable offenses. Summary offenses are the least serious and are tried in the Magistrates’ Court, with a maximum penalty of six months imprisonment and/of a fine of up to £5,000. Triable either way offenses are the middle range of crimes and can be tried in either the Magistrates’ Court of Crown Court. Indictable offenses are the most serious crimes, including murder, manslaughter, and rape, and must be tried in the Crown Court, with the first hearing at the Magistrates’ Court.

      Magistrates’ courts handle 95% of cases, including many civil cases such as family matters, liquor licensing, and betting and gaming. Magistrates cannot typically order sentences of imprisonment exceeding six months (of 12 months for consecutive sentences) of fines exceeding £5,000. In cases triable either way, the offender may be committed by the magistrates to the Crown Court for sentencing if a more severe sentence is deemed necessary.

      The Crown Court deals with serious criminal cases, some of which are on appeal of referred from Magistrates’ courts. Trials are heard by a Judge and a 12-person jury. The Crown Court is located at 77 centers across England and Wales and handles cases transferred from the Magistrates’ Courts. It also hears appeals against decisions of Magistrate’s Courts and deals with cases sent for sentence from Magistrates’ Courts.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 40 - A 62-year-old woman is referred to your clinic. Her daughter has noticed a...

    Incorrect

    • A 62-year-old woman is referred to your clinic. Her daughter has noticed a slight change in her mother's behavior and increased forgetfulness over the past six months. This started after she had a transient ischemic attack and has since worsened. She has type 1 diabetes mellitus and is on insulin. You perform cognitive testing and refer the woman for an EEG.
      What is the most probable EEG result?

      Your Answer:

      Correct Answer: Asymmetrical pattern of waves

      Explanation:

      The individual is exhibiting symptoms consistent with vascular dementia, which is supported by minor changes in behavior, a medical history of transient ischaemic attacks and diabetes mellitus. An EEG scan reveals an uneven pattern caused by infarctions in the brain due to small vessel disease.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 41 - What is the minimum effective dose of amisulpride recommended for treating first-episode psychosis...

    Incorrect

    • What is the minimum effective dose of amisulpride recommended for treating first-episode psychosis in an adult male?

      Your Answer:

      Correct Answer: 300 mg

      Explanation:

      Antipsychotics: Minimum Effective Doses

      The Maudsley Guidelines provide a table of minimum effective oral doses for antipsychotics in schizophrenia. The following doses are recommended for first episode and relapse (multi-episode) cases:

      – Chlorpromazine: 200mg (first episode) and 300mg (relapse)
      – Haloperidol: 2mg (first episode) and 4mg (relapse)
      – Sulpiride: 400mg (first episode) and 800mg (relapse)
      – Trifluoperazine: 10mg (first episode) and 15mg (relapse)
      – Amisulpride: 300mg (first episode) and 400mg (relapse)
      – Aripiprazole: 10mg (first episode and relapse)
      – Olanzapine: 5mg (first episode) and 7.5mg (relapse)
      – Quetiapine: 150mg (first episode) and 300mg (relapse)
      – Risperidone: 2mg (first episode) and 4mg (relapse)

      The minimum effective doses may vary depending on individual patient factors and response to treatment. It is important to consult with a healthcare professional before making any changes to medication dosages.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 42 - What is the term used to describe when a parent takes the life...

    Incorrect

    • What is the term used to describe when a parent takes the life of their own child?

      Your Answer:

      Correct Answer: Filicide

      Explanation:

      The act of a parent killing their child is known as filicide, while matricide specifically refers to the killing of one’s husband. Matricide is the act of killing one’s mother, while patricide refers to the killing of one’s father. Fratricide, on the other hand, refers to the act of killing one’s own brother.

      Infant Homicide

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 43 - What type of regression is appropriate for analyzing data with dichotomous variables? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Logistic

      Explanation:

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

      Stats: Correlation and Regression

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 44 - What diagnosis is suggested by the MRI findings of ventricular enlargement with preserved...

    Incorrect

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

      Your Answer:

      Correct Answer: Lewy body dementia

      Explanation:

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 45 - What is the most prevalent type of anxiety disorder? ...

    Incorrect

    • What is the most prevalent type of anxiety disorder?

      Your Answer:

      Correct Answer: Specific phobia

      Explanation:

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 46 - An aging patient is referred by their GP due to concerns about memory...

    Incorrect

    • An aging patient is referred by their GP due to concerns about memory loss that has been worsening over the past three years. Upon examination, you diagnose the patient with Alzheimer's disease and administer an MMSE test resulting in a score of 9. A CT scan is ordered and reveals only generalized atrophy. What would be the appropriate course of action in this scenario?

      Your Answer:

      Correct Answer: Memantine

      Explanation:

      The clinical assessment of a patient with Alzheimer’s disease guides the decision to initiate treatment. NICE guidelines suggest the use of memantine for individuals with advanced Alzheimer’s disease, as indicated by a score of 0-10 on the MMSE.

      Treatment of Dementia: AChE Inhibitors and Memantine

      Dementia is a debilitating condition that affects millions of people worldwide. Acetylcholinesterase inhibitors (AChE inhibitors) and memantine are two drugs used in the management of dementia. AChE inhibitors prevent cholinesterase from breaking down acetylcholine, which is deficient in Alzheimer’s due to loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are AChE inhibitors used in the management of Alzheimer’s. Memantine is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.

      NICE guidelines recommend the use of AChE inhibitors for managing mild to moderate Alzheimer’s and memantine for managing moderate to severe Alzheimer’s. For those already taking an AChE inhibitor, memantine can be added if the disease is moderate of severe. AChE inhibitors are also recommended for managing mild, moderate, and severe dementia with Lewy bodies, while memantine is considered if AChE inhibitors are not tolerated of contraindicated. AChE inhibitors and memantine are not recommended for vascular dementia, frontotemporal dementia, of cognitive impairment due to multiple sclerosis.

      The British Association for Psychopharmacology recommends AChE inhibitors as the first choice for Alzheimer’s and mixed dementia, while memantine is the second choice. AChE inhibitors and memantine are also recommended for dementia with Parkinson’s and dementia with Lewy bodies.

      In summary, AChE inhibitors and memantine are important drugs used in the management of dementia. The choice of drug depends on the type and severity of dementia, as well as individual patient factors.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 47 - A 70 year old woman is referred by her general practitioner due to...

    Incorrect

    • A 70 year old woman is referred by her general practitioner due to a concern about cognitive impairment confirmed by a score of 20 on the MMSE. Her MRI shows atrophy and white matter hyperintensities. What would be the most appropriate course of action for management?

      Your Answer:

      Correct Answer: Donepezil

      Explanation:

      The CT scan commonly shows mixed dementia in patients with Alzheimer’s, making it challenging to distinguish from vascular dementia even with imaging. NICE recommends using AChE-I for mixed dementia cases. A previous Cochrane review (Rands 2000) found no proof to support the use of aspirin in vascular dementia.

      Treatment of Dementia: AChE Inhibitors and Memantine

      Dementia is a debilitating condition that affects millions of people worldwide. Acetylcholinesterase inhibitors (AChE inhibitors) and memantine are two drugs used in the management of dementia. AChE inhibitors prevent cholinesterase from breaking down acetylcholine, which is deficient in Alzheimer’s due to loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are AChE inhibitors used in the management of Alzheimer’s. Memantine is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.

      NICE guidelines recommend the use of AChE inhibitors for managing mild to moderate Alzheimer’s and memantine for managing moderate to severe Alzheimer’s. For those already taking an AChE inhibitor, memantine can be added if the disease is moderate of severe. AChE inhibitors are also recommended for managing mild, moderate, and severe dementia with Lewy bodies, while memantine is considered if AChE inhibitors are not tolerated of contraindicated. AChE inhibitors and memantine are not recommended for vascular dementia, frontotemporal dementia, of cognitive impairment due to multiple sclerosis.

      The British Association for Psychopharmacology recommends AChE inhibitors as the first choice for Alzheimer’s and mixed dementia, while memantine is the second choice. AChE inhibitors and memantine are also recommended for dementia with Parkinson’s and dementia with Lewy bodies.

      In summary, AChE inhibitors and memantine are important drugs used in the management of dementia. The choice of drug depends on the type and severity of dementia, as well as individual patient factors.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 48 - What defence mechanism is commonly observed in individuals in the paranoid-schizoid position? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Splitting

      Explanation:

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

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 49 - The national Health Department is concerned about reducing mortality rates among elderly patients...

    Incorrect

    • The national Health Department is concerned about reducing mortality rates among elderly patients with heart disease. They have tasked a team of researchers with comparing the effectiveness and economic costs of treatment options A and B in terms of life years gained. The researchers have collected data on the number of life years gained by each treatment option and are seeking advice on the next steps for analysis. What type of analysis would you recommend they undertake?

      Your Answer:

      Correct Answer: Cost effectiveness analysis

      Explanation:

      Cost effectiveness analysis (CEA) is an economic evaluation method that compares the costs and outcomes of different courses of action. The outcomes of the interventions must be measurable using a single variable, such as life years gained, making it useful for comparing preventative treatments for fatal conditions.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 50 - What drug is classified as a schedule 3 controlled substance? ...

    Incorrect

    • What drug is classified as a schedule 3 controlled substance?

      Your Answer:

      Correct Answer: Temazepam

      Explanation:

      Temazepam falls under the category of drugs classified as schedule 3.

      Drug Misuse (Law and Scheduling)

      The Misuse of Drugs Act (1971) regulates the possession and supply of drugs, classifying them into three categories: A, B, and C. The maximum penalty for possession varies depending on the class of drug, with Class A drugs carrying a maximum sentence of 7 years.

      The Misuse of Drugs Regulations 2001 further categorizes controlled drugs into five schedules. Schedule 1 drugs are considered to have no therapeutic value and cannot be lawfully possessed of prescribed, while Schedule 2 drugs are available for medical use but require a controlled drug prescription. Schedule 3, 4, and 5 drugs have varying levels of restrictions and requirements.

      It is important to note that a single drug can have multiple scheduling statuses, depending on factors such as strength and route of administration. For example, morphine and codeine can be either Schedule 2 of Schedule 5.

      Overall, the Misuse of Drugs Act and Regulations aim to regulate and control the use of drugs in the UK, with the goal of reducing drug misuse and related harm.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 51 - 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
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  • Question 52 - As a consultant child and adolescent psychiatrist visiting a local high school, you...

    Incorrect

    • As a consultant child and adolescent psychiatrist visiting a local high school, you have been asked by the principal for advice on interventions to reduce the suicide rate among students. Due to limited funds, it is important to focus on the most common method of suicide among this age group.

      Which method of suicide would you recommend the principal to address in their intervention plan?

      Your Answer:

      Correct Answer: Hanging

      Explanation:

      The most prevalent method of suicide in prisons across the country is hanging of self-strangulation. As a result, the prison service places a high priority on eliminating ligature points. For more information on this topic, refer to the National Clinical Survey on Suicide by Prisoners conducted by Shaw et al. in 2004, which can be found in the British Journal of Psychiatry.

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 53 - A 16-year-old male is caught spying on his neighbour whilst she is undressing....

    Incorrect

    • A 16-year-old male is caught spying on his neighbour whilst she is undressing. The police report that this is the fifth time he has been caught doing this in the past 6 months. He is assessed by a psychiatrist and discloses a six-month history of intense urges to watch females undressing in their homes. He denies feeling distressed by these urges.

      Which of the following conclusion would be most appropriate in this case according to the DSM-5?

      Your Answer:

      Correct Answer: A diagnosis of ‘Voyeuristic Disorder’ should not be made as the individual is under the age of 18

      Explanation:

      Voyeuristic disorder is typically observed in adult males who develop a sexual interest in secretly observing individuals without their knowledge. While this interest may first arise during adolescence, a diagnosis of voyeuristic disorder is only made after the age of 18 due to challenges in distinguishing it from normal sexual curiosity during puberty. The DSM-5 identifies voyeuristic behavior as a disorder when it causes harm, which can manifest as either personal distress of engaging in non-consensual acts.

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

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 54 - 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
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  • Question 55 - 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
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  • Question 56 - What is a true statement about frontotemporal lobar degeneration? ...

    Incorrect

    • What is a true statement about frontotemporal lobar degeneration?

      Your Answer:

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

      Explanation:

      Frontotemporal Lobar Degeneration

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

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 57 - 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
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  • Question 58 - Which of the following factors does not increase the risk of developing tardive...

    Incorrect

    • Which of the following factors does not increase the risk of developing tardive dyskinesia?

      Your Answer:

      Correct Answer: Male gender

      Explanation:

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 59 - A new medication is being developed to treat hypertension in elderly patients. Several...

    Incorrect

    • A new medication is being developed to treat hypertension in elderly patients. Several different drugs are being considered for their efficacy in reducing blood pressure. Which study design would require the largest number of participants to achieve a significant outcome?

      Your Answer:

      Correct Answer: Superiority trial

      Explanation:

      Since a superiority trial involves comparing a new drug with an already existing treatment that can also reduce HbA1c levels, a substantial sample size is necessary to establish a significant distinction.

      Study Designs for New Drugs: Options and Considerations

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 60 - Which drug is most likely to cause postural hypotension? ...

    Incorrect

    • Which drug is most likely to cause postural hypotension?

      Your Answer:

      Correct Answer: Risperidone

      Explanation:

      Maudsley Guidelines: Antipsychotics for Postural Hypotension

      When postural hypotension is a concern, it may be necessary to switch to an antipsychotic that is less likely to cause this side effect. The following antipsychotics are recommended by the Maudsley Guidelines:

      – Amisulpride
      – Aripiprazole
      – Haloperidol
      – Sulpiride
      – Trifluoperazine

      These medications have a lower risk of causing postural hypotension compared to other antipsychotics such as risperidone, clozapine, olanzapine, paliperidone, quetiapine, and ziprasidone. It is important to discuss any concerns about side effects with a healthcare provider before making any changes to medication.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 61 - Which statement accurately describes the CATIE study? ...

    Incorrect

    • Which statement accurately describes the CATIE study?

      Your Answer:

      Correct Answer: Olanzapine was found to be more effective than the other atypical antipsychotics used in phase I

      Explanation:

      Olanzapine was found to have the highest duration of treatment before discontinuation due to inadequate efficacy, the longest period of successful treatment, and the lowest number of hospitalizations caused by worsening of schizophrenia among the patients.

      CATIE Study: Comparing Antipsychotic Medications for Schizophrenia Treatment

      The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Study, funded by the National Institute of Mental Health (NIMH), was a nationwide clinical trial that aimed to compare the effectiveness of older and newer antipsychotic medications used to treat schizophrenia. It is the largest, longest, and most comprehensive independent trial ever conducted to examine existing therapies for schizophrenia. The study consisted of two phases.

      Phase I of CATIE compared four newer antipsychotic medications to one another and an older medication. Participants were followed for 18 months to evaluate longer-term patient outcomes. The study involved over 1400 participants and was conducted at various treatment sites, representative of real-life settings where patients receive care. The results from CATIE are applicable to a wide range of people with schizophrenia in the United States.

      The medications were comparably effective, but high rates of discontinuation were observed due to intolerable side-effects of failure to adequately control symptoms. Olanzapine was slightly better than the other drugs but was associated with significant weight gain as a side-effect. Surprisingly, the older, less expensive medication (perphenazine) used in the study generally performed as well as the four newer medications. Movement side effects primarily associated with the older medications were not seen more frequently with perphenazine than with the newer drugs.

      Phase II of CATIE sought to provide guidance on which antipsychotic to try next if the first failed due to ineffectiveness of intolerability. Participants who discontinued their first antipsychotic medication because of inadequate management of symptoms were encouraged to enter the efficacy (clozapine) pathway, while those who discontinued their first treatment because of intolerable side effects were encouraged to enter the tolerability (ziprasidone) pathway. Clozapine was remarkably effective and was substantially better than all the other atypical medications.

      The CATIE study also looked at the risk of metabolic syndrome (MS) using the US National Cholesterol Education Program Adult Treatment Panel criteria. The prevalence of MS at baseline in the CATIE group was 40.9%, with female patients being three times as likely to have MS compared to matched controls and male patients being twice as likely.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 62 - With which condition are raised liver function tests most commonly associated? ...

    Incorrect

    • With which condition are raised liver function tests most commonly associated?

      Your Answer:

      Correct Answer: Valproate

      Explanation:

      Biochemical Changes Associated with Psychotropic Drugs

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 63 - 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
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  • Question 64 - A 45-year-old female is referred to you by her primary care physician. She...

    Incorrect

    • A 45-year-old female is referred to you by her primary care physician. She recently experienced a traumatic event and has been crying frequently in response to minor triggers. On your assessment, you do not find any evidence of depression, anxiety, of suicidal ideation, but note that the patient started crying several times during the hour you spent with her. Which antidepressant medication would you consider prescribing in this situation?

      Your Answer:

      Correct Answer: Citalopram

      Explanation:

      The patient has been diagnosed with post-stroke pathological crying, a condition characterized by episodes of crying triggered by minor stimuli without any accompanying changes in mood. This condition is associated with disrupted serotonergic neurotransmission. Treatment options include the use of antidepressants, with SSRIs being the preferred choice over venlafaxine and tricyclics due to their better tolerability and greater efficacy.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 65 - What medication should be avoided when a patient is already taking clozapine? ...

    Incorrect

    • What medication should be avoided when a patient is already taking clozapine?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      It is important to avoid carbamazepine due to its potential to cause agranulocytosis. Additionally, Sulpiride and lamotrigine can be effective in augmenting treatment for individuals with clozapine-resistant schizophrenia. Valproate is commonly prescribed as a preventative measure against seizures when clozapine is being used.

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 66 - What is the estimated percentage of 10 year olds affected by encopresis? ...

    Incorrect

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

      Your Answer:

      Correct Answer: 1.60%

      Explanation:

      Elimination Disorders

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 67 - Which of the following is not a common problem associated with ADHD? ...

    Incorrect

    • Which of the following is not a common problem associated with ADHD?

      Your Answer:

      Correct Answer: Seizures

      Explanation:

      While there is a potential connection between seizures and ADHD, it is not a confirmed link. The prompt is inquiring about prevalent issues.

      ADHD: Common Associated Problems

      ADHD is often accompanied by a range of problems that can affect a person’s daily life. These problems include non-compliant behavior, motor tics, mood swings, sleep disturbance, aggression, temper tantrums, learning difficulties, unpopularity with peers, and clumsiness. These issues can make it challenging for individuals with ADHD to navigate social situations, perform well in school of work, and maintain healthy relationships. It is essential to seek professional help to manage these associated problems and improve the quality of life for those with ADHD.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 68 - What eye condition is frequently linked to Charles Bonnet syndrome? ...

    Incorrect

    • What eye condition is frequently linked to Charles Bonnet syndrome?

      Your Answer:

      Correct Answer: Macular degeneration

      Explanation:

      Macular degeneration is the sole condition among the options that typically results in notable visual impairment, which is often associated with Charles Bonnet syndrome.

      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
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  • Question 69 - What is the risk factor that the selection drift hypothesis aims to explain...

    Incorrect

    • What is the risk factor that the selection drift hypothesis aims to explain in relation to schizophrenia?

      Your Answer:

      Correct Answer: Social class

      Explanation:

      Schizophrenia: Understanding the Risk Factors

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 70 - What is the alternative name for the model of family therapy that is...

    Incorrect

    • What is the alternative name for the model of family therapy that is referred to as the 'Milan model'?

      Your Answer:

      Correct Answer: Systemic

      Explanation:

      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
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  • Question 71 - A 10-year-old boy is causing his parents some concern. He progressed normally until...

    Incorrect

    • A 10-year-old boy is causing his parents some concern. He progressed normally until the age of 5 years after which his milestones slowed down. His language development is delayed and he lacks imaginative play. More recently, he has begun repeated 'hand-wringing' movements. You refer him for karyotype testing and the number of chromosomes is normal. Which one of the following conditions could this boy suffer from?

      Your Answer:

      Correct Answer: Rett syndrome

      Explanation:

      Rett syndrome should be suspected in a young girl who exhibits autistic features and hand wringing movements. Despite having a normal number of chromosomes, a mutation in the MECP2 gene on the X chromosome is believed to be the cause. For more information, please refer to the Rett Syndrome Fact Sheet provided by the National Institute of Neurological Disorders and Stroke.

    • This question is part of the following fields:

      • Psychiatry Of Learning Disability
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  • Question 72 - What is the probable diagnosis for a patient with schizophrenia who experiences discomfort...

    Incorrect

    • What is the probable diagnosis for a patient with schizophrenia who experiences discomfort in their legs, particularly at night, and finds relief by moving their legs?

      Your Answer:

      Correct Answer: Restless leg syndrome

      Explanation:

      Restless Leg Syndrome, also known as Wittmaack-Ekbom syndrome, is a condition that causes an irresistible urge to move in order to alleviate uncomfortable sensations, primarily in the legs but sometimes in other areas of the body. The symptoms are exacerbated by rest and tend to worsen at night. Treatment options for this condition include dopamine agonists, opioids, benzodiazepines, and anticonvulsants. Sibler (2004) has developed an algorithm for managing Restless Leg Syndrome.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 73 - In typically developing children, which age groups are most likely to exhibit a...

    Incorrect

    • In typically developing children, which age groups are most likely to exhibit a strong fear of animals, particularly dogs?

      Your Answer:

      Correct Answer: Age 3 - 4

      Explanation:

      Childhood Fear: Normal Development

      It is normal for children to experience fear and anxiety as they grow and develop. According to Marks’ ‘ontogenetic parade’ theory, children’s fears follow a predictable pattern throughout their development. In the preschool years, children may fear imaginary creatures, animals, strangers, and their environment. As they enter middle childhood, fears of physical danger, bodily injury, and school performance become more prominent. During adolescence, fears about social evaluations and interactions become more common.

      Gullone’s research in 1999 identified specific fears that are prominent at different ages. For example, towards the end of the first year, children may fear strangers, heights, and separation anxiety. In preschool years, fears of being alone, the dark, and animals are common. During the school years, children may fear bodily injury, illness, social situations, supernatural phenomena, failure, and criticism. Finally, in adolescence, fears about death, economic and political concerns may persist.

      Overall, fear and anxiety are a normal part of child development, and parents and caregivers can support children by acknowledging their fears and helping them develop coping strategies.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 74 - What should people with insomnia avoid doing? ...

    Incorrect

    • What should people with insomnia avoid doing?

      Your Answer:

      Correct Answer: Get regular exercise in the evening

      Explanation:

      Insomnia Treatment: Sleep Hygiene

      Before resorting to medication, it is important to try sleep hygiene approaches to treat insomnia. These approaches include increasing daily exercise (but not in the evening), avoiding large meals in the evening, ensuring exposure to natural light during the day, reducing of stopping daytime napping, reducing alcohol and stimulant (caffeine and nicotine) intake, associating the bed with sleep (not using it for TV, radio, of reading), using anxiety management and relaxation techniques, and developing a regular routine of rising and retiring at the same time each day (regardless of the amount of sleep taken). By implementing these strategies, individuals can improve their sleep quality and quantity without the use of medication.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 75 - What is the most prevalent type of Down's syndrome? ...

    Incorrect

    • What is the most prevalent type of Down's syndrome?

      Your Answer:

      Correct Answer: Trisomy 21

      Explanation:

      Down Syndrome: Causes and Risk Factors

      Down syndrome is a genetic disorder caused by the presence of extra genetic material from chromosome 21. There are three different types of Down syndrome, each with its own cause and inheritance pattern. The most common form, full trisomy 21, is not inherited and accounts for 95% of cases. It occurs when there is a failure of chromosome 21 to separate properly during cell division, resulting in an extra copy of the chromosome. This can happen randomly, with the extra chromosome coming from the mother 88% of the time and from the father 12% of the time.

      The second type, translocation Down syndrome, is inherited and accounts for 2-3% of cases. It occurs when a piece of chromosome 21 breaks off and attaches to another chromosome, resulting in extra genetic material. This type of Down syndrome is caused by a balanced translocation, which means that the parent carrying the translocation has no signs of symptoms of the disorder.

      The third type, mosaic Down syndrome, is not inherited and also accounts for 2-3% of cases. It occurs as a random event during cell division early in fetal development, resulting in some cells having an extra copy of chromosome 21 while others do not.

      The risk of having a child with Down syndrome increases as a mother gets older. At age 35, the risk is 1 in 385; at age 40, the risk is 1 in 106; and at age 45, the risk is 1 in 30. It is important for women to be aware of these risk factors and to discuss them with their healthcare provider if they are planning to have a child.

    • This question is part of the following fields:

      • Learning Disability
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  • Question 76 - What is a true statement about searching in PubMed? ...

    Incorrect

    • What is a true statement about searching in PubMed?

      Your Answer:

      Correct Answer: Truncation is generally not a recommended search technique for PubMed

      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
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  • Question 77 - 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
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  • Question 78 - What is the main cannabinoid responsible for the psychoactive effects of cannabis? ...

    Incorrect

    • What is the main cannabinoid responsible for the psychoactive effects of cannabis?

      Your Answer:

      Correct Answer: Tetrahydrocannabinol

      Explanation:

      Cannabis, also known as marijuana, grass, pot, weed, tea, of Mary Jane, is a plant that contains over 60 unique cannabinoids. The primary psychoactive component of cannabis is delta-9-tetrahydrocannabinol (Delta 9-THC), which is rapidly converted into 11-hydroxy-delta 9-THC, the active metabolite in the central nervous system. Specific cannabinoid receptors, including CB1 and CB2 receptors, have been identified in the body. CB1 receptors are found mainly at nerve terminals, where they inhibit transmitter release, while CB2 receptors occur mainly on immune cells and modulate cytokine release. The cannabinoid receptor is found in highest concentrations in the basal ganglia, hippocampus, and cerebellum, with lower concentrations in the cerebral cortex. Cannabis use has been associated with the amotivational syndrome, characterized by apathy, anergy, weight gain, and a lack of persistence in tasks requiring prolonged attention of tenacity.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 79 - 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
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  • Question 80 - If a 14 year old boy with schizophrenia does not show improvement with...

    Incorrect

    • If a 14 year old boy with schizophrenia does not show improvement with olanzapine or risperidone despite being given adequate doses for adequate durations, what would be your recommendation for the next antipsychotic medication to try?

      Your Answer:

      Correct Answer: Clozapine

      Explanation:

      The NICE guidelines require that before attempting clozapine, at least one second-generation (atypical) antipsychotic should have been tested. There is no mandate for a trial of a typical antipsychotic.

      Antipsychotics in Young People

      Antipsychotics are just as effective in children and adolescents as they are in adults. However, the rate of side effects in young people is higher than in adults. Clozapine is a beneficial second-line agent for treating children with refractory schizophrenia and some argue for its early use in first-episode psychosis. Before starting clozapine, a patient should have tried at least two different antipsychotics, with at least one being a second-generation (atypical) antipsychotic, according to NICE guidelines.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 81 - You are consulted by the healthcare team for advice on a patient who...

    Incorrect

    • You are consulted by the healthcare team for advice on a patient who is HIV positive and experiencing depression. What would be the most effective course of treatment?

      Your Answer:

      Correct Answer: Citalopram

      Explanation:

      Citalopram is the preferred first-line treatment for depression in patients with HIV, as it has minimal impact on the cytochrome system and does not interfere with HIV medications (unlike fluoxetine). TCAs are generally not well-tolerated in this population due to severe side effects, and MAOIs are not recommended. Although other medications such as mirtazapine, trazodone, reboxetine, and bupropion have been studied, they were limited by high rates of side effects.

      HIV and Mental Health: Understanding the Relationship and Treatment Options

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 82 - For a study comparing two chemotherapy regimens for small cell lung cancer patients...

    Incorrect

    • For a study comparing two chemotherapy regimens for small cell lung cancer patients based on survival time, which statistical measure is most suitable for comparison?

      Your Answer:

      Correct Answer: Hazard ratio

      Explanation:

      Understanding Hazard Ratio in Survival Analysis

      Survival analysis is a statistical method used to analyze the time it takes for an event of interest to occur, such as death of disease progression. In this type of analysis, the hazard ratio (HR) is a commonly used measure that is similar to the relative risk but takes into account the fact that the risk of an event may change over time.

      The hazard ratio is particularly useful in situations where the risk of an event is not constant over time, such as in medical research where patients may have different survival times of disease progression rates. It is a measure of the relative risk of an event occurring in one group compared to another, taking into account the time it takes for the event to occur.

      For example, in a study comparing the survival rates of two groups of cancer patients, the hazard ratio would be used to compare the risk of death in one group compared to the other, taking into account the time it takes for the patients to die. A hazard ratio of 1 indicates that there is no difference in the risk of death between the two groups, while a hazard ratio greater than 1 indicates that one group has a higher risk of death than the other.

      Overall, the hazard ratio is a useful tool in survival analysis that allows researchers to compare the risk of an event occurring between different groups, taking into account the time it takes for the event to occur.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 83 - Who is recognized for creating an improved version of CBT specifically designed for...

    Incorrect

    • Who is recognized for creating an improved version of CBT specifically designed for treating eating disorders?

      Your Answer:

      Correct Answer: Fairburn

      Explanation:

      Although CBT is effective in treating bulimia nervosa, it is not always successful in achieving full and lasting recovery for all patients. To address this, an enhanced form of CBT was developed by Fairburn. This treatment uses a range of strategies and procedures to improve treatment adherence and outcomes, and to identify and address obstacles to change. It has also been adapted to be suitable for all forms of eating disorders, not just bulimia, based on the transdiagnostic theory of the maintenance of eating disorders.

      The enhanced CBT treatment comes in two forms: a focused form that concentrates solely on eating disorder psychopathology, and a broad form that also addresses external barriers to change, such as clinical perfectionism, core low self-esteem, and interpersonal difficulties. Eating disorders are often complex, with patients experiencing other problems such as mood disorders, substance misuse, personality disorders, and physical complications. Enhanced CBT is designed to manage these issues while providing treatment.

      Eating Disorders: NICE Guidelines

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

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

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

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

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

      Note: These guidelines are taken from NICE guidelines 2017.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 84 - The population of middle-aged individuals (aged 40-59 years) in correctional facilities in the...

    Incorrect

    • The population of middle-aged individuals (aged 40-59 years) in correctional facilities in the United Kingdom is on the rise. This group has unique healthcare requirements. What is the incidence of depression among this demographic?

      Your Answer:

      Correct Answer: 30%

      Explanation:

      Elderly prisoners have a higher rate of depression, estimated at around 30%, compared to younger adult prisoners and community studies of the elderly in the UK. The risk of depression is even higher in prisoners with a history of psychiatric illness and those who report poor physical health. For more information, see the study by Fazel et al. (2001) titled Hidden psychiatric morbidity in elderly prisoners in the British Journal of Psychiatry.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 85 - Dealing with smoking among patients with schizophrenia has been a significant concern on...

    Incorrect

    • Dealing with smoking among patients with schizophrenia has been a significant concern on the national agenda lately. What is accurate regarding individuals who have schizophrenia?

      Your Answer:

      Correct Answer: They smoke at rates higher than the general population

      Explanation:

      Individuals diagnosed with schizophrenia have a higher prevalence of smoking compared to the general population, with earlier onset and greater difficulty in quitting. This leads to increased cardiovascular comorbidity. Furthermore, smoking can induce CYP450 enzyme systems, which can interfere with the effectiveness of medications like clozapine.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 86 - A woman is referred by her GP due to her persistent belief that...

    Incorrect

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

      Your Answer:

      Correct Answer: Hypochondriasis

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 87 - A 61 year old male recently started on a new treatment has suddenly...

    Incorrect

    • A 61 year old male recently started on a new treatment has suddenly started texting his wife rude text messages and binge eating. Which of the following treatment would you suspect he has been started on?:

      Your Answer:

      Correct Answer: Ropinirole

      Explanation:

      Dopamine Agonists

      Dopamine receptor agonists are medications that directly affect dopamine receptors and are commonly used to treat Parkinson’s disease. Examples of these drugs include apomorphine and ropinirole. However, these medications are known to have psychiatric side effects, particularly impulse control disorders such as pathological gambling, binge eating, and hypersexuality. This information is according to the British National Formulary (BNF) from March 2012.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 88 - For which patient group does NICE not recommend the use of HMPAO SPECT...

    Incorrect

    • For which patient group does NICE not recommend the use of HMPAO SPECT to distinguish between Alzheimer's disease, vascular dementia, and frontotemporal dementia?

      Your Answer:

      Correct Answer: Down's syndrome

      Explanation:

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 89 - A 56-year-old female is currently receiving care in a nursing home due to...

    Incorrect

    • A 56-year-old female is currently receiving care in a nursing home due to a diagnosis of Wernicke's encephalopathy. She has a lengthy history of alcohol addiction.
      What vitamin deficiency is the cause of Wernicke's encephalopathy?

      Your Answer:

      Correct Answer: Thiamine

      Explanation:

      Wernicke’s encephalopathy is linked to bleeding in the Mammillary bodies of the brain and is commonly seen in individuals with insufficient thiamine levels. The condition is characterized by a combination of symptoms including changes in mental state, unsteady walking, and difficulty moving the eyes. It is especially prevalent in individuals who abuse alcohol over extended periods as they rely heavily on alcohol for their energy needs.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 90 - 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
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  • Question 91 - 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
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  • Question 92 - A 70-year-old patient with cognitive impairment, who was discharged from section 2 of...

    Incorrect

    • A 70-year-old patient with cognitive impairment, who was discharged from section 2 of the Mental Health Act a month ago and was under Deprivation of Liberty Safeguards, has been discovered deceased in her care home with an empty bottle of opioids beside her bed. Why is it necessary to notify the coroner?

      Your Answer:

      Correct Answer: Because the death appears to be due to self-inflicted poisoning

      Explanation:

      Guidance for Registered Medical Practitioners on the Notification of Deaths Regulations 2019

      If there is reason to suspect that the deceased died from self-inflicted poisoning, the coroner should be informed. The Notification of Deaths Regulations 2019 provides national guidance for registered medical practitioners on reporting deaths. This guidance supersedes any local protocols. There are several causes of death that must be referred to the coroner, including death from poisoning, violence of trauma, self-harm, neglect, medical procedures, employment-related injury of disease, unnatural death, unknown cause of death, death in state detention, and unidentified individuals. This does not include patients recently detained under the Mental Health Act of subject to DOLS, unless one of the above reasons applies.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
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  • Question 93 - A study looks into the effects of alcohol consumption on female psychiatrists. A...

    Incorrect

    • A study looks into the effects of alcohol consumption on female psychiatrists. A group are selected and separated by the amount they drink into four groups. The first group drinks no alcohol, the second occasionally, the third often, and the fourth large and regular amounts. The group is followed up over the next ten years and the rates of cirrhosis are recorded.
      What is the dependent variable in the study?

      Your Answer:

      Correct Answer: Rates of liver cirrhosis

      Explanation:

      Understanding Stats Variables

      Variables are characteristics, numbers, of quantities that can be measured of counted. They are also known as data items. Examples of variables include age, sex, business income and expenses, country of birth, capital expenditure, class grades, eye colour, and vehicle type. The value of a variable may vary between data units in a population. In a typical study, there are three main variables: independent, dependent, and controlled variables.

      The independent variable is something that the researcher purposely changes during the investigation. The dependent variable is the one that is observed and changes in response to the independent variable. Controlled variables are those that are not changed during the experiment. Dependent variables are affected by independent variables but not by controlled variables, as these do not vary throughout the study.

      For instance, a researcher wants to test the effectiveness of a new weight loss medication. Participants are divided into three groups, with the first group receiving a placebo (0mg dosage), the second group a 10 mg dose, and the third group a 40 mg dose. After six months, the participants’ weights are measured. In this case, the independent variable is the dosage of the medication, as that is what is being manipulated. The dependent variable is the weight, as that is what is being measured.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 94 - A 38-year-old lady attends clinic for a medication review. She has been established...

    Incorrect

    • A 38-year-old lady attends clinic for a medication review. She has been established on lithium carbonate, once daily, for prophylaxis of recurrent depression for several years and has had stable levels. She also suffers from ankylosing spondylitis for which she has been prescribed celecoxib for many years. Her lithium level was checked three days prior to her appointment and was 0.6 mmol/L.

      When should her next lithium levels be checked?

      Your Answer:

      Correct Answer: In three months

      Explanation:

      Patients taking lithium should be cautious when using celecoxib, an NSAID that has the potential to elevate lithium levels.

      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
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  • Question 95 - What is a true statement about deep brain stimulation? ...

    Incorrect

    • What is a true statement about deep brain stimulation?

      Your Answer:

      Correct Answer: It is an invasive procedure

      Explanation:

      DBS, a type of neurosurgery, is typically conducted in an operating theatre and has been shown to be effective in treating OCD based on randomized controlled trial (RCT) data. However, there are currently no NICE Guidelines available for DBS.

      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
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  • Question 96 - What is the most accurate definition of 'opportunity cost'? ...

    Incorrect

    • What is the most accurate definition of 'opportunity cost'?

      Your Answer:

      Correct Answer: The forgone benefit that would have been derived by an option not chosen

      Explanation:

      Opportunity Cost in Economics: Understanding the Value of Choices

      Opportunity cost is a crucial concept in economics that helps us make informed decisions. It refers to the value of the next-best alternative that we give up when we choose one option over another. This concept is particularly relevant when we have limited resources, such as a fixed budget, and need to make choices about how to allocate them.

      For instance, if we decide to spend our money on antidepressants, we cannot use that same money to pay for cognitive-behavioral therapy (CBT). Both options have a value, but we have to choose one over the other. The opportunity cost of choosing antidepressants over CBT is the value of the benefits we would have received from CBT but did not because we chose antidepressants instead.

      To compare the opportunity cost of different choices, economists often use quality-adjusted life years (QALYs). QALYs measure the value of health outcomes in terms of both quantity (life years gained) and quality (health-related quality of life). By using QALYs, we can compare the opportunity cost of different healthcare interventions and choose the one that provides the best value for our resources.

      In summary, understanding opportunity cost is essential for making informed decisions in economics and healthcare. By recognizing the value of the alternatives we give up, we can make better choices and maximize the benefits we receive from our limited resources.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 97 - A teenage girl is referred by her pediatrician who is concerned about her...

    Incorrect

    • A teenage girl is referred by her pediatrician who is concerned about her weight. She has a BMI of 15 and has stopped having regular periods. She denies purging behaviors but admits to extended periods of fasting and excessive exercise in order to lose weight. Despite her low BMI, she insists that she is overweight and is very apprehensive about seeing a psychiatrist as she fears being pressured to gain weight.

      What is the most probable ICD-11 diagnosis for this patient?

      Your Answer:

      Correct Answer: Anorexia nervosa

      Explanation:

      The diagnosis would be coded as ARFID (Avoidant/Restrictive Food Intake Disorder) in the ICD-11, as it encompasses the three criteria mentioned above. Anorexia nervosa would require additional criteria, such as amenorrhea in females of a fear of gaining weight.

      Eating disorders are a serious mental health condition that can have severe physical and psychological consequences. The ICD-11 lists several types of eating disorders, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant-Restrictive Food Intake Disorder, Pica, and Rumination-Regurgitation Disorder.

      Anorexia Nervosa is characterized by significantly low body weight, a persistent pattern of restrictive eating of other behaviors aimed at maintaining low body weight, excessive preoccupation with body weight of shape, and marked distress of impairment in functioning. Bulimia Nervosa involves frequent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain, excessive preoccupation with body weight of shape, and marked distress of impairment in functioning. Binge Eating Disorder is characterized by frequent episodes of binge eating without compensatory behaviors, marked distress of impairment in functioning, and is more common in overweight and obese individuals. Avoidant-Restrictive Food Intake Disorder involves avoidance of restriction of food intake that results in significant weight loss of impairment in functioning, but is not motivated by preoccupation with body weight of shape. Pica involves the regular consumption of non-nutritive substances, while Rumination-Regurgitation Disorder involves intentional and repeated regurgitation of previously swallowed food.

      It is important to seek professional help if you of someone you know is struggling with an eating disorder. Treatment may involve a combination of therapy, medication, and nutritional counseling.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 98 - What factor is most likely to trigger a manic episode? ...

    Incorrect

    • What factor is most likely to trigger a manic episode?

      Your Answer:

      Correct Answer: Selegiline

      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
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  • Question 99 - 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
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  • Question 100 - Which statement accurately reflects the data from the national confidential inquiry? ...

    Incorrect

    • Which statement accurately reflects the data from the national confidential inquiry?

      Your Answer:

      Correct Answer: 30% of those with schizophrenia convicted of homicide had never had contact with psychiatric services

      Explanation:

    • This question is part of the following fields:

      • Forensic Psychiatry
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  • Question 101 - What is the most probable cause of withdrawal symptoms in an opioid-dependent patient...

    Incorrect

    • What is the most probable cause of withdrawal symptoms in an opioid-dependent patient who has not completed their detox program when starting a particular medication?

      Your Answer:

      Correct Answer: Buprenorphine

      Explanation:

      Opioid Maintenance Therapy and Detoxification

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

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 102 - A 32-year-old man is referred by his primary care service due to concerns...

    Incorrect

    • A 32-year-old man is referred by his primary care service due to concerns about social anxiety and isolation.

      His mother reports that he avoids socialising and instead spends his time on the internet in chat rooms. He expresses numerous beliefs that are considered to be paranoid, for example, that the government is trying to suppress the minds of the public by encouraging unhealthy diets.

      He is highly animated throughout the discussion and smiles and laughs for much of the interview. He states that the COVID pandemic introduced him to the concept of viruses and that this was a sign to him that his purpose in life is to educate the public that viruses are not real.

      He is very suspicious of psychiatrists and suggests that as an arm of the state they will try and limit him so that the government remains in power.

      Based on this presentation, which personality disorder would you most expect to be present?

      Your Answer:

      Correct Answer: Schizotypal

      Explanation:

      Paranoid personality disorder and schizotypal personality disorder share some common traits such as suspiciousness, interpersonal aloofness, and paranoid ideation. However, schizotypal personality disorder also includes symptoms like magical thinking, unusual perceptual experiences, and odd thinking and speech. In this particular case, the individual’s inappropriate affect and ideas of reference suggest schizotypal personality disorder rather than paranoid personality disorder. Individuals with schizoid personality disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually exhibit prominent paranoid ideation. Interestingly, research has shown that schizotypal personality disorder is a significant predictor of belief in conspiracy theories (March, 2019).

      Schizotypal Personality Disorder: Symptoms and Diagnostic Criteria

      Schizotypal personality disorder is a type of personality disorder that is characterized by a pervasive pattern of discomfort with close relationships, distorted thinking and perceptions, and eccentric behavior. This disorder typically begins in early adulthood and is present in a variety of contexts. To be diagnosed with schizotypal personality disorder, an individual must exhibit at least five of the following symptoms:

      1. Ideas of reference (excluding delusions of reference).
      2. Odd beliefs of magical thinking that influences behavior and is inconsistent with subcultural norms.
      3. Unusual perceptual experiences, including bodily illusions.
      4. Odd thinking and speech.
      5. Suspiciousness of paranoid ideation.
      6. Inappropriate or constricted affect.
      7. Behavior of appearance that is odd, eccentric, of peculiar.
      8. Lack of close friends of confidants other than first-degree relatives.
      9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

      It is important to note that the ICD-11 does not have a specific category for schizotypal personality disorder, as it has abandoned the categorical approach in favor of a dimensional one.

    • This question is part of the following fields:

      • General Adult Psychiatry
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  • Question 103 - 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
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  • Question 104 - Which condition is primarily associated with cortical dementia rather than subcortical dementia? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Creutzfeldt-Jakob disease

      Explanation:

      Distinguishing Cortical and Subcortical Dementia: A Contested Area

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 105 - What is a distinguishing trait of the initial phase of Alzheimer's disease? ...

    Incorrect

    • What is a distinguishing trait of the initial phase of Alzheimer's disease?

      Your Answer:

      Correct Answer: Impaired short term memory

      Explanation:

      Dementia: Types and Clinical Characteristics

      Dementia is a progressive impairment of cognitive functions occurring in clear consciousness. There are over 100 different causes of dementia, and a detailed knowledge is required for the more common types. The following are some of the subtypes of dementia, along with their early features, neuropathology, and proportion:

      – Alzheimer’s disease: Impaired memory, apathy, and depression; gradual onset; cortical amyloid plaques and neurofibrillary tangles; 50-75% proportion.
      – Vascular dementia: Similar to AD, but memory less affected, and mood fluctuations more prominent; physical frailty; stepwise onset; cerebrovascular disease; single infarcts in critical regions, of more diffuse multi-infarct disease; 20-30% proportion.
      – Frontotemporal dementia: Personality changes, mood changes, disinhibition, language difficulties; no single pathology – damage limited to frontal and temporal lobes; 5-10% proportion.
      – Dementia with Lewy Bodies: Marked fluctuation in cognitive ability, visual hallucinations, Parkinsonism (tremor and rigidity); cortical Lewy bodies (alpha-synuclein); <5% proportion. Other types of dementia include Pick’s disease, Huntington’s disease, pseudodementia, and progressive supranuclear palsy. Each subtype has its own unique clinical characteristics and neuropathology. It is important to accurately diagnose the type of dementia in order to provide appropriate treatment and care.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 106 - Which of the following conditions is not considered a type of frontotemporal lobar...

    Incorrect

    • Which of the following conditions is not considered a type of frontotemporal lobar degeneration?

      Your Answer:

      Correct Answer: Lewy body dementia

      Explanation:

      Frontotemporal Lobar Degeneration

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

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 107 - Which brain region experiences increased neuronal activity leading to symptoms like yawning, abdominal...

    Incorrect

    • Which brain region experiences increased neuronal activity leading to symptoms like yawning, abdominal cramps, and goosebumps during opioid withdrawal?

      Your Answer:

      Correct Answer: Locus coeruleus

      Explanation:

      Opioid Maintenance Therapy and Detoxification

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

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

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

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

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

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 108 - Which statement accurately describes child abuse? ...

    Incorrect

    • Which statement accurately describes child abuse?

      Your Answer:

      Correct Answer: Boys are more likely than girls to experience physical abuse

      Explanation:

      The Royal College of Psychiatrists in London published a report in April 2004 on the role of mental health services in addressing child abuse and neglect. The report identifies neglect as the most common form of child abuse, followed by physical abuse, emotional abuse, sexual abuse, and fabricated or induced illness. The report emphasizes the importance of mental health services in addressing and preventing child abuse and neglect.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 109 - What is the most significant risk factor for developing Alzheimer's disease? ...

    Incorrect

    • What is the most significant risk factor for developing Alzheimer's disease?

      Your Answer:

      Correct Answer: Age

      Explanation:

      The development of Alzheimer’s disease is most strongly associated with increasing age.

      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
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  • Question 110 - A study is conducted to investigate whether a new exercise program has any...

    Incorrect

    • A study is conducted to investigate whether a new exercise program has any impact on weight loss. A total of 300 participants are enrolled from various locations and are randomly assigned to either the exercise group of the control group. Weight measurements are taken at the beginning of the study and at the end of a six-month period.

      What is the most effective method of visually presenting the data?

      Your Answer:

      Correct Answer: Kaplan-Meier plot

      Explanation:

      The Kaplan-Meier plot is the most effective graphical representation of survival probability. It presents the overall likelihood of an individual’s survival over time from a baseline, and the comparison of two lines on the plot can indicate whether there is a survival advantage. To determine if the distinction between the two groups is significant, a log rank test can be employed.

    • This question is part of the