-
Question 1
Incorrect
-
What factors during pregnancy can cause fingernail hypoplasia?
Your Answer: Valproic acid
Correct Answer: Carbamazepine
Explanation:Teratogens and Their Associated Defects
Valproic acid is a teratogen that has been linked to various birth defects, including neural tube defects, hypospadias, cleft lip/palate, cardiovascular abnormalities, developmental delay, endocrinological disorders, limb defects, and autism (Alsdorf, 2005). Lithium has been associated with cardiac anomalies, specifically Ebstein’s anomaly. Alcohol consumption during pregnancy can lead to cleft lip/palate and fetal alcohol syndrome. Phenytoin has been linked to fingernail hypoplasia, craniofacial defects, limb defects, cerebrovascular defects, and mental retardation. Similarly, carbamazepine has been associated with fingernail hypoplasia and craniofacial defects. Diazepam has been linked to craniofacial defects, specifically cleft lip/palate (Palmieri, 2008). The evidence for steroids causing craniofacial defects is not convincing, according to the British National Formulary (BNF). Selective serotonin reuptake inhibitors (SSRIs) have been associated with congenital heart defects and persistent pulmonary hypertension (BNF). It is important for pregnant women to avoid exposure to these teratogens to reduce the risk of birth defects in their babies.
-
This question is part of the following fields:
- General Adult Psychiatry
-
-
Question 2
Correct
-
Which statement accurately describes the court process in the UK?
Your Answer: All criminal cases will first go to the Magistrates Court
Explanation:The county courts handle civil cases, while the magistrates court is the starting point for all criminal cases.
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
-
-
Question 3
Correct
-
Who is responsible for introducing eye movement desensitisation and reprocessing?
Your Answer: Francine Shapiro
Explanation:EMDR: A Trauma-Focused Therapy for PTSD
EMDR, of eye movement desensitisation and reprocessing, is a therapy developed by Francine Shapiro in the 1980s that focuses on processing traumatic memories. While the exact way it works is not fully understood, it involves reliving traumatic memories while experiencing bilateral alternating stimulation, often through a light source. EMDR is recommended by the NICE Guidelines as a treatment for PTSD, along with trauma-focused cognitive-behavioral therapy.
-
This question is part of the following fields:
- General Adult Psychiatry
-
-
Question 4
Correct
-
What is the primary treatment option for a 10 year old child diagnosed with Tourette's syndrome?
Your Answer: Clonidine
Explanation:Tourette’s Syndrome: Understanding the Disorder and Management Options
Tourette’s syndrome is a type of tic disorder characterized by multiple motor tics and one of more vocal tics. Tics are sudden, involuntary movements of vocalizations that serve no apparent purpose and can be suppressed for varying periods of time. Unlike stereotyped repetitive movements seen in other disorders, tics lack rhythmicity. Manneristic motor activities tend to be more complex and variable than tics, while obsessive-compulsive acts have a defined purpose.
Tourette’s syndrome typically manifests in childhood, with a mean age of onset of six to seven years. Tics tend to peak in severity between nine and 11 years of age and may be exacerbated by external factors such as stress, inactivity, and fatigue. The estimated prevalence of Tourette’s syndrome is 1% of children, and it is more common in boys than girls. A family history of tics is also common.
Management of Tourette’s syndrome may involve pharmacological options of behavioral programs. Clonidine is recommended as first-line medication, with antipsychotics as a second-line option due to their side effect profile. Selective serotonin reuptake inhibitors (SSRIs) have not been found to be effective in suppressing tics. However, most people with tics never require medication, and behavioral programs appear to work equally as well.
-
This question is part of the following fields:
- Child And Adolescent Psychiatry
-
-
Question 5
Correct
-
What is a true statement about night terrors?
Your 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
-
-
Question 6
Correct
-
What is the most precise estimation of the occurrence of problematic behaviors among adults who have learning disabilities?
Your Answer: 20%
Explanation: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
-
-
Question 7
Correct
-
What is a true statement regarding schizophrenia in women?
Your Answer: Schizophrenia in women is associated with fewer structural brain abnormalities than in men
Explanation:Schizophrenia presents differently in men and women. Women tend to have a later onset and respond better to treatment, requiring lower doses of antipsychotics. Men, on the other hand, have an earlier onset, poorer premorbid functioning, and more negative symptoms and cognitive deficits. They also have greater structural brain and neurophysiological abnormalities. Females display more affective symptoms, auditory hallucinations, and persecutory delusions, but have a more favorable short- and middle-term course of illness with less smoking and substance abuse. Families of males are more critical, and expressed emotion has a greater negative impact on them. Certain neurological soft signs may be more prevalent in males. There are no clear sex differences in family history, obstetric complications, and minor physical anomalies.
Schizophrenia Epidemiology
Prevalence:
– In England, the estimated annual prevalence for psychotic disorders (mostly schizophrenia) is around 0.4%.
– Internationally, the estimated annual prevalence for psychotic disorders is around 0.33%.
– The estimated lifetime prevalence for psychotic disorders in England is approximately 0.63% at age 43, consistent with the typically reported 1% prevalence over the life course.
– Internationally, the estimated lifetime prevalence for psychotic disorders is around 0.48%.Incidence:
– In England, the pooled incidence rate for non-affective psychosis (mostly schizophrenia) is estimated to be 15.2 per 100,000 years.
– Internationally, the incidence of schizophrenia is about 0.20/1000/year.Gender:
– The male to female ratio is 1:1.Course and Prognosis:
– Long-term follow-up studies suggest that after 5 years of illness, one quarter of people with schizophrenia recover completely, and for most people, the condition gradually improves over their lifetime.
– Schizophrenia has a worse prognosis with onset in childhood of adolescence than with onset in adult life.
– Younger age of onset predicts a worse outcome.
– Failure to comply with treatment is a strong predictor of relapse.
– Over a 2-year period, one-third of patients with schizophrenia showed a benign course, and two-thirds either relapsed of failed to recover.
– People with schizophrenia have a 2-3 fold increased risk of premature death.Winter Births:
– Winter births are associated with an increased risk of schizophrenia.Urbanicity:
– There is a higher incidence of schizophrenia associated with urbanicity.Migration:
– There is a higher incidence of schizophrenia associated with migration.Class:
– There is a higher prevalence of schizophrenia among lower socioeconomic classes.Learning Disability:
– Prevalence rates for schizophrenia in people with learning disabilities are approximately three times greater than for the general population. -
This question is part of the following fields:
- General Adult Psychiatry
-
-
Question 8
Correct
-
What term is commonly used in reference to the type of therapy offered to dysfunctional families known as strategic family therapy?
Your Answer: Task setting
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
-
-
Question 9
Incorrect
-
What assessment tool of method would be of the least value when assessing a patient who is suspected of having a personality disorder?
Your Answer: IIP-PD
Correct Answer: BPRS
Explanation:There are several screening tools available for personality disorder, including SAPAS, FFMRF, IPDE, PDQ-R, IPDS, and IIP-PD. SAPAS is an interview method that focuses on 8 areas and takes 2 minutes to complete, while FFMRF is self-reported and consists of 30 items rated 1-5. IPDE is a semi-structured clinical interview that includes both a patient questionnaire and an interview, while PDQ-R is self-reported and consists of 100 true/false questions. IPDS is an interview method that consists of 11 criteria and takes less than 5 minutes, while IIP-PD is self-reported and contains 127 items rated 0-4. A score of 3 of more on SAPAS warrants further assessment.
-
This question is part of the following fields:
- Forensic Psychiatry
-
-
Question 10
Correct
-
What is the most probable condition of a patient referred by cardiologists who persists in believing that he has heart disease despite multiple normal tests and reassurances from several cardiologists?
Your Answer: Hypochondriacal disorder
Explanation:There is often confusion between hypochondriasis and somatisation disorder, which have been renamed illness anxiety disorder and somatic symptom disorder in the DSM-5. Hypochondriasis involves a preoccupation with a specific condition, while somatisation disorder is characterized by a focus on symptoms rather than a particular illness.
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
-
-
Question 11
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: Amitriptyline
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
-
-
Question 12
Incorrect
-
What is the association between the use of ipecac and patients with eating disorders?
Your Answer: Toxic megacolon
Correct Answer: Cardiomyopathy
Explanation:Bulimia, a disorder characterized by inducing vomiting, is a serious health concern. One method used to induce vomiting is through the use of syrup of ipecac, which contains emetine, a toxic alkaloid that irritates the stomach and causes vomiting. While it may produce vomiting within 15-30 minutes, it is not always effective. Unfortunately, nearly 8% of women with eating disorders experiment with ipecac, and 1-2% use it frequently. This is concerning because ipecac is associated with serious cardiac toxicity, including cardiomyopathy and left ventricular dysfunction. Elevated serum amylase levels are a strong indication that a patient has recently been vomiting. It is important to seek professional help for bulimia and avoid using dangerous methods like ipecac to induce vomiting.
-
This question is part of the following fields:
- General Adult Psychiatry
-
-
Question 13
Incorrect
-
A 40-year-old man visits his doctor requesting to discontinue his long-term use of diazepam. If he discontinues the medication, what is the most probable outcome he will encounter?
Your Answer: Seizures
Correct Answer: Insomnia
Explanation:The most prevalent indication of benzodiazepine withdrawal is insomnia.
Benzodiazepines and Addiction
Benzodiazepines are known to be addictive and should only be prescribed as a hypnotic or anxiolytic for a maximum of 4 weeks. Withdrawal symptoms can be physical of psychological, including stiffness, weakness, GI disturbance, paraesthesia, flu-like symptoms, visual disturbance, anxiety, insomnia, nightmares, depersonalisation, decreased memory and concentration, delusions, and hallucinations. Patients who wish to withdraw from short-acting benzodiazepines should first be converted to diazepam, which has a longer half-life and produces less severe withdrawal. The table provides approximate equivalent doses for different benzodiazepines. These guidelines are from the Maudsley Guidelines 10th Edition.
-
This question is part of the following fields:
- Substance Misuse/Addictions
-
-
Question 14
Correct
-
What factor is the most reliable indicator of the success of psychodynamic psychotherapy?
Your Answer: Therapeutic alliance
Explanation:Psychological Therapy – Evidence Based Recommendations
The Department of Health (DoH) conducted a systematic review of literature on psychological therapies and counselling, which resulted in evidence-based recommendations. The review acknowledged that there are few pure forms of therapy and provided general recommendations.
The review found that the therapeutic alliance between the therapist and patient is the best predictor of benefit. Therapies with fewer than eight sessions are unlikely to be optimally effective for moderate to severe mental health problems. Symptomatic relief may require 16 of more sessions, and longer therapies may be necessary for lasting change in social and personality functioning.
The patient’s age, sex, social class, of ethnic group are not significant factors in choosing therapy and should not determine access to therapies. However, interest in self-exploration and the ability to tolerate frustration in relationships may be crucial for success in interpretative therapies, such as psychoanalytic and psychodynamic therapies, compared to supportive therapy.
-
This question is part of the following fields:
- Psychotherapy
-
-
Question 15
Correct
-
What is a fact about self-harm among youth?
Your Answer: It is more common in girls than boys
Explanation:Self-harm is a common issue among young people, particularly girls, with rates appearing to have risen over the past decade. It is most likely to occur between the ages of 12 and 15 years and is associated with a range of psychiatric problems. Short-term management involves a psychosocial assessment and consideration of activated charcoal for drug overdose. Longer-term management may involve psychological interventions, but drug treatment should not be offered as a specific intervention to reduce self-harm. Risk assessment tools should not be used to predict future suicide of repetition of self-harm, but certain factors such as male gender, substance misuse, and parental mental disorder may be associated with a higher risk of completed suicide. It is important to seek professional help if you of someone you know is engaging in self-harm.
-
This question is part of the following fields:
- Child And Adolescent Psychiatry
-
-
Question 16
Correct
-
What is a criterion used to evaluate the quality of reporting in randomized controlled trials?
Your Answer: CONSORT
Explanation:As an AI language model, I do not have personal opinions of beliefs. However, I can provide information and guidance on the standards of reporting for different types of research studies. The guidelines mentioned above are essential for ensuring that research studies are reported accurately and transparently, which is crucial for the scientific community to evaluate and replicate the findings. It is important for researchers to be familiar with these standards and follow them when reporting their studies to ensure the quality and integrity of their research.
-
This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
-
-
Question 17
Correct
-
What is the recommended course of treatment for a man who experiences depression after a heart attack?
Your Answer: Sertraline
Explanation:SSRI for Post-MI Depression
Post-myocardial infarction (MI), approximately 20% of people develop depression, which can worsen prognosis if left untreated. Selective serotonin reuptake inhibitors (SSRIs) are the preferred antidepressant group for post-MI depression. However, they can increase the risk of bleeding, especially in those using anticoagulation. Mirtazapine is an alternative option, but it is also associated with bleeding. The SADHART study found sertraline to be a safe treatment for depression post-MI. It is important to consider the bleeding risk when choosing an antidepressant for post-MI depression.
References:
– Davies, P. (2004). Treatment of anxiety and depressive disorders in patients with cardiovascular disease. BMJ, 328, 939-943.
– Glassman, A. H. (2002). Sertraline treatment of major depression in patients with acute MI of unstable angina. JAMA, 288, 701-709.
– Goodman, M. (2008). Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients. Journal of Psychiatric Research, 42, 670-675.
– Na, K. S. (2018). Can we recommend mirtazapine and bupropion for patients at risk for bleeding? A systematic review and meta-analysis. Journal of Affective Disorders, 225, 221-226. -
This question is part of the following fields:
- Old Age Psychiatry
-
-
Question 18
Correct
-
What is a characteristic of alcoholic hallucinosis?
Your Answer: Occurs in clear consciousness
Explanation:Alcoholic Hallucinosis: Definition and Symptoms
Alcoholic hallucinosis is a condition characterized by auditory of visual hallucinations that occur during of after a period of heavy alcohol consumption. These hallucinations are intense, sudden, and typically happen when the person is fully aware. The symptoms usually involve hearing unrecognizable sounds of fragments of music, but most commonly, the person hears voices. The condition can last for several weeks of even months, but it eventually subsides.
-
This question is part of the following fields:
- Substance Misuse/Addictions
-
-
Question 19
Correct
-
What is a commonly known negative outcome of undergoing psychodynamic psychotherapy?
Your Answer: Malignant regression and suicide
Explanation:Selecting appropriate psychological interventions for individual patients can be challenging. Psychodynamic psychotherapy may not always be suitable for patients as it can potentially exacerbate their symptoms and lead to dangerous behaviors such as self-harm, suicide, violence, and stalking. However, prolonged psychosis is unlikely to occur unless the patient has a severe and enduring mental illness, which may make them unsuitable for psychodynamic psychotherapy. While the cost of attending sessions and ambivalence towards decision-making may be minor adverse effects, increased distress after sessions can occur, although it may indicate an appropriate response to the session’s content. Nonetheless, patients should not leave feeling uncontained.
-
This question is part of the following fields:
- Psychotherapy
-
-
Question 20
Correct
-
What is the most accurate way to describe the way Klinefelter syndrome is inherited?
Your Answer: Sporadic
Explanation:Klinefelter syndrome is not inherited in a predictable manner as it occurs randomly. Additionally, due to the infertility of almost all affected males, it is unlikely to observe any other type of inheritance pattern.
Genetic Conditions and Their Features
Genetic conditions are disorders caused by abnormalities in an individual’s DNA. These conditions can affect various aspects of a person’s health, including physical and intellectual development. Some of the most common genetic conditions and their features are:
– Downs (trisomy 21): Short stature, almond-shaped eyes, low muscle tone, and intellectual disability.
– Angelman syndrome (Happy puppet syndrome): Flapping hand movements, ataxia, severe learning disability, seizures, and sleep problems.
– Prader-Willi: Hyperphagia, excessive weight gain, short stature, and mild learning disability.
– Cri du chat: Characteristic cry, hypotonia, down-turned mouth, and microcephaly.
– Velocardiofacial syndrome (DiGeorge syndrome): Cleft palate, cardiac problems, and learning disabilities.
– Edwards syndrome (trisomy 18): Severe intellectual disability, kidney malformations, and physical abnormalities.
– Lesch-Nyhan syndrome: Self-mutilation, dystonia, and writhing movements.
– Smith-Magenis syndrome: Pronounced self-injurious behavior, self-hugging, and a hoarse voice.
– Fragile X: Elongated face, large ears, hand flapping, and shyness.
– Wolf Hirschhorn syndrome: Mild to severe intellectual disability, seizures, and physical abnormalities.
– Patau syndrome (trisomy 13): Severe intellectual disability, congenital heart malformations, and physical abnormalities.
– Rett syndrome: Regression and loss of skills, hand-wringing movements, and profound learning disability.
– Tuberous sclerosis: Hamartomatous tumors, epilepsy, and behavioral issues.
– Williams syndrome: Elfin-like features, social disinhibition, and advanced verbal skills.
– Rubinstein-Taybi syndrome: Short stature, friendly disposition, and moderate learning disability.
– Klinefelter syndrome: Extra X chromosome, low testosterone, and speech and language issues.
– Jakob’s syndrome: Extra Y chromosome, tall stature, and lower mean intelligence.
– Coffin-Lowry syndrome: Short stature, slanting eyes, and severe learning difficulty.
– Turner syndrome: Short stature, webbed neck, and absent periods.
– Niemann Pick disease (types A and B): Abdominal swelling, cherry red spot, and feeding difficulties.It is important to note that these features may vary widely among individuals with the same genetic condition. Early diagnosis and intervention can help individuals with genetic conditions reach their full potential and improve their quality of life.
-
This question is part of the following fields:
- Child And Adolescent Psychiatry
-
-
Question 21
Correct
-
Who is recognized for introducing behavioral activation?
Your Answer: Martell
Explanation:Fonagy and Bateman – Mentalisation-Based Treatment
Mentalisation-Based Treatment (MBT) was developed by Peter Fonagy and Anthony Bateman in the 1990s. It is a psychodynamic therapy that focuses on improving the patient’s ability to mentalise, which is the capacity to understand one’s own and others’ mental states. MBT is primarily used to treat borderline personality disorder, but it has also been used to treat other mental health conditions.
Fonagy and Bateman work on MBT was influenced by their research on attachment theory and the importance of early relationships in shaping mentalisation abilities. They believed that individuals with borderline personality disorder have difficulties with mentalisation due to early attachment disruptions, and that MBT could help them develop more stable and secure relationships.
MBT is typically delivered in a group of individual format, and it involves a combination of psychoeducation, cognitive-behavioral techniques, and psychodynamic interventions. The therapist helps the patient to identify and reflect on their thoughts, feelings, and behaviors, and to understand how these are influenced by their past experiences and relationships. The therapist also helps the patient to develop more adaptive coping strategies and to improve their interpersonal skills.
Overall, Fonagy and Bateman work on MBT has contributed to the development of psychodynamic therapies that are more focused on specific treatment goals and evidence-based practices.
-
This question is part of the following fields:
- Psychotherapy
-
-
Question 22
Correct
-
A 72-year-old man comes to you with complaints of feeling low and having trouble sleeping. Upon further discussion and using a validated symptom measure, you diagnose him with moderate depression. He has a history of cerebrovascular disease and is currently on aspirin, ramipril, and simvastatin. What would be the best course of action in this case?
Your Answer: Start citalopram + lansoprazole
Explanation: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
-
-
Question 23
Correct
-
What is a true statement about night terrors?
Your Answer: They are associated with complete amnesia for the episode
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
-
-
Question 24
Incorrect
-
Which option is not suggested by NICE for aiding relapse prevention in individuals with alcohol addiction?
Your Answer: Disulfiram
Correct Answer: Diazepam
Explanation:Anticonvulsants are not recommended for relapse prevention in alcohol dependence. While some studies have shown potential benefits for certain anticonvulsants, such as carbamazepine and valproate, the evidence is not strong enough to support their routine use. Additionally, these drugs can have significant side effects, including liver toxicity and blood disorders, and require careful monitoring. Therefore, they are not recommended by NICE for this indication.
-
This question is part of the following fields:
- Substance Misuse/Addictions
-
-
Question 25
Correct
-
Which statement accurately describes autism spectrum disorder?
Your 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
-
-
Question 26
Correct
-
For which conditions is rTMS recommended?
Your Answer: Unipolar depression
Explanation:Neurostimulation is a treatment that uses electromagnetic energy targeted at the brain. There are several forms of neurostimulation, including TMS, deep brain stimulation, and ECT. TMS is a non-invasive, non-convulsive technique used to stimulate neural tissue. It involves the placement of an electromagnetic coil on the patient’s scalp to deliver a short, powerful magnetic field pulse through the scalp and induce electric current in the brain. TMS is used to treat depression when standard treatments have failed. Deep brain stimulation is a neurosurgical technique that involves placing an electrode within the brain to deliver a high-frequency current in a specific subcortical of deep cortical structure. It has been used to treat Parkinson’s, dysthymia, OCD, and Tourette syndrome. There is RCT evidence to demonstrate its effectiveness in OCD, but conflicting results in depression and Tourette’s. DBS is also being trailed in other conditions such as anorexia, bipolar, and additions.
-
This question is part of the following fields:
- Organisation And Delivery Of Psychiatric Services
-
-
Question 27
Incorrect
-
What assessment tool would be most suitable for determining if a 55-year-old patient with Down's syndrome is showing signs of Alzheimer's disease?
Your Answer: CAMDEX
Correct Answer: DLD
Explanation:The CAMDEX assessment is not effective in detecting dementia in adults with learning disabilities, whose developmental ages are typically between 2 and 10 years. However, the Dementia Questionnaire for People with Learning Disabilities (DLD) is a useful tool for early detection of dementia in this population. For individuals with Down’s syndrome, an adapted version of the CAMDEX called the CAMDEX-DS can be utilized.
Assessment of Dementia in Down’s Syndrome
Individuals with Down’s syndrome are at a higher risk of developing Alzheimer’s disease. However, the commonly used MMSE test is not effective in assisting diagnosis in this population. Instead, two alternative tests are recommended: the Dementia Questionnaire for people with Learning Disabilities (DLD), previously known as the Dementia Questionnaire for Persons with Mental Retardation (DMR), and the Dementia Scale for Down Syndrome (DSDS). These tests are specifically designed to assess cognitive decline in individuals with Down’s syndrome and can aid in the early detection and management of dementia in this population.
-
This question is part of the following fields:
- Learning Disability
-
-
Question 28
Correct
-
Which odds ratio, along with its confidence interval, indicates a statistically significant reduction in the odds?
Your Answer: 0.7 (0.1 - 0.8)
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
-
-
Question 29
Correct
-
What is the estimated percentage of children with conduct disorders who are believed to fulfill the diagnostic criteria for antisocial personality disorder in adulthood?
Your Answer: 50%
Explanation:Disruptive Behaviour of Dissocial Disorders
Conduct disorders are the most common reason for referral of young children to mental health services. These disorders are characterized by a repetitive and persistent pattern of antisocial, aggressive, of defiant conduct that goes beyond ordinary childish mischief of adolescent rebelliousness. Oppositional defiant disorder (ODD) shares some negative attributes but in a more limited fashion.
ICD-11 terms the disorder as ‘Conduct-dissocial disorder’, while DSM-5 recognizes three separate conditions related to emotional/behavioral problems seen in younger people: conduct disorder, oppositional defiant disorder, and intermittent explosive disorder. Conduct disorder is about poorly controlled behavior, intermittent explosive disorder is about poorly controlled emotions, and ODD is in between. Conduct disorders are further divided into childhood onset (before 10 years) and adolescent onset (10 years of older).
The behavior pattern of conduct disorders must be persistent and recurrent, including multiple incidents of aggression towards people of animals, destruction of property, deceitfulness of theft, and serious violations of rules. The pattern of behavior must result in significant impairment in personal, family, social, educational, occupational, of other important areas of functioning.
Oppositional defiant disorder represents a less severe form of conduct disorder, where there is an absence of more severe dissocial of aggressive acts. The behavior pattern of ODD includes persistent difficulty getting along with others, provocative, spiteful, of vindictive behavior, and extreme irritability of anger.
The prevalence of conduct disorders increases throughout childhood and is more common in boys than girls. The most frequent comorbid problem seen with conduct disorder is hyperactivity. The conversion rate from childhood conduct disorder to adult antisocial personality disorder varies from 40 to 70% depending on the study.
NICE recommends group parent-based training programs of parent and child training programs for children with complex needs for ages 3-11, child-focused programs for ages 9-14, and multimodal interventions with a family focus for ages 11-17. Medication is not recommended in routine practice, but risperidone can be used where other approaches fail and they are seriously aggressive.
-
This question is part of the following fields:
- Child And Adolescent Psychiatry
-
-
Question 30
Correct
-
What is the recommended course of action when a patient with psychotic depression cannot tolerate a tricyclic antidepressant?
Your Answer: SSRI with antipsychotic augmentation
Explanation:Psychotic Depression
Psychotic depression is a type of depression that is characterized by the presence of delusions and/of hallucinations in addition to depressive symptoms. This condition is often accompanied by severe anhedonia, loss of interest, and psychomotor retardation. People with psychotic depression are tormented by hallucinations and delusions with typical themes of worthlessness, guilt, disease, of impending disaster. This condition affects approximately 14.7-18.5% of depressed patients and is estimated to affect around 0.4% of community adult samples, with a higher prevalence in the elderly community at around 1.4-3.0%. People with psychotic depression are at a higher risk of attempting and completing suicide than those with non-psychotic depression.
Diagnosis
Psychotic depression is currently classified as a subtype of depression in both the ICD-11 and the DSM-5. The main difference between the two is that in the ICD-11, the depressive episode must be moderate of severe to qualify for a diagnosis of depressive episode with psychotic symptoms, whereas in the DSM-5, the diagnosis can be applied to any severity of depressive illness.
Treatment
The recommended treatment for psychotic depression is tricyclics as first-line treatment, with antipsychotic augmentation. Second-line treatment includes SSRI/SNRI. Augmentation of antidepressant with olanzapine or quetiapine is recommended. The optimum dose and duration of antipsychotic augmentation are unknown. If one treatment is to be stopped during the maintenance phase, then this should be the antipsychotic. ECT should be considered where a rapid response is required of where other treatments have failed. According to NICE (ng222), combination treatment with antidepressant medication and antipsychotic medication (such as olanzapine or quetiapine) should be considered for people with depression with psychotic symptoms. If a person with depression with psychotic symptoms does not wish to take antipsychotic medication in addition to an antidepressant, then treat with an antidepressant alone.
-
This question is part of the following fields:
- General Adult Psychiatry
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)