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  • Question 1 - What is the medical condition that is identified by the presence of global...

    Correct

    • What is the medical condition that is identified by the presence of global confusion, ophthalmoplegia, and ataxia as its triad of symptoms?

      Your Answer: Wernicke's encephalopathy

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      5.1
      Seconds
  • Question 2 - Within what timeframe after giving birth should women requiring inpatient treatment for a...

    Incorrect

    • Within what timeframe after giving birth should women requiring inpatient treatment for a mental disorder be admitted to a specialized mother and baby unit, as per the guidelines of NICE?

      Your Answer: 0 - 6 weeks

      Correct Answer: 0 - 12 months

      Explanation:

      Mothers who require hospitalization for a mental illness within a year of delivering a baby should be admitted to a dedicated facility that specializes in caring for both the mother and her infant.

      Paroxetine Use During Pregnancy: Is it Safe?

      Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
      29.6
      Seconds
  • Question 3 - What symptom of characteristic would strongly indicate the presence of Niemann-Pick disease as...

    Incorrect

    • What symptom of characteristic would strongly indicate the presence of Niemann-Pick disease as an underlying diagnosis?

      Your Answer: Personality change and attentional issues in adulthood associated with irritability and aggression and jaundice

      Correct Answer: Treatment resistant psychosis with executive dysfunction

      Explanation:

      If a patient presents with both treatment resistant psychosis and executive dysfunction, it may be worth considering Niemann-Pick disease. Additionally, if a patient experiences treatment resistant anxiety symptoms accompanied by tachycardia, a pheochromocytoma should be considered. In cases where a patient exhibits personality changes and attentional issues in adulthood, along with irritability, aggression, and jaundice, it may suggest a mixed presentation of Wilson’s disease.

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      34.2
      Seconds
  • Question 4 - A young woman diagnosed with bipolar disorder and a history of severe mania...

    Correct

    • A young woman diagnosed with bipolar disorder and a history of severe mania has been effectively managed on lithium during her pregnancy. As she approaches her due date, she is eager to discuss the plan for her medication as she plans to breastfeed. What guidance would you offer?

      Your Answer: Switch from lithium to olanzapine

      Explanation:

      Consider prescribing olanzapine of quetiapine as prophylactic medication for women with bipolar disorder who stop taking lithium during pregnancy of plan to breastfeed, according to the Maudsley Prescribing Guidelines 13th edition. These medications can also be considered for post-partum initiation.

      Paroxetine Use During Pregnancy: Is it Safe?

      Prescribing medication during pregnancy and breastfeeding is challenging due to the potential risks to the fetus of baby. No psychotropic medication has a UK marketing authorization specifically for pregnant of breastfeeding women. Women are encouraged to breastfeed unless they are taking carbamazepine, clozapine, of lithium. The risk of spontaneous major malformation is 2-3%, with drugs accounting for approximately 5% of all abnormalities. Valproate and carbamazepine are associated with an increased risk of neural tube defects, and lithium is associated with cardiac malformations. Benzodiazepines are associated with oral clefts and floppy baby syndrome. Antidepressants have been linked to preterm delivery and congenital malformation, but most findings have been inconsistent. TCAs have been used widely without apparent detriment to the fetus, but their use in the third trimester is known to produce neonatal withdrawal effects. Sertraline appears to result in the least placental exposure among SSRIs. MAOIs should be avoided in pregnancy due to a suspected increased risk of congenital malformations and hypertensive crisis. If a pregnant woman is stable on an antipsychotic and likely to relapse without medication, she should continue the antipsychotic. Depot antipsychotics should not be offered to pregnant of breastfeeding women unless they have a history of non-adherence with oral medication. The Maudsley Guidelines suggest specific drugs for use during pregnancy and breastfeeding. NICE CG192 recommends high-intensity psychological interventions for moderate to severe depression and anxiety disorders. Antipsychotics are recommended for pregnant women with mania of psychosis who are not taking psychotropic medication. Promethazine is recommended for insomnia.

    • This question is part of the following fields:

      • General Adult Psychiatry
      679.3
      Seconds
  • Question 5 - What percentage of individuals aged 16 years and older in the UK are...

    Incorrect

    • What percentage of individuals aged 16 years and older in the UK are considered to be harmful drinkers?

      Your Answer: 10%

      Correct Answer: 4%

      Explanation:

      Out of the population aged 16 of over, 19% do not consume alcohol, while 60% have a low risk pattern of alcohol consumption. 17% have an increased risk pattern, and 4% have a higher risk pattern, according to the classification of alcohol consumption based on weekly units.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      16
      Seconds
  • Question 6 - What is true about diagnosing recurrent depression? ...

    Incorrect

    • What is true about diagnosing recurrent depression?

      Your Answer: The ICD-11 specifies that to qualify for a diagnosis of recurrent depression there must be a period of at least one month in between depressive episodes during which there is no mood disturbance

      Correct Answer: According to the DSM-5, a patient may still qualify for a diagnosis of recurrent depression if their depressive symptoms persist in between depressive episodes as long as during that time they do not meet criteria for a depressive episode

      Explanation:

      The ICD-11 and DSM-5 both allow for a diagnosis of recurrent depression if there is continued mood disturbance between depressive episodes. However, the ICD-11 requires that the mood disturbance during the intervening period is not significant, while the DSM-5 requires that the symptoms are below the diagnostic threshold. Both classifications require at least two episodes, including the current one, for a diagnosis of recurrent depression. The ICD-11 specifies that the two episodes must be separated by several months, while the DSM-5 requires an intervening time period of at least two months.

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

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      44.7
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  • Question 7 - A 45-year-old woman presents to the local Emergency department with double vision.
    She has...

    Correct

    • A 45-year-old woman presents to the local Emergency department with double vision.
      She has been consuming more than 20 units of alcohol daily for several years. She appears unkempt, emaciated and malnourished. Her blood alcohol level is negative and she claims to have stopped drinking five days ago. She has been experiencing vomiting multiple times a day for the past three days.
      The Emergency department physician seeks your expert opinion. You observe signs of lateral rectus palsy, ataxia and nystagmus.
      What is the most probable location of the lesion in the women's nervous system?

      Your Answer: Mammillary bodies

      Explanation:

      This case presents a man who exhibits the classic triad of symptoms associated with Wernicke’s encephalopathy, including ophthalmoplegia, ataxia, and confusion. The underlying lesion is located in the Mammillary bodies and around the third ventricle and aqueduct. This condition is typically caused by a deficiency in thiamine (vitamin B-1), which can be triggered in individuals who are malnourished and dependent on alcohol due to prolonged vomiting. Korsakoff’s amnesic syndrome is a later manifestation of this condition, characterized by memory loss and confabulation.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      31.7
      Seconds
  • Question 8 - What is true about the 2014 Adult Psychiatric Morbidity Survey? ...

    Correct

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

      Your 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
      18.8
      Seconds
  • Question 9 - What is the enzyme that is lacking in Niemann-Pick disease? ...

    Correct

    • What is the enzyme that is lacking in Niemann-Pick disease?

      Your Answer: Sphingomyelinase

      Explanation:

      Phenylketonuria is caused by a deficiency in the enzyme phenylalanine hydroxylase.

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      5.6
      Seconds
  • Question 10 - What are the accurate statements about the risk factors associated with schizophrenia? ...

    Correct

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

      Your Answer: Winter birth is a risk factor for schizophrenia

      Explanation:

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

      Schizophrenia: Understanding the Risk Factors

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

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      15.4
      Seconds
  • Question 11 - Which of the following resources has been filtered? ...

    Incorrect

    • Which of the following resources has been filtered?

      Your Answer: Embase

      Correct Answer: DARE

      Explanation:

      The main focus of the Database of Abstracts of Reviews of Effect (DARE) is on systematic reviews that assess the impact of healthcare interventions and the management and provision of healthcare services. In order to be considered for inclusion, reviews must satisfy several requirements.

      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
      14.9
      Seconds
  • Question 12 - At what age can a person be diagnosed with the personality disorder that...

    Correct

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

      Your Answer: Antisocial

      Explanation:

      Personality Disorder: Understanding the Clinical Diagnosis

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      14.7
      Seconds
  • Question 13 - Which symptom is not considered a sign of PTSD in individuals with learning...

    Correct

    • Which symptom is not considered a sign of PTSD in individuals with learning disabilities?

      Your Answer: Auditory hallucinations

      Explanation:

      Post Traumatic Stress Disorder in People with Learning Difficulties

      Post traumatic stress disorder (PTSD) can present differently in people with learning difficulties compared to those without. While nightmares, jumpiness, and sleep disturbance are common in the general population, aggression and behavioral disturbance are more common in those with learning disabilities. Other symptoms may include disruptive of defiant behavior, self-harm, agitation, distractibility, and depressed mood.

      The most common cause of PTSD in people with learning difficulties is abuse. Treatment for PTSD in this population is similar to that for those without learning difficulties, including trauma-focused cognitive behavioral therapy of eye movement desensitization and reprocessing (EMDR) with selective serotonin reuptake inhibitors (SSRIs) of venlafaxine as an alternative of combined. However, the therapy must be tailored to the individual’s ability to understand and communicate.

    • This question is part of the following fields:

      • Learning Disability
      9.5
      Seconds
  • Question 14 - At low doses, which medications are purported to have an antidepressant effect? ...

    Correct

    • At low doses, which medications are purported to have an antidepressant effect?

      Your Answer: Flupentixol

      Explanation:

      Flupentixol as an Antidepressant

      Flupentixol is a conventional antipsychotic medication that works by strongly blocking D1 and D2 receptors, as well as having some weak antagonistic effects on 5-HT2A receptors. It is commonly used as an antidepressant at doses ranging from 0.5 to 3 mg per day. The British National Formulary (BNF) has approved flupentixol for the treatment of depression. In the 13th edition of the Maudsley Prescribing Guidelines, intramuscular flupentixol is recommended as an alternative route of administration for patients who are unable of unwilling to take oral antidepressants.

    • This question is part of the following fields:

      • General Adult Psychiatry
      9.3
      Seconds
  • Question 15 - What is the subtype of Niemann-Pick disease that manifests in the first few...

    Correct

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

      Your Answer: Type A

      Explanation:

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      16.1
      Seconds
  • Question 16 - What was the most common disorder identified in the Epidemiological Catchment Area study?...

    Incorrect

    • What was the most common disorder identified in the Epidemiological Catchment Area study?

      Your Answer: Affective disorders

      Correct Answer: Substance misuse disorders

      Explanation:

      The most common disorder identified in the study was substance misuse, which encompassed both alcohol and drug use. This finding differs from the National Psychiatric Morbidity Survey, which reported neurotic disorders as the most prevalent. However, this discrepancy is likely due to differences in study design rather than actual differences in prevalence. The ECA study specifically identified high rates of alcohol dependence and illicit drug use, but presented these findings as distinct categories.

      Epidemiological Catchment Area Study: A Landmark Community-Based Survey

      The Epidemiological Catchment Area Study (ECA) was a significant survey conducted in five US communities from 1980-1985. The study included 20,000 participants, with 3000 community residents and 500 residents of institutions sampled in each site. The Diagnostic Interview Schedule (DIS) was used to conduct two interviews over a year with each participant.

      However, the DIS diagnosis of schizophrenia was not consistent with psychiatrists’ classification, with only 20% of cases identified by the DIS in the Baltimore ECA site matching the psychiatrist’s diagnosis. Despite this, the ECA produced valuable findings, including a lifetime prevalence rate of 32.3% for any disorder, 16.4% for substance misuse disorder, 14.6% for anxiety disorder, 8.3% for affective disorder, 1.5% for schizophrenia and schizophreniform disorder, and 0.1% for somatization disorder.

      The ECA also found that phobia had a one-month prevalence of 12.5%, generalized anxiety and depression had a prevalence of 8.5%, obsessive-compulsive disorder had a prevalence of 2.5%, and panic had a prevalence of 1.6%. Overall, the ECA was a landmark community-based survey that provided valuable insights into the prevalence of mental disorders in the US.

    • This question is part of the following fields:

      • General Adult Psychiatry
      8.6
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  • Question 17 - What is a true statement about night terrors? ...

    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
      7.5
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  • Question 18 - What is a true statement about acute and transient psychotic disorder? ...

    Correct

    • What is a true statement about acute and transient psychotic disorder?

      Your Answer: Symptoms such as affective flattening and avolition are not expected

      Explanation:

      In order to diagnose acute and transient psychotic disorder, it is crucial that the individual does not exhibit negative symptoms such as affective flattening, alogia, avolition, asociality, of anhedonia during the psychotic episode. Despite the severity of symptoms being comparable to those seen in schizophrenia, there is typically no prodrome and symptoms can fluctuate rapidly in both frequency and intensity.

      – Schizophrenia and other primary psychotic disorders are characterized by impairments in reality testing and alterations in behavior.
      – Schizophrenia is a chronic mental health disorder with symptoms including delusions, hallucinations, disorganized speech of behavior, and impaired cognitive ability.
      – The essential features of schizophrenia include persistent delusions, persistent hallucinations, disorganized thinking, experiences of influence, passivity of control, negative symptoms, grossly disorganized behavior, and psychomotor disturbances.
      – Schizoaffective disorder is diagnosed when all diagnostic requirements for schizophrenia are met concurrently with mood symptoms that meet the diagnostic requirements of a moderate or severe depressive episode, a manic episode, of a mixed episode.
      – Schizotypal disorder is an enduring pattern of unusual speech, perceptions, beliefs, and behaviors that are not of sufficient intensity of duration to meet the diagnostic requirements of schizophrenia, schizoaffective disorder, of delusional disorder.
      – Acute and transient psychotic disorder is characterized by an acute onset of psychotic symptoms, which can include delusions, hallucinations, disorganized thinking, of experiences of influence, passivity of control, that emerge without a prodrome, progressing from a non-psychotic state to a clearly psychotic state within 2 weeks.
      – Delusional disorder is diagnosed when there is a presence of a delusion of set of related delusions, typically persisting for at least 3 months and often much longer, in the absence of a depressive, manic, of mixed episode.

    • This question is part of the following fields:

      • General Adult Psychiatry
      11.9
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  • Question 19 - What is the most reliable predictor of a positive outcome in psychodynamic psychotherapy?...

    Incorrect

    • What is the most reliable predictor of a positive outcome in psychodynamic psychotherapy?

      Your Answer: Patient is of above average intelligence

      Correct Answer: Patient is motivated to change

      Explanation:

      Factors Predicting Favorable Outcome for Psychotherapy

      There are several factors that can predict a favorable outcome for psychotherapy, indicating that a patient is suitable for this type of treatment. One of the most important factors is the patient’s capacity to form a therapeutic relationship with the therapist. This means that the patient is able to establish a trusting and collaborative relationship with the therapist, which is essential for effective therapy.

      Another important factor is the patient’s motivation to change. Patients who are motivated to change are more likely to engage in therapy and to make progress towards their goals. This motivation can come from a variety of sources, such as a desire to improve their quality of life, reduce symptoms of mental illness, of improve their relationships with others.

      Psychological mindedness is also an important factor in predicting a favorable outcome for psychotherapy. This refers to the patient’s ability to understand and reflect on their own thoughts, feelings, and behaviors, as well as those of others. Patients who are psychologically minded are more likely to benefit from therapy because they are able to engage in self-reflection and gain insight into their own experiences.

      Finally, good ego strength is another factor that predicts a favorable outcome for psychotherapy. Ego strength refers to the patient’s ability to cope with stress and adversity, and to maintain a sense of self-worth and self-esteem. Patients with good ego strength are better able to tolerate the emotional challenges of therapy and to make progress towards their goals. Overall, these factors can help clinicians identify patients who are likely to benefit from psychotherapy and tailor their treatment accordingly.

    • This question is part of the following fields:

      • Psychotherapy
      17.1
      Seconds
  • Question 20 - What is the recommended treatment for a stroke patient experiencing pathological crying? ...

    Correct

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

      Your Answer: Amitriptyline

      Explanation:

      Pathological Crying

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

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

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

    • This question is part of the following fields:

      • Old Age Psychiatry
      4.8
      Seconds
  • Question 21 - What intervention has been proven to effectively decrease suicidal behavior? ...

    Correct

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

      Your Answer: Clozapine

      Explanation:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.3
      Seconds
  • Question 22 - A client who has recently been diagnosed with schizophrenia asks for information regarding...

    Correct

    • A client who has recently been diagnosed with schizophrenia asks for information regarding their prognosis. What factor has been consistently linked to a poor prognosis in schizophrenia?

      Your Answer: Younger age of onset

      Explanation:

      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
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  • Question 23 - What type of amnesia is typically associated with Korsakoff's syndrome? ...

    Correct

    • What type of amnesia is typically associated with Korsakoff's syndrome?

      Your Answer: Anterograde amnesia

      Explanation:

      Korsakoff’s syndrome is characterized by a significant and disproportionate loss of the ability to form new memories, known as anterograde amnesia, in an otherwise cognitively intact individual (Caulo 2005). Additionally, individuals with this syndrome may experience source amnesia, where they can recall information but cannot remember where of how they learned it, as well as prosopamnesia, which is the inability to recognize of remember faces.

      Korsakoff’s Syndrome

      Korsakoff’s Syndrome, also known as amnesic syndrome, is a chronic condition that affects recent and anterograde memory in an alert and responsive patient. It is caused by prolonged thiamine (vitamin B1) deficiency and often follows Wernicke’s encephalopathy. The syndrome is characterized by a lack of insight, apathy, and confabulation. Thiamine is essential for glucose metabolism in the brain, and its deficiency leads to a toxic buildup of glucose, causing neuronal loss. The Mammillary bodies are the main areas affected in Korsakoff’s syndrome.

      While intelligence on the WAIS is preserved, episodic memory is severely affected in Korsakoff’s syndrome. Semantic memory is variably affected, but implicit aspects of memory, such as response to priming and procedural memory, are preserved. Immediate memory tested with the digit span is normal, but information can only be retained for a few minutes at most. Patients with Korsakoff’s syndrome often display apathy, lack of initiative, and profound lack of insight.

      Source: Kopelman M (2009) The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment. Alcohol and Alcoholism 44 (2): 148-154.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 24 - What is a known factor that can lead to psychosis? ...

    Correct

    • What is a known factor that can lead to psychosis?

      Your Answer: Huntington's disease

      Explanation:

      Psychiatric and Behavioural Symptoms of Huntington’s Disease

      Huntington’s disease is a condition that affects individuals with a triad of symptoms, including motor, cognitive, and psychiatric symptoms. While the symptoms typically begin in the third and fourth decades of life, individuals with a high number of CAG repeats may experience symptoms before the age of 20, known as juvenile Huntington’s disease.

      The psychiatric symptoms of Huntington’s disease can include depression, apathy, dementia, psychosis, anxiety, mania, sexual dysfunction, and even suicide. These symptoms can significantly impact an individual’s quality of life and require appropriate treatment. Advances in psychiatric treatment have been made to address these symptoms and improve the overall well-being of individuals with Huntington’s disease.

    • This question is part of the following fields:

      • Old Age Psychiatry
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  • Question 25 - What is the name of the self-reported screening tool for personality disorders that...

    Incorrect

    • What is the name of the self-reported screening tool for personality disorders that consists of 100 true and false questions and is developed based on DSM-IV criteria?

      Your Answer: IIP-PD

      Correct Answer: PDQ-R

      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
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  • Question 26 - A client inquires about the concept of transference, what would be your best...

    Correct

    • A client inquires about the concept of transference, what would be your best answer?

      Your Answer: The effect of past relationships on current relationships

      Explanation:

      Transference and Countertransference

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

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

    • This question is part of the following fields:

      • Psychotherapy
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  • Question 27 - Which of the following is an atypical characteristic of PANDAS? ...

    Incorrect

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

      Your Answer: Obsessions

      Correct Answer: Hallucinations

      Explanation:

      PANDAS: A Disorder Linked to Streptococcal Infections

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 28 - Which of the options below is not included in the DSM-5 criteria for...

    Incorrect

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

      Your Answer: Often interrupts of intrudes on others

      Correct Answer: Often loses temper

      Explanation:

      ADHD (Diagnosis and Management in Children)

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
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  • Question 29 - What does a smaller p-value indicate in terms of the strength of evidence?...

    Correct

    • What does a smaller p-value indicate in terms of the strength of evidence?

      Your Answer: The alternative hypothesis

      Explanation:

      A p-value represents the likelihood of rejecting a null hypothesis that is actually true. A smaller p-value indicates a lower chance of mistakenly rejecting the null hypothesis, providing evidence in favor of the alternative hypothesis.

      Understanding Hypothesis Testing in Statistics

      In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.

      The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.

      Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.

      P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 30 - What is the estimated percentage of patients with schizophrenia who will not adhere...

    Correct

    • What is the estimated percentage of patients with schizophrenia who will not adhere to their antipsychotic medication regimen after 24 months of treatment?

      Your Answer: 75%

      Explanation:

      Non-Compliance

      Studies have shown that adherence rates in patients with psychosis who are treated with antipsychotics can range from 25% to 75%. Shockingly, approximately 90% of those who are non-compliant admit to doing so intentionally (Maudsley 12th edition). After being discharged from the hospital, the expected non-compliance rate in individuals with schizophrenia is as follows (Maudsley 12th Edition): 25% at ten days, 50% at one year, and 75% at two years. The Drug Attitude Inventory (DAI) is a useful tool for assessing a patient’s attitude towards medication and predicting compliance. Other scales that can be used include the Rating of Medication Influences Scale (ROMI), the Beliefs about Medication Questionnaire, and the Medication Adherence Rating Scale (MARS).

    • This question is part of the following fields:

      • General Adult Psychiatry
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SESSION STATS - PERFORMANCE PER SPECIALTY

Substance Misuse/Addictions (3/3) 100%
General Adult Psychiatry (9/12) 75%
Child And Adolescent Psychiatry (3/6) 50%
Organisation And Delivery Of Psychiatric Services (0/1) 0%
Research Methods, Statistics, Critical Review And Evidence-Based Practice (1/2) 50%
Learning Disability (1/1) 100%
Psychotherapy (1/2) 50%
Old Age Psychiatry (2/2) 100%
Forensic Psychiatry (0/1) 0%
Passmed