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  • Question 1 - What is the conventional cutoff for a p-value of 0.05 and what does...

    Correct

    • What is the conventional cutoff for a p-value of 0.05 and what does it mean in terms of the likelihood of detecting a difference by chance?

      Your Answer: 1 in 14 times

      Explanation:

      The probability of detecting a difference by chance is 1 in 20 times when the p-value is 0.05, which is the conventional cutoff. In this case, the answer is 1 in 14 times, which is equivalent to a p-value of 0.07.

      Understanding Hypothesis Testing in Statistics

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

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

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

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

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      140.4
      Seconds
  • Question 2 - What is the typical duration and frequency of cognitive analytic therapy sessions? ...

    Incorrect

    • What is the typical duration and frequency of cognitive analytic therapy sessions?

      Your Answer: 6-12 weeks

      Correct Answer: 16-24 weeks

      Explanation:

      Understanding Cognitive Analytic Therapy

      Cognitive Analytic Therapy (CAT) is a form of therapy that combines psychodynamic and cognitive approaches. It is a brief therapy that typically lasts between 16-24 sessions. Developed by Anthony Ryle, CAT aims to identify the useful parts of psychotherapy and make it more efficient. It also aims to create a therapy that can be easily researched.

      CAT focuses on identifying key issues early on and conceptualizing them as repeated unsuccessful strategies. These strategies are categorized into traps, dilemmas, and snags. Traps are flawed thinking patterns that result in a vicious cycle of negative assumptions and actions. Dilemmas occur when a person believes their choices are restricted to opposite actions, neither of which is satisfactory. Snags are thinking patterns that restrict actions due to a perception of potential harm of failure.

      CAT follows a procedural sequence model, where the problem is appraised, options are discussed, a plan is created and put into place, and consequences are evaluated. The therapist often summarizes the problem and plan in a letter to the client.

      CAT also identifies reciprocal role procedures (RRPs), which are patterns observed in the way we related to others. These patterns are visually presented using a sequential diagrammatic reformulation. For example, a client who rebelled against a stern, dominating father may be dismissive of therapy because they see the therapist as a demanding authority figure.

      Overall, CAT is a useful therapy that combines psychodynamic and cognitive approaches to identify and address maladaptive patterns. Its procedural sequence model and use of RRPs make it an efficient and effective therapy.

    • This question is part of the following fields:

      • Psychotherapy
      12.8
      Seconds
  • Question 3 - A 72-year-old man comes to you with complaints of feeling low and having...

    Incorrect

    • 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

      Correct 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
      53.9
      Seconds
  • Question 4 - To address the increasing suicidal tendencies of a patient with bipolar disorder, what...

    Correct

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

      Your Answer: Lithium

      Explanation:

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

      Lithium’s Effectiveness in Reducing Suicide in Bipolar Disorder Patients

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      9.9
      Seconds
  • Question 5 - What is the recommended initial medication for treating panic disorder, as per the...

    Correct

    • What is the recommended initial medication for treating panic disorder, as per the NICE guidelines?

      Your Answer: SSRI

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      7.3
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  • Question 6 - What is a true statement about cost-benefit analysis? ...

    Incorrect

    • What is a true statement about cost-benefit analysis?

      Your Answer: It involves the use of the QALY

      Correct Answer: Benefits are valued in monetary terms

      Explanation:

      The net benefit of a proposed scheme is calculated by subtracting the costs from the benefits in a CBA. For instance, if the benefits of the scheme are valued at £140 k and the costs are £10 k, then the net benefit would be £130 k.

      Methods of Economic Evaluation

      There are four main methods of economic evaluation: cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), cost-utility analysis (CUA), and cost-minimisation analysis (CMA). While all four methods capture costs, they differ in how they assess health effects.

      Cost-effectiveness analysis (CEA) compares interventions by relating costs to a single clinical measure of effectiveness, such as symptom reduction of improvement in activities of daily living. The cost-effectiveness ratio is calculated as total cost divided by units of effectiveness. CEA is typically used when CBA cannot be performed due to the inability to monetise benefits.

      Cost-benefit analysis (CBA) measures all costs and benefits of an intervention in monetary terms to establish which alternative has the greatest net benefit. CBA requires that all consequences of an intervention, such as life-years saved, treatment side-effects, symptom relief, disability, pain, and discomfort, are allocated a monetary value. CBA is rarely used in mental health service evaluation due to the difficulty in converting benefits from mental health programmes into monetary values.

      Cost-utility analysis (CUA) is a special form of CEA in which health benefits/outcomes are measured in broader, more generic ways, enabling comparisons between treatments for different diseases and conditions. Multidimensional health outcomes are measured by a single preference- of utility-based index such as the Quality-Adjusted-Life-Years (QALY). QALYs are a composite measure of gains in life expectancy and health-related quality of life. CUA allows for comparisons across treatments for different conditions.

      Cost-minimisation analysis (CMA) is an economic evaluation in which the consequences of competing interventions are the same, and only inputs, i.e. costs, are taken into consideration. The aim is to decide the least costly way of achieving the same outcome.

      Costs in Economic Evaluation Studies

      There are three main types of costs in economic evaluation studies: direct, indirect, and intangible. Direct costs are associated directly with the healthcare intervention, such as staff time, medical supplies, cost of travel for the patient, childcare costs for the patient, and costs falling on other social sectors such as domestic help from social services. Indirect costs are incurred by the reduced productivity of the patient, such as time off work, reduced work productivity, and time spent caring for the patient by relatives. Intangible costs are difficult to measure, such as pain of suffering on the part of the patient.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      23.7
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  • Question 7 - Which treatment option is not suggested by the Maudsley Guidelines to enhance the...

    Incorrect

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

      Your Answer: Haloperidol

      Correct Answer: Pimozide

      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
      16.1
      Seconds
  • Question 8 - What medication should be avoided when a patient is already taking clozapine? ...

    Correct

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

      Your Answer: Carbamazepine

      Explanation:

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      23
      Seconds
  • Question 9 - What is the weekly unit intake of a patient who consumes 3 litres...

    Correct

    • What is the weekly unit intake of a patient who consumes 3 litres of 12% ABV wine per day?

      Your Answer: 252

      Explanation:

      The weekly total is 252 units.

      Alcohol Conversion

      When converting alcohol volume to units, use the equation: Alcohol (units) = Alcohol volume (litres) x Alcohol by volume. For example, if you have 2 liters of cider with 6% alcohol, it is equal to 12 units. Remember to always use this equation to accurately convert alcohol volume to units.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      24.4
      Seconds
  • Question 10 - What is a characteristic of data that is positively skewed? ...

    Incorrect

    • What is a characteristic of data that is positively skewed?

      Your Answer: Mode > median > mean

      Correct Answer:

      Explanation:

      Skewed Data: Understanding the Relationship between Mean, Median, and Mode

      When analyzing a data set, it is important to consider the shape of the distribution. In a normally distributed data set, the curve is symmetrical and bell-shaped, with the median, mode, and mean all equal. However, in skewed data sets, the distribution is asymmetrical, with the bulk of the data concentrated on one side of the figure.

      In a negatively skewed distribution, the left tail is longer, and the bulk of the data is concentrated to the right of the figure. In contrast, a positively skewed distribution has a longer right tail, with the bulk of the data concentrated to the left of the figure. In both cases, the median is positioned between the mode and the mean, as it represents the halfway point of the distribution.

      However, the mean is affected by extreme values of outliers, causing it to move away from the median in the direction of the tail. In positively skewed data, the mean is greater than the median, which is greater than the mode. In negatively skewed data, the mode is greater than the median, which is greater than the mean.

      Understanding the relationship between mean, median, and mode in skewed data sets is crucial for accurate data analysis and interpretation. By recognizing the shape of the distribution, researchers can make informed decisions about which measures of central tendency to use and how to interpret their results.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      52.7
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  • Question 11 - Which symptom is not commonly linked to PTSD? ...

    Correct

    • Which symptom is not commonly linked to PTSD?

      Your Answer: Hallucinations

      Explanation:

      Common signs of PTSD may include:

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      10.1
      Seconds
  • Question 12 - What is a correct statement about funnel plots? ...

    Incorrect

    • What is a correct statement about funnel plots?

      Your Answer: A symmetric funnel shape indicates possible publication bias

      Correct Answer: Each dot represents a separate study result

      Explanation:

      An asymmetric funnel plot may indicate the presence of publication bias, although this is not a definitive confirmation. The x-axis typically represents a measure of effect, such as the risk ratio of odds ratio, although other measures may also be used.

      Stats Publication Bias

      Publication bias refers to the tendency for studies with positive findings to be published more than studies with negative findings, leading to incomplete data sets in meta-analyses and erroneous conclusions. Graphical methods such as funnel plots, Galbraith plots, ordered forest plots, and normal quantile plots can be used to detect publication bias. Funnel plots are the most commonly used and offer an easy visual way to ensure that published literature is evenly weighted. The x-axis represents the effect size, and the y-axis represents the study size. A symmetrical, inverted funnel shape indicates that publication bias is unlikely, while an asymmetrical funnel indicates a relationship between treatment effect and study size, indicating either publication bias of small study effects.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      22.5
      Seconds
  • Question 13 - What percentage of alcoholic beverages were estimated to be sold at a price...

    Incorrect

    • What percentage of alcoholic beverages were estimated to be sold at a price lower than their cost before the ban was implemented in 2014?

      Your Answer: 23%

      Correct Answer:

      Explanation:

      In May 2014, the UK implemented a ban on selling alcohol below the cost of duty and VAT, known as below-cost selling. Prior to the ban, only 0.7% of all units sold were estimated to be sold below duty plus VAT. A recent study by the University of Sheffield suggests that the ban will prevent 14 deaths and 500 hospital admissions annually in England. However, if the ban had been set at a higher price point, between 40 pence and 50 pence per unit, the impact would have been much greater, preventing 624 deaths and 23,700 admissions, and affecting almost a quarter (23.2%) of all alcohol units sold.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      120.6
      Seconds
  • Question 14 - What antibiotic is utilized for treating schizophrenia that is resistant to other forms...

    Correct

    • What antibiotic is utilized for treating schizophrenia that is resistant to other forms of treatment?

      Your Answer: Minocycline

      Explanation:

      Treatment resistant schizophrenia may benefit from minocycline, a medication typically used for pneumonia and acne.

      Treatment Options for Schizophrenia (Resistance)

      Schizophrenia can be a challenging condition to treat, especially when it is resistant to standard therapies. In such cases, clozapine is the preferred treatment option. However, if this medication is not suitable of fails to produce the desired results, there are other options available, although their effectiveness is often limited.

      There is little variation between the alternative treatments, and in practice, olanzapine is typically the first choice, often prescribed at doses higher than those recommended by the manufacturer. If this approach proves ineffective, a second antipsychotic medication may be added to the treatment regimen. Despite these efforts, treatment-resistant schizophrenia remains a significant challenge for clinicians and patients alike.

    • This question is part of the following fields:

      • General Adult Psychiatry
      13.2
      Seconds
  • Question 15 - What is a true statement about catatonia? ...

    Incorrect

    • What is a true statement about catatonia?

      Your Answer: Catatonia is pathognomonic of schizophrenia

      Correct Answer: Patients with schizophrenia who develop catatonia are less likely to respond to treatment than those with mood disorders

      Explanation:

      Catatonia can occur in both functional mental illnesses like schizophrenia and general medical conditions such as infections, drug withdrawal, and endocrine disorders. The primary treatment for catatonia is benzodiazepines, with a typical response time of 3-7 days. If benzodiazepines are ineffective, electroconvulsive therapy (ECT) may be necessary. However, patients with schizophrenia are less likely to respond to either treatment compared to those with mood disorders.

      Catatonia Treatment

      Catatonia can lead to complications such as dehydration, deep vein thrombosis, pulmonary embolism, and pneumonia. Therefore, prompt treatment is essential. The first-line treatment is benzodiazepines, particularly lorazepam. If this is ineffective, electroconvulsive therapy (ECT) may be considered. The use of antipsychotics is controversial and should be avoided during the acute phase of catatonia.

    • This question is part of the following fields:

      • General Adult Psychiatry
      41.1
      Seconds
  • Question 16 - What does the psychodynamic term condensation refer to when used by a psychotherapy...

    Incorrect

    • What does the psychodynamic term condensation refer to when used by a psychotherapy supervisor during a discussion about a patient's dream?

      Your Answer: The act of converting the manifest content into the latent content

      Correct Answer: The process of combining several concepts into a single image

      Explanation:

      As an AI language model, I do not have personal opinions of beliefs. However, I can provide a summary of the information presented in the text. The text discusses different models of dream interpretation in psychodynamic therapy, including Freudian interpretation, compensatory theory, content analysis, the Five Star Method, and the cognitive-experiential model. Each model has its own approach to understanding the meaning of dreams, with some focusing on unconscious desires and motivations, while others emphasize personal experiences and attitudes. The text provides an overview of each model and their key assumptions and techniques.

    • This question is part of the following fields:

      • Psychotherapy
      33.5
      Seconds
  • Question 17 - A 42-year-old man with a history of heavy alcohol use for the past...

    Incorrect

    • A 42-year-old man with a history of heavy alcohol use for the past 15 years presents with seizures and worsening difficulty with walking. During a mini-mental state examination, you observe that his score is 20/30, which is two points lower than his previous score from a few months ago. What is the most probable site of the lesion?

      Your Answer: Mammillary bodies

      Correct Answer: Corpus callosum

      Explanation:

      The passage details the effects of Marchiafava-Bignami disease, a condition resulting from excessive alcohol consumption that leads to the deterioration of the corpus callosum.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      56
      Seconds
  • Question 18 - What is the level of CPA designed for individuals with high-risk and complex...

    Incorrect

    • What is the level of CPA designed for individuals with high-risk and complex needs?

      Your Answer: Level 5

      Correct Answer: Enhanced

      Explanation:

      The Care Program Approach (CPA) was implemented in 1991 to enhance community care for individuals with severe mental illness. The CPA comprises four primary components, including assessment, a care plan, a Care Coordinator (formerly known as a Key Worker), and regular review. There are two levels of CPA, namely standard and enhanced. Standard care plans are suitable for individuals who require minimal input from a single agency and pose minimal risk to themselves of others. Enhanced care plans are designed for individuals with complex needs who require collaboration among multiple agencies.

    • This question is part of the following fields:

      • Organisation And Delivery Of Psychiatric Services
      28
      Seconds
  • Question 19 - What is the required frequency and duration of bedwetting behavior to meet the...

    Correct

    • What is the required frequency and duration of bedwetting behavior to meet the diagnostic threshold for enuresis?

      Your Answer: At least twice weekly for at least 3 months

      Explanation:

      Elimination Disorders

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

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

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

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      18.5
      Seconds
  • Question 20 - In which therapeutic model are reciprocal role procedures included? ...

    Correct

    • In which therapeutic model are reciprocal role procedures included?

      Your Answer: Cognitive analytic therapy

      Explanation:

      Understanding Cognitive Analytic Therapy

      Cognitive Analytic Therapy (CAT) is a form of therapy that combines psychodynamic and cognitive approaches. It is a brief therapy that typically lasts between 16-24 sessions. Developed by Anthony Ryle, CAT aims to identify the useful parts of psychotherapy and make it more efficient. It also aims to create a therapy that can be easily researched.

      CAT focuses on identifying key issues early on and conceptualizing them as repeated unsuccessful strategies. These strategies are categorized into traps, dilemmas, and snags. Traps are flawed thinking patterns that result in a vicious cycle of negative assumptions and actions. Dilemmas occur when a person believes their choices are restricted to opposite actions, neither of which is satisfactory. Snags are thinking patterns that restrict actions due to a perception of potential harm of failure.

      CAT follows a procedural sequence model, where the problem is appraised, options are discussed, a plan is created and put into place, and consequences are evaluated. The therapist often summarizes the problem and plan in a letter to the client.

      CAT also identifies reciprocal role procedures (RRPs), which are patterns observed in the way we related to others. These patterns are visually presented using a sequential diagrammatic reformulation. For example, a client who rebelled against a stern, dominating father may be dismissive of therapy because they see the therapist as a demanding authority figure.

      Overall, CAT is a useful therapy that combines psychodynamic and cognitive approaches to identify and address maladaptive patterns. Its procedural sequence model and use of RRPs make it an efficient and effective therapy.

    • This question is part of the following fields:

      • Psychotherapy
      9.6
      Seconds
  • Question 21 - Which condition is believed to be linked to puerperal psychosis? ...

    Incorrect

    • Which condition is believed to be linked to puerperal psychosis?

      Your Answer: Schizophrenia

      Correct Answer: Bipolar affective disorder

      Explanation:

      Psychiatric Issues in the Postpartum Period

      The period following childbirth, known as the postpartum period, can be a time of significant psychiatric challenges for women. Many women experience a temporary mood disturbance called baby blues, which is characterized by emotional instability, sadness, and tearfulness. This condition typically resolves within two weeks.

      However, a minority of women (10-15%) experience postpartum depression, which is similar to major depression in its clinical presentation. In contrast, a very small number of women (1-2 per 1000) experience postpartum psychosis, also known as puerperal psychosis. This is a severe form of psychosis that occurs in the weeks following childbirth.

      Research suggests that there may be a link between puerperal psychosis and mood disorders, as approximately 50% of women who develop the condition have a family history of mood disorder. Puerperal psychosis typically begins within the first two weeks following delivery. It is important for healthcare providers to be aware of these potential psychiatric issues and to provide appropriate support and treatment to women during the postpartum period.

    • This question is part of the following fields:

      • General Adult Psychiatry
      17
      Seconds
  • Question 22 - A 65-year-old patient develops tardive dyskinesia while taking zuclopenthixol. What is the most...

    Incorrect

    • A 65-year-old patient develops tardive dyskinesia while taking zuclopenthixol. What is the most suitable course of action in this scenario?

      Your Answer: Reduce the dose and continue

      Correct Answer: Switch to olanzapine

      Explanation:

      The practice of reducing the dosage of antipsychotics is outdated and no longer recommended, as per Cochrane’s 2006 findings. Instead, a more effective approach is to switch to an antipsychotic medication that has a lower risk of causing the condition.

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

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

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

    • This question is part of the following fields:

      • General Adult Psychiatry
      285.3
      Seconds
  • Question 23 - For what age group would early onset schizophrenia be a suitable diagnosis? ...

    Correct

    • For what age group would early onset schizophrenia be a suitable diagnosis?

      Your Answer: 13-18

      Explanation:

      Schizophrenia in children is rare compared to adults, with a prevalence estimate of 0.05% for those under 15 years old. There are two classifications based on age of onset: early onset schizophrenia (EOS) when symptoms appear between 13-18 years old, and very early onset schizophrenia (VEOS) when symptoms appear at of before 13 years old. EOS and VEOS have atypical features compared to adult-onset schizophrenia, including insidious onset, more severe neurodevelopmental abnormalities, terrifying visual hallucinations, constant inappropriate of blunted affects, higher rates of familial psychopathology, minor response to treatment, and poorer outcomes. Preliminary data suggests that VEOS and EOS may be due to greater familial vulnerability from genetic, psychosocial, and environmental factors. Poor outcomes are most reliably linked to a positive history of premorbid difficulties, greater symptom severity (especially negative symptoms) at baseline, and longer duration of untreated psychosis. Age at psychosis onset and sex are not consistent predictors of outcome.

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      13.7
      Seconds
  • Question 24 - What is the approach of the criminal justice system towards managing young individuals?...

    Incorrect

    • What is the approach of the criminal justice system towards managing young individuals?

      Your Answer: A Local Child Curfew refers to a child being placed under the supervision of a youth offending team

      Correct Answer: A Child Safety Order can be imposed for a child under 10 who breaks the law

      Explanation:

      Criminal Responsibility and Age Limits

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

      Not Guilty by Reason of Insanity and Other Defenses

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

    • This question is part of the following fields:

      • Forensic Psychiatry
      20.8
      Seconds
  • Question 25 - Which statement accurately describes borderline learning disability? ...

    Correct

    • Which statement accurately describes borderline learning disability?

      Your Answer: It is not generally associated with deficits in adaptive functioning

      Explanation:

      To diagnose a learning disability, there must be evidence of both impaired intelligence and difficulties in adaptive functioning, such as the ability to live independently, manage finances, and attend to personal safety. Borderline learning disability, on the other hand, is typically not accompanied by deficits in adaptive functioning.

      Borderline Learning Disability

      Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

    • This question is part of the following fields:

      • Learning Disability
      41.5
      Seconds
  • Question 26 - A team of investigators aimed to explore the perspectives of experienced psychologists on...

    Incorrect

    • A team of investigators aimed to explore the perspectives of experienced psychologists on the use of cognitive-behavioral therapy in treating anxiety disorders. They randomly selected a group of psychologists to participate in the study.
      To enhance the credibility of their results, they opted to employ two researchers with different expertise (a clinical psychologist and a social worker) to conduct interviews with the selected psychologists. Furthermore, they collected data from the psychologists not only through interviews but also by organizing focus groups.
      What is the approach used in this qualitative study to improve the credibility of the findings?

      Your Answer: Bracketing

      Correct Answer: Triangulation

      Explanation:

      Triangulation is a technique commonly employed in research to ensure the accuracy and reliability of results. It involves using multiple methods to verify findings, also known as ‘cross examination’. This approach increases confidence in the results by demonstrating consistency across different methods. Investigator triangulation involves using researchers with diverse backgrounds, while method triangulation involves using different techniques such as interviews and focus groups. The goal of triangulation in qualitative research is to enhance the credibility and validity of the findings by addressing potential biases and limitations associated with single-method, single-observer studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      79.3
      Seconds
  • Question 27 - What statement accurately describes Munchausen's syndrome by proxy? ...

    Incorrect

    • What statement accurately describes Munchausen's syndrome by proxy?

      Your Answer: The victim rather than the perpetrator receives the diagnosis

      Correct Answer: It can be diagnosed in the case of a child who is fit and well

      Explanation:

      While the caregiver’s motive may be helpful for the therapist, it is not a significant factor in determining whether abuse has occurred.

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

    • This question is part of the following fields:

      • Child And Adolescent Psychiatry
      37.3
      Seconds
  • Question 28 - What is the closest estimate of the prevalence of schizophrenia in the UK?...

    Incorrect

    • What is the closest estimate of the prevalence of schizophrenia in the UK?

      Your Answer: 1 per 100 / year

      Correct Answer: 0.2 per 1000 / year

      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
      7.5
      Seconds
  • Question 29 - A patient tells you that they are extremely frightened of the dentist. When...

    Correct

    • A patient tells you that they are extremely frightened of the dentist. When they think of going they get palpitations and become breathless. They haven't visited a dentist for 10 years and have very poor dental hygiene.

      What diagnosis is indicated?

      Your Answer: Specific phobia

      Explanation:

      Understanding Specific Phobia: Diagnosis, Course, and Treatment

      A specific phobia is a type of anxiety disorder characterized by an intense fear of anxiety about a particular object of situation that is out of proportion to the actual danger it poses. This fear of anxiety is evoked almost every time the individual comes into contact with the phobic stimulus, and they actively avoid it of experience intense fear of anxiety if they cannot avoid it. Specific phobias usually develop in childhood, with situational phobias having a later onset than other types. Although most specific phobias develop in childhood, they can develop at any age, often due to traumatic experiences.

      Exposure therapy is the current treatment of choice for specific phobias, involving in-vivo of imaging approaches to phobic stimuli of situations. Pharmacotherapy is not commonly used, but glucocorticoids and D-cycloserine have been found to be effective. Systematic desensitization, developed by Wolpe, was the first behavioral approach for phobias, but subsequent research found that exposure was the crucial variable for eliminating phobias. Graded exposure therapy is now preferred over flooding, which is considered unnecessarily traumatic. Only a small percentage of people with specific phobias receive treatment, possibly due to the temporary relief provided by avoidance.

    • This question is part of the following fields:

      • General Adult Psychiatry
      16.5
      Seconds
  • Question 30 - Among the given drugs, which one has the highest likelihood of causing myocarditis?...

    Correct

    • Among the given drugs, which one has the highest likelihood of causing myocarditis?

      Your Answer: Clozapine

      Explanation:

      Chest pain and palpitations are common symptoms of myocarditis, which can be identified through ECG changes such as widespread T wave inversion. Although it may resemble a heart attack, there is no obstruction in the coronary arteries. Although other antipsychotics have been linked to myocarditis, clozapine has the most significant correlation.

      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
      4.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Research Methods, Statistics, Critical Review And Evidence-Based Practice (1/5) 20%
Psychotherapy (1/3) 33%
Old Age Psychiatry (0/1) 0%
General Adult Psychiatry (7/12) 58%
Substance Misuse/Addictions (1/2) 50%
Organisation And Delivery Of Psychiatric Services (0/2) 0%
Child And Adolescent Psychiatry (2/3) 67%
Forensic Psychiatry (0/1) 0%
Learning Disability (1/1) 100%
Passmed