March 2024 recall Flashcards
What are Susser’s core criteria for causality?
Strength, specificity, consistency, predictive performance, & coherence. Time-order is most critical.
What do micro-proximity criteria for causality assess?
Strength of association, temporality, and dose-response relationship.
What do macro-proximity criteria for causality assess?
Plausibility, coherence, consistency, specificity, and analogy.
Which PTSD presentation typically has a worse prognosis?
Chronic PTSD.
What is the IES-R cut-off score for possible PTSD?
33 or above.
What IES-R score change is ‘statistically reliable’?
A reduction of 9 or more points.
What correlation exists between clozapine-induced sedation and motivation/pleasure?
A negative correlation exists.
How does clozapine directly affect motivation and pleasure?
Clozapine directly affects motivation & pleasure pathways in the brain.
What is the lifetime prevalence of suicide attempts in EUPD/BPD?
Approximately 10%.
What type of data requires a log transformation for analysis?
Skewed data, to normalize distribution.
What statistical test is used when both variables are binary?
Chi-squared or logistic regression if one is dependent.
What statistical test is used when the dependent variable is binary?
Logistic regression.
What statistical test is used for continuous variables, controlling for a confounder?
Linear regression.
How is internal consistency measured in a scale?
Split-half method.
What approach focuses on patients’ subjective views in qualitative research?
Phenomenology.
What method reduces bias by comparing data from different sources?
Triangulation.
What process involves comparing data to form new theories?
Constant comparison analysis (Grounded theory).
What is ‘cycles of action’ analysis linked with?
Grounded theory.
What class of controlled drug is ketamine?
Class B.
What type of drug is cathinone?
Stimulant.
Which drug can cause false positives for cathinone on a urine drug screen?
Pseudoephedrine.
A person accusing their spouse of cheating while planning to cheat themselves exhibits what defense?
Projection.
A person with alcohol issues accusing others of drinking too much is an example of what defense?
Projective identification.
Expressing excessive love while feeling hate is what defense?
Reaction formation.
Analyzing a traumatic event in depth is an example of what defense?
Intellectualization.
What is a risk factor for ADHD?
Maternal smoking.
What is a risk factor for anorexia nervosa?
High family enmeshment.
What is linked to disinhibited behavior?
Conduct disorder.
What is a method of transforming qualitative into quantitative data?
Log transformation.
What is a method to select participants with equal proportions from a list?
Simple random sampling.
Which conditions have a high risk of arson?
Intellectual Disability (ID) and substance misuse.
What behavior suggests bipolar 1 in a person with ID?
Taking clothes off and not needing sleep for a prolonged time.
What medication is preferred for ADHD with tics and liver disease?
Guanfacine.
What is the management for a pregnant woman at 10 weeks on 80mg methadone?
Maintain the current dose.
A patient with grunting, throat clearing, grimacing tics over a year likely has?
Tourette’s disorder.
Which condition is a contraindication to lithium use?
Addison’s disease.
Which antidepressant requires a decreased ECT voltage?
Lofepramine.
For what condition is ECT a first-line treatment?
Treatment-resistant depression.
How does ECT compare to rTMS in treatment-resistant depression?
ECT is considered superior to rTMS for treatment-resistant depression.
Non-fluent aphasia with intact comprehension is what type?
Broca’s aphasia.
Fluent aphasia with impaired comprehension is what type?
Wernicke’s aphasia.
Difficulty with word finding is known as?
Anomia or progressive aphasia.
What is the second-line treatment option for panic disorder after SSRIs?
Tricyclic antidepressant (TCA), e.g., clomipramine, or venlafaxine if TCA is not tolerated.
What is the medication of choice for BDD?
Fluoxetine.
How is study completion & dropout rates calculated using CONSORT diagrams?
Using the study diagram to determine how many patients completed the study vs. those that dropped out.
What is the preferred treatment for depression in Alzheimer’s?
SSRI (e.g., sertraline or citalopram) or donepezil if SSRI is not tolerated.
What should be done if risperidone 1mg doesn’t improve behavioral symptoms in Alzheimer’s?
Gradually reduce and stop risperidone.
What study design is best to validate the MMSE against post-mortem diagnosis of Alzheimer’s?
Retrospective cohort.
What is the most common cause of young-onset dementia in the UK?
Alzheimer’s disease.
What is the first-line treatment for behavioral issues in Parkinson’s/LBD?
Quetiapine.
What is the first-line treatment for visual hallucinations in LBD?
Rivastigmine.
A depression scale lacking somatic symptom questions demonstrates poor what?
Content validity.
Which genetic disorder presents with feeding difficulties, cardiac anomalies, and epicanthic folds?
Down’s syndrome.
Which genetic disorder includes a high-pitched cry and hypertelorism?
Cri-du-chat syndrome.
Which condition is associated with jocular speech and gaze aversion?
Fragile X syndrome.
Genomic imprinting is associated with which condition?
Prader-Willi syndrome.
What is the first-line treatment option for mild depression in a 12-year-old?
Digital CBT.
What antidepressant should be used with caution in patients after a hemorrhagic stroke?
SSRIs (paroxetine as first line).
Involuntary flinging movements after a hemorrhagic stroke suggest what?
Hemiballismus.
What condition causes ‘bird flapping’ tremors (asterixis)?
Hepatic encephalopathy.
What is a dynamic risk factor for sexual re-offending?
Deviant sexual preferences.
What is the first-line treatment of bulimia nervosa?
Self-guided help.
What is the first-line medication for a 16-year-old with OCD?
Sertraline.
If a teenager with anorexia needs medication, what is it?
Fluoxetine.
What is the legal term when a person has a psychotic delusion when committing a crime?
Diminished responsibility.
What is a legal term when someone commits a crime while unconscious?
Automatism.
A person is considered morally and criminally responsible with?
Criminal responsibility.
What are the two key elements of criminal guilt?
Mens rea (guilty mind) and actus rea (guilty act).
A person insensitive to social norms exhibits what personality trait?
Schizoid personality.
A patient on sertraline, procyclidine, and lithium with hyperthermia & hyperreflexia likely has?
Serotonin syndrome.
Which regression is needed for a binary outcome?
Logistic regression.
What is the best regression to analyze the relationship between two continuous variables after adjusting for age?
Linear regression.
What medication is added next in the STAR*D trial?
Bupropion.
Which condition is equally common in men and women?
Hypochondriasis.
What is the classification of Ganser syndrome in ICD-11?
Dissociative.
A person with persistent concerns despite tests showing nothing is wrong likely has?
Bodily distress/somatization disorder.
A person feeling dysphoric about not having a physical abnormality has?
Body integrity dysphoria.
Vague generalized symptoms such as fatigue are classified as?
Somatization or bodily distress disorder.
What is a risk factor for dementia?
Elevated homocysteine.
Which antidepressant has an increased suicide risk?
Amitriptyline is associated with increased suicide risk.
Which antidepressant has the least sexual dysfunction?
Bupropion has the lowest risk of sexual side effects.
Which antidepressants need dose reduction with ECT?
Venlafaxine and Moclobemide doses should be reduced.
Which is the first-line treatment for OCD with Depression?
An SSRI such as fluoxetine is first-line.
What is the second-line for OCD with Depression?
Fluvoxamine is often used second-line.
Which antidepressant should be avoided when treating breast cancer with tamoxifen?
Not specified.
What is hyperhomocystinemia linked to?
Hyperhomocystinemia is associated with an increased risk of dementia.
What test assesses premorbid intelligence in cognitively impaired older adults?
The NART (National Adult Reading Test) assesses premorbid intellect.
What are core diagnostic features of Dementia with Lewy Bodies (DLB)?
Visual hallucinations and neuroleptic sensitivity.
What type of dementia does Donepezil treat?
Alzheimer’s dementia and mixed vascular/Alzheimer’s dementia.
What is the treatment of mild cognitive impairment (MCI)?
There is no specific treatment for MCI itself.
What could be the initial management for an elderly person, with long-standing Alzheimer’s, presenting with new behavioral issues and non-verbal?
Consider paracetamol for non-verbal pain and initial blood/urine tests.
What medication is for alcohol withdrawal with liver problems?
Lorazepam is safer for alcohol withdrawal with liver disease.
What substance can cause a false positive for methadone?
Quetiapine can cause a false positive result on methadone screens.
Which plant-based substance creates relaxation, while which other one increases energy?
Cannabis creates relaxation, while cocaine increases energy.
How is heterogeneity in a systematic review measured?
The I² statistic quantifies heterogeneity (0-100%).
An I² value of 66% signifies what type of heterogeneity?
An I² of 66% indicates substantial heterogeneity.
What is the simplest statistic used to quantify heterogeneity?
The I² is the simple statistic used to quantify heterogeneity.
What method gathers all evidence about a treatment?
A systematic review gathers all available evidence.
What type of analysis was it if the study used fixed effect analysis?
A fixed effect analysis assumes variability is due to error.
What demonstrates causality in research?
Internal validity demonstrates causality in research studies.
What is a systematic error?
A systematic error is repeatable in studies.
What method reduces social desirability bias in research?
Member checking or respondent validation can reduce bias.
What method is used to adjust for age when assessing a continuous variable?
Matching or stratification can adjust for age in data.
What test is used to analyze a relationship between two continuous variables while adjusting for a confounder?
A linear regression analysis.
Which statistical test is used to investigate the relationship between binary variables?
Logistic regression.
What method is used to convert qualitative data into quantitative data?
A log transformation.
Which non-parametric method is used to assess correlation?
Kendall or Spearman coefficients.
What test is used to analyze a relationship between two continuous variables while adjusting for a confounder?
A linear regression analysis is used for this purpose.
Which statistical test is used to investigate the relationship between binary variables?
Logistic regression is used when the dependent variable is binary.
What method is used to convert qualitative data into quantitative data?
A log transformation can convert qualitative data.
Which non-parametric method is used to assess correlation?
Kendall or Spearman coefficients are non-parametric.
When is Chi-square used?
Chi-square test is used for binary data analysis.
What type of randomization is it when participants are put into groups of 6?
This is block randomization.
What type of randomization is computer pairing data 1:1?
This is simple randomization.
What test is used when assessing for causality?
Cox regression is used when assessing for causation.
What test is used to assess association?
Pearson or Spearman are used to assess association.
What type of study is it when cases are matched to the population?
This would be a case-control study.
What is used to assess internal consistency in a research design?
Split-half method assesses internal consistency.
What test is used when you have an ordinal independent variable with a dependent variable?
This is assessed with logistic regression.
What kind of analysis do you do if a patient is adjusting the blood pressure of an individual based on their age?
This is done using linear regression.
What type of study is it if a family is being assessed for schizophrenia?
This could be a cohort study.
What sampling type is used if there are participants sharing subjective views?
Phenomenological sampling is used in qualitative research.
What is a method to reduce bias in qualitative data analysis?
Triangulation is used to reduce bias in qualitative research.
What kind of cost is hospital transport to ECT for the patient?
This is an indirect cost, not direct (hospital cost).
What kind of error is one that is repeatable?
This is a systematic error.
What does ‘unlikely due to chance’ mean in research?
Results are unlikely to be due to chance, but statistically significant.
What term describes a variable that affects the outcome when analyzing for association and causality?
This is a confounder.
In an adjusted and unadjusted risk analysis, what explains the difference?
The difference is explained by confounders.
When analyzing standard deviation, what is the 95% confidence range?
95% CI = Mean ± 2 * standard error (SE).
When calculating the standard error, what must you do after you have the standard deviation?
Divide the standard deviation by the square root of the sample size.
What mood disorder is linked to head injuries in children?
Mood disorders can occur after head injury in children.
What neurodevelopmental disorder is associated with avoiding gaze?
Fragile X syndrome is linked with avoiding eye contact.
What genetic condition shows imprinting?
Prader-Willi syndrome demonstrates genomic imprinting.
What is the ICD-11 diagnosis for an LD patient with new disinhibition, restlessness, and insomnia?
Bipolar 1 disorder, not psychosis, is the likely diagnosis.
What medication is used in ADHD + Tourette with no sedation?
Guanfacine is used for ADHD + Tourette, with less sedation.
What symptom is most closely associated with Wilson’s disease?
A wing-beating tremor is associated with Wilson’s disease.
What neurotransmitter is affected by full agonists, which can cause paranoia?
Methamphetamine affecting dopamine pathways can cause paranoia.
What conditions present with chorea and hemiballismus?
Huntington’s and other basal ganglia disorders cause this.
Which genetic condition would have a parent and grandparent who died from the same disease?
Huntington’s.
What is the term for being considered morally or criminally responsible?
Criminal responsibility is the appropriate legal term.
What are the two components of criminal responsibility?
- Guilty mind (mens rea)
- Guilty act (actus reus)
What type of memory loss is associated with ECT?
Explicit memory is impacted by ECT, particularly anterograde.
What condition is an indication for Deep Brain Stimulation?
Obsessive-Compulsive Disorder (OCD).
What defense mechanism is an example of someone being resentful of taking care of a child?
Reaction formation.
What defense mechanism is used when someone does not call back, so they must hate you?
Jumping to conclusions, also called arbitrary inference.
What is the presentation of someone talking about psychology but not about themselves?
This is an example of intellectualization.
What does a patient show if they have non-fluent aphasia but understand?
They have Broca’s/motor aphasia.
What does a patient show if they have fluent aphasia but do not understand?
They have sensory/Wernicke’s aphasia.
What does a patient present with if they have word-finding difficulties?
They have anomia or progressive aphasia.
What is the next step with a patient who presents with a 4As score of 6?
They will require a comprehensive assessment for the underlying cause.
What is the next step with a patient who presents to A&E with falls, and bloods are normal?
The next step is an MRI.
What is the clinical presentation of a girl with a BMI of 24, who is preoccupied with weight and is binging/purging?
This is bulimia.
What type of bias is shown when people think they are socially desirable?
Social desirability bias.
When would you consider the use of lithium with depression, and what is the first-line augmentation?
When patients have treatment-resistant depression, and first-line augmentation is quetiapine.
What is most helpful in preventing seclusion?
Increasing the staff-to-patient ratio.
What is an indicator of sexual recidivism?
Deviant interest in child pornography is an indicator.
What are the levels of the SUSSER’s model?
- Proximity
- Microscopic
- Macroscopic
- End-stage
What does a unimodal negative skew show?
It shows the tail on the left.
When to hospitalize an eating disorder patient?
HR 42, BP 80/56, unable to sit up, or psychosis is present.
What are the common medical indications for hospital admission in ED?
- Low BP
- Fainting
- Delusions
- HR < 40
- Inability to sit
- Self-harm
Where should an ED patient with low BP, fainting, and delusions be admitted?
Acute Medical Unit (AMU) or Medical Assessment Unit (MAU) first.
Is bulimia more prevalent than anorexia?
Yes, bulimia is more prevalent than anorexia nervosa.
What is a common presentation of synthetic cannabis use?
Constricted pupils and hypotension are common.
A person presents with hypertension, tachycardia, sweating, and hyperthermia. What drug is most likely involved?
MDMA, amphetamine intoxication, or cocaine withdrawal would cause this.
What are symptoms of cocaine intoxication?
Ischemic changes and chest pain are a sign.
Which drug is most likely to cause physical dependence?
Alprazolam has the greatest risk of physical dependence.
What gene is associated with Lewy Body Dementia (LBD)?
Alpha-synuclein (alpha-synucleinopathy) gene on chromosome 4.
What is a non-degenerative cause of cognitive impairment?
Alcoholic dementia or Multiple Sclerosis can be a cause.
What cognitive assessment is useful for non-English speakers with dementia?
The Rowland Universal Dementia Assessment Scale (RUDAS).
Parkinsonism, MMSE 21/30, with visual hallucinations—what is the treatment?
Rivastigmine is an appropriate treatment.
What causes low mood, eye signs, dementia, and a family history of dementia?
Friedrich’s ataxia can cause this.
What type of dementia is associated with subcortical damage?
Vascular dementia, Parkinson’s, and MS are associated with subcortical damage.
What is the initial dementia associated with Parkinson’s disease?
Dementia with Lewy bodies (DLB), if it occurs within 12 months.
Frontal lobe dementia has what type of aphasia?
Non-fluent dysphasia is characteristic in frontal lobe dementia.
Progranulin is linked to what neurodegenerative disease?
Progranulin gene on Chr 17 is linked to Parkinson’s.
Which condition is characterized by headache, migraine, and TIAs?
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy).
What is not a degenerative cause of dementia from the options: DLB, MND, MS?
Multiple sclerosis is not a primary neurodegenerative disorder.
What can one say about aspirin use and dementia?
It may delay vascular dementia but does not prevent it.
What is typical of a formal thought disorder, inappropriate affect, and bizarre delusions?
Schizophrenia.
What cognitive test is impaired in a patient with formal thought disorder and psychosis?
A selective attention test will be impaired.
What are good prognostic factors for schizophrenia?
Higher socioeconomic status is a better prognostic factor.
Which patients with Erotomania are most likely to end up in forensic services?
Males with Erotomania are more likely to end up in forensic services.
What is the least effective use of clonidine?
Inattention and overarousal.
What is a major finding of the CUTLASS study?
FGA and SGA had similar effectiveness/side effects, except for clozapine.
What is the most common complication of rTMS?
Headache is the most common complication.
What medications can cause a disulfiram-like reaction?
- Metronidazole
- Decongestants
- Some cephalosporins
What is the remission rate of ECT?
70-90% is the typical remission rate.
What is a key aspect of motivational interviewing?
Rolling with resistance (acceptance) is key.
What is the next step for SSRI and SNRI non-responders?
Consider phenelzine (MAOI) for social phobia.
What treatment is best for treatment-resistant OCD?
Clomipramine is effective for treatment-resistant OCD.
What medication is used for tics and ADHD after first-line hypertension?
Clonidine or Guanfacine should be used.
What is the second-line treatment for clozapine-induced hypersalivation?
Piperazine is a second-line treatment option.
What is the first-line treatment for Akathisia?
Pirenzepine.
What non-medication method is used for anxiety-provoking stimuli?
Systematic desensitization using a hierarchy.
What is the most appropriate treatment for PTSD in a teenager?
EMDR, over 3 months after the event if TFCBT has failed.
What is the best therapy for Borderline patients who are talking about their boyfriend’s reaction?
Mentalization-Based Therapy (MBT).
What therapy uses the concept that a child criticized grows up self-critical?
Schema therapy addresses core beliefs developed in childhood.
What is a good initial treatment for a child with aggression?
Intramuscular lorazepam or risperidone for children.
What should you do if you have a child scared of an appointment in autism?
Use a social story.
How would you manage a child in autism who already has a social story?
Use now and next cards for daily routine.
What can help a child in autism who is imitating behavior?
Intensive interaction (body language).
What should you do for a pregnant woman on 60mg duloxetine?
Continue at the same dose.
How do you calculate the Standard Error of the Mean (SEM)?
SEM = Standard Deviation / Square root of the sample size.
What is concurrent validity?
Comparing a test to an established gold standard test.
What does predictive validity measure?
How well a test predicts a future outcome or criterion.
What is an example of convenience sampling?
Including all patients who attend a clinic in a specific week.
What is the key principle of Intent-to-Treat (ITT) analysis?
Once randomized, always analyzed, despite patient non-adherence.
What is the function of ITT in trials?
It gives more accurate results and reduces type 2 error.
How do you calculate NNT?
NNT = 1 / (CER – EER).
What is the formula for absolute risk reduction?
ARR = CER - EER.
What is the formula for RRR?
RRR = ARR / CER.
What does adding more samples do to underpowered studies?
It increases the power.
What does the sample size do to the SEM?
A larger sample size reduces the SEM.
What is Kruskal-Wallis used for?
Three or more variables, non-normal data, between subjects.
What is the formula for ARR?
ARR = CER - EER
ARR stands for Absolute Risk Reduction, CER for Control Event Rate, and EER for Experimental Event Rate.
What is the formula for RRR?
RRR = ARR / CER
RRR stands for Relative Risk Reduction.
What does adding more samples do to underpowered studies?
It increases the power
Power refers to the probability of correctly rejecting a false null hypothesis.
What does the sample size do to the SEM?
A larger sample size reduces the SEM
SEM stands for Standard Error of the Mean.
What is Kruskal-Wallis used for?
Three or more variables, non-normal data, between subjects
It is a non-parametric method for comparing multiple independent samples.
What statistical analysis is used for associations, risks, proportions, rates?
Chi-squared test
This test assesses the association between categorical variables.
When do you use a paired t-test?
Continuous data, compare two means within the same subject
It is used when the samples are dependent.
What is the hazard ratio used for?
Used in survival analysis, constant over time
It compares the hazard rates between two groups.
What is an odds ratio used for in a study with an intervention group and control group over time?
To understand the difference over time
It measures the odds of an event occurring in the intervention group relative to the control group.
What statistical method is used for non-normal data in within-subject design?
Friedman test
It is a non-parametric alternative to the repeated measures ANOVA.
What causes cataplexy?
Emotional arousal is the most common trigger
Cataplexy is often associated with narcolepsy.
What does an increase in prevalence do to PPV?
PPV will increase with increased prevalence
PPV stands for Positive Predictive Value.
What are complex tics?
Grimacing, echopraxia, shrugging are examples of complex tics
Tics can be classified into simple and complex types.
Which methods are used to remove confounders in epidemiological studies?
MMRR (Randomization, restriction, minimization, matching) SAM (Stratification, adjustment, multivariate stats)
These methods help to control for variables that may distort study results.
What is the most common age of homicide victims killed by women?
Under 16 years old
This statistic highlights a significant demographic in homicide cases.
What is the main predictive factor for violence?
Previous history of violence
Historical behavior is often a strong indicator of future actions.
What is the most predictive risk factor for suicide?
Being male
Gender differences in suicide rates are well-documented.
What is the purpose of family therapy in a 12-year-old with anorexia?
Family therapy is essential for addressing family dynamics
Involving family can be crucial in the treatment of eating disorders.
What should you do for an intellectually disabled person with harming behaviors?
Implement a behavior support plan
Tailored support plans can help manage and reduce harmful behaviors.
Flupentixol had no facial expression and hypersalivation—what is it and what is the treatment?
Parkinsonism, treated with Procyclidine
Procyclidine is an anticholinergic medication used to treat drug-induced parkinsonism.
What is the LR+ if you know the sensitivity = 80%, specificity = 60%?
2
LR+ (Positive Likelihood Ratio) is calculated as sensitivity / (1 - specificity).
