MOCK EXAMS Flashcards
What percentage of UK adults are problem gamblers?
0.7%
In psychiatric cohorts may be 6 - 12%
At risk group 7.3%
Effective interventions:
- Brief interventions - motivational enhancement therapy (1 session) or 10-minute motivational interviewing session or 3 x CBT interventions
- Pharmacological depending on co-morbidity e.g. SSRI if mood component or Naltrexone for impulse-control disorders
- Psychosocial interventions need replication in bigger studies with long term follow ups - CBT has promise
Do SSRIs increase the risk of falls?
YES
Does agomelatine increase the risk of hyponatraemia?
No - has been linked to LFT elevations but it is generally well tolerated
Compare and contrast the following ASD tools:
a) ADI - R
b) ADOS - G
c) AAA
d) ASDI
e) RAADS-R
a) Autism Diagnostic Interview - Revised: semi-structured interview with caregivers, recommended by NICE for individuals with LD. 1.5 - 2.5 hrs
b) Autism Diagnostic Observation Schedule - Generic: semistructured assessment that includes activities and behaviour is observed. Again recommended by NICE for patients with LD
c) Adult Aspergers Assessment. 3 parts - Autism Spectrum Quotient (AQ), Empathy Quotient (EQ) and the clinician conducted questionnaire
d) Aspergers Syndrome (and High Functioning Autism) Diagnostic Interview: brief interview with 20 questions that assess for Aspergers Syndrome - can be used for children and adults. The 20 items are grouped into 6 areas
e) Ritvo Autism Aspergers Diagnostic Scale - Revised. 80 item self-rated questionnaire
There is also the DISCO
- Diagnostic Interview for Social and Communication Disorders (DISCO) - a structured tool to guide assessment
Outline the DVLA driving rules for epilepsy?
- If epileptic seizures while awake and lost consciousness: reapply if haven’t had a seizure for a year (if due to change in medication can reapply if 6 months if back on old medication)
- One off seizure awake and lost consciousness –> 6 months seizure free
- Seizures while asleep and awake –> may still qualify if only seizures in last 3 years have been when asleep
- Seizures when asleep –> may qualify if 12 months since last seizure
- Seizures that don’t affect consciousness - need 12 months with seizure that doesn’t affect consciousness
For busses and lorries and had not been on medication:
- If one seizure - 5 years
- If two or more seizures - 10 years
When may a patient be able to drive following acute psychosis/mania/hypomania/severe anxiety or depression?
No driving during acute episode
Need to be stable for 3 months, on an agreed medication plan, have insight
If rapid cycling bipolar need - 6 months of stability
What is co-dependency (in addictions terminology)?
When a friend/relative/carer is psychologically dependent on the addiction behaviour
The friend/relative/carer goes beyond normal behaviour and their actions may be maladaptive and the dynamic destructive
‘Enabling behaviour’ occurs when a codependent person, helps or encourages an addict to continue using drugs, either directly or indirectly. An example could be a spouse giving the addict money to buy drugs.
How does bipolar depression differ to unipolar depression
Episodes are more rapid in onset
Episodes are more frequent
Episodes are more severe
Episodes are shorter
Episodes are more likely to involve reverse neurovegetative symptoms such as hyperphagia and hypersomnia
What is the suicide rate in prisoners?
133 per 100, 000 person years
(for those on remand 339 per 100,000 person year)
Rate in the general population is 9.4 per 100,000 person years
32% occurred in 7 days - 11% in 24hrs (higher rates in alcohol/substance misuse individuals)
How long does conduct disorder behaviour need to be present for to qualify for a diagnosis?
12 months
Note adolescent onset refers to symptoms > age 10
What is catamenial epilepsy?
Where a women experiences worsening of seizures around her menstrual cycle
Outline some psychotropics that alter calcium levels?
Raise: Lithium
Lower: Haloperidol, Barbituates, Carbamazepine and Valproate
How should Lithium dosing/regime be managed at the point of labour?
Suspend 24-48hrs before induction/c-section - check levels 12hrs last dose.
If below therapeutic range - re-start and check levels at 1 week
Anti-depressants that are low risk for individuals living with epilepsy include?
SSRI
Mirtazapine
Duloxetine
Probably low risk: MAOIs, Vortioxetine, Agomelatine, Reboxetine, Moclobemide
Moderate risk:
Lithium
Venlafaxine
Trazadone
High risk:
TCAs
Buproprion
Maptroline
What type of qualitative research examines media articles for patterns/themes?
Content analysis
When is McNemar test used for?
Paired categorical data
In linear regression what is R2 known as?
Coefficient of determination
What are the ICD-11 trait domains qualifiers?
Negativity affectivity
Detachment
Dissociality
Anakastia
Borderline Pattern
What is the male:female ratio for OCD?
1 : 1.5
What percentage of individuals will die by completed suicide within 2 years after an act of self harm?
1.49%
What neuroimaging finding do patients with Alzheimer’s share with Down’s syndrome?
Cortical thinning
What percentage of individuals with fragile X experience psychosis?
< 10%
More commonly ADHD, LD, OCD, Depression, Anxiety, Language function
Outline the stages of DBT?
Pre-treatment: assessment, orientation to therapy, commitment to therapeutic contract
Stage 1: reducing life threatening behaviour (as interferes with QoL and therapy)
Stage 2: Emotional processing of traumatic experiences to target PTSD experiences such as flashbacks
Stage 3: Develop self-esteem and establish future goals
What are the stages of CAT?
Reformulation - identifying key relational patterns and ways of coping
Recognition - Recognise unhelpful patterns
Revision - Developing alternatives
Describe features of neonatal opioid withdrawal syndrome?
Hyper-irritability, high pitched cry
Usually begins 24-48hrs after birth - may be delayed for 7 days in some cases
Buprenorphine symptoms are milder than methadone
May get exaggerated normal reflexes, jittery movements, loose stools
GI/Resp dysfunction and vague autonomic symptoms e.g runny nose, fever
Breastfeeding reduces severity
What is the earliest anti-D can be used in children?
5 years - if severe and psychological interventions have failed.
No evidence showed their use
The MAPT mutation for frontotemporal dementia is passed in what fashion?
Autosomal dominant
Which antipsychotics are associated with postural hypotension and which can be used as an alternative?
Associated with postural hypotension:
- Quetiapine
- Risperidone
- Clozapine
- Olanzapine
- Ziprasidone
Alternatives:
- Haloperidol
- Amisulpride
- Sulpride
- Aripiprazole
What percentage of individuals with Alzheimers have one E4 allele?
> 50%
note risk of Alzheimers is 1% at 60 - doubles every 5 years
What can Propanetheline be used for?
Excessive drooling with Clozapine
What is the inheritance of tuberous sclerosis?
Autosomal dominant
“Outside-in” approach is used in which psychological therapy?
Behavioural activation - choose behaviours to do in advance of the feeling/mood state
What does a safe place mean in EMDR therapy?
Identifying a reassuring image/memory that the client can return to give a positive sense of self
What is fornication and which drug is associated with it?
Tactile sensation of crawling under the skin - associated with cocaine use
Does Cochrane maintain a trials register?
Yes
What is SIGLE?
Grey literature data base
What physiological parameter must be monitored with Donepezil?
Heart rate - can cause bradycardia, syncope and arrhythmias
Name some cognitive impairments seen in Schizophrenia?
Working memory - most common
Selective attention
Abstract reasoning
The prevalence of postnatal depression is?
10-15%
In ROC curves what value for area under the curve has no value?
0.5 - chance alone
How does caffeine affect CYP1A2 metabolism?
Moderate inhibitor
Which type of dementia are rates of depression most co-morbid?
Vascular dementia
The year on year conversion of MCI to Alzheimer’s is?
9.6%
How are Lithium levels monitored in pregnancy?
4 weekly then weekly after 36 wks
High scores on the Edinburgh Post Natal Depression Scale have been found to correlate with?
Suicidality
Cross-over designs may partially mitigate….
smaller sample sizes
What is discounting in health economics
Assessing how the cost/benefits today differ to the cost/benefits in the future:
Discounting will play a big role in expensive interventions now but when there are larger costs in the future.
Examples include - EIS programmes or vaccination programmes
Can Rivastigmine be used in Parkinson’s Disease dementia?
Yes
Name some hormonal changes in Anorexia Nervosa?
Low T3, normal T4, normal TSH
Elevated growth hormone
Low reproductive hormones
Slightly elevated cortisol
What is the denominator of prevalence?
Mid-year population
When cases and controls are identified in an existing cohort what is this known as?
Nested-case control study
Cronbach’s alpha varies between what values?
- infinity and 1
What biochemical abnormality is associated with DiGeorge syndrome?
Hypocalcaemia
Name two analytical methods for qualitative research?
Content analysis (generate coding categories - can use computerised software to do)
Constant checking - grounded theory
If a mother becomes unwell after what period of childbirth how long can she be admitted to a mother and baby unit?
0 - 12 months
After a seizure on Clozapine what should the management entail?
Withhold for a day / start at half the previous dose / commence sodium valproate
What do different Clozapine : Norclozapine ratios suggest with regards to timing of blood test / patient metabolism
0.5 - 2.5 : optimum timing of blood test and within range. Suggested ratio of Clozapine:Norclozapine is 1.3
> 2.5 : Sample taken < 11hrs since the last dose - the ratio gets bigger as the clozapine metabolism becomes saturated therefore may indicate an enzyme inhibitor is added or the patient has stopped smoking (as there is an increase in Clozapine to Norclozapine)
< 0.5 : > 13hrs since last dose or that the patient blood sample is low < 0.5 mg/L or if some doses have been missed. May also indicate a fast metabolism of Clozapine due to smoking started or an inducer.
How do WBC levels indicate green, amber and red?
WBC:
- > 3.5 = Green
-3 - 3.5 = Amber
- < 3 = Red
Neutrophils
- > 2 = green
- 1.5 - 2 = amber
- < 1.5 = red (neutropenia)
note - < 0.5 is agranular cytosis
When should Lofexidine be contraindicated?
Post-MI
Severe coronary insufficiency
Bradycardia
Hypotension
Cerebrovascular disease
Name the following suicide statistics
a) % of inpatient suicides that occur during first week of admission
b) % of inpatient suicides that occurred whilst the patient is on routine observation
c) % seen a psychiatrist in the last week
d) % in contact with MH services in year before death
e) The number that will repeat DSH within one year
a) 25%
b) 80%
c) 12.5%
d) 25%
e) 30%
PsychInfo has records from?
1890
What does neurodegenerative disease mean?
Disease that leads to the loss of structure or function of neurons
Which electrolyte may result in treatment refractory Wernicke’s encephalopathy?
Low magnesium
Name some predisposing/precipitating features for NMS?
- High ambient temperature
- Rapid antipsychotic dose increase/withdrawal
- Use of high potency antipsychotics/depot formulations
- History of affective disorder
- Use of anticholinergics/Lithium
- History of NMS
- Withdrawal of anti-parkinson medications
- History of organic brain disease
What are Thomas Nolan’s 3 questions in quality improvement?
What are we trying to accomplish?
How we will know that a change is an improvement?
What changes can we make to result in this improvement?
Describe how progressive supra-nuclear palsy presents?
In the 6th decade of life:
- Extrapyramidal symptoms
- Cognitive impairment
- Supranuclear palsy affecting vertical gaze dysfunction
When is medication indicated for insomnia?
Short term insomnia - expected to resolve within 3-7 days.
z-drugs are preferred and should not be continued for longer than 2 weeks
What is IIa and IIb stages in a trial?
IIa - optimal dosing
IIb - efficacy
SVR is a….
20-item checklist to assess risk of sexual violence
How do the defence mechanisms Isolation and Intellectualisation differ?
Isolation - disconnecting an event from its emotional content
Intellectualisation - focussing on an details of an event in order to avoid painful emotions/thoughts
What is the static-99?
A 10 item actuarial assessment instrument for use with adult male sexual offenders who are at least 18 years of age at the time released into the community
A 14-item instrument used to assess risk of violent and sexual recidivism of previously convicted sex offenders within a specific period of release?
SORAG
The RRSAOR
A 4-item actuarial risk assessment to assess different levels of sexual recidivism in convicted sex offenders
The 4 items are prior sexual arrests, age, ever targeted male victims, and whether any victims were unrelated to the offender
How is population attributable fraction calculated?
Proportion of population exposed to risk factor x (RR - 1)
/
1 + (Proportion of population exposed to risk factor x (RR - 1)
- Proportion of the outcome attributable to the exposure in the population
As prevalence falls what happens to NPV and PPV
NPV increases
PPV decreases
Define population attributable risk?
The reduction in the incidence of disease achieved by eliminating an exposure
Calculated by ARR x Proportion of population that is exposed
Lowering the cut off of a test…
increases sensitivity
Decreases specificity (higher false positive rate)
