MRCPych Mentor 2 Flashcards
1
Q
What survey did ECA use?
A
DS
2
Q
Which country did the ECA take place?
A
USA
3
Q
Partial defences for murder?
A
Diminished responsibility
Loss of control
Suicide pact
4
Q
Risk of schizophrenia if cannabis use <18?
A
4 fold
5
Q
Risk of schizophrenia if cannabis use >18?
A
2 fold
6
Q
What antidepressant has been shown to be effective or depression if given S/L?
A
Fluoxetine
7
Q
Who created behavioural activation?
A
Martell
8
Q
What drug is licensed for opiate detox in pregnancy?
A
Methadone
9
Q
SSRIs to use in breastfeeding?
A
Paroxetine
Sertraline
10
Q
SSRIs to use in pregnancy?
A
Fluoxetine
Amitriptyline
Imipramine
11
Q
Requirements of testamentary capacity
A
They must know Extent and value of their property Who the natural beneficiaries are The disposition they are making The plan as to how the property will be distributed
12
Q
Who coined the term ‘therapeutic community’?
A
Thomas Main
13
Q
ARR equation?
A
CER - EER
14
Q
NNT equation?
A
1/ARR
15
Q
Relative risk reduction equation?
A
ARR/CER
16
Q
Relative risk equation?
A
EER/CER
17
Q
What measures inter-rater agreement/reliability?
A
Kappa
18
Q
Equation for standard error of the mean
A
SD/square root of n
19
Q
What does standard error of the mean tell us?
A
Spread expected for the mean of the observations i.e. how accurate the calculated mean is based on the true population mean
20
Q
Calculation for variance?
A
Sum(x - xbar)^2 / n-1
xbar = sample mean
21
Q
How much of the data lies within 1 SD?
A
68.3%
22
Q
How much of the data lies within 2 SD?
A
95.4%
23
Q
How much of the data lies within 3 SD?
A
99.7%
24
Q
What is GRADE used for?
A
To rate the quality of evidence of systematic reviews and guidelines
25
What is linear regression used for?
To predict how much one variable changes when a 2nd variable is changed
26
What increases as prevalence falls?
NPV
27
What does cost-effectiveness analysis do?
Compares interventions by relating costs to single clinical measure of effectiveness e.g. sx reduction
28
In which study are results reported as ICER?
Cost-effectiveness analysis
29
What is measured in cost-benefit analysis?
Money
30
What is measured in cost-utility analysis?
Multi-dimensional health outcomes such as QALY
31
Which economic study can compare treatments across conditions?
Cost-utility analysis
32
Sensitivity equation
TP/TP+FN
33
Specificity equation
TN/TN+FP
34
LR+ equation
sens/1-spec
35
LR- equation
1-sens/spec
36
PPV equation
TP/TP+FP
37
NPV equation
TN/FN+TN
38
What is opportunity cost?
Value of the next-best alternative that is forgone when a choice is made
39
How is opportunity cost measured in healthcare?
QALY
40
Define p value
Probability of rejecting null hypothesis when it is true
41
Equation for power
1 - beta
42
How do you find out the lower quartile?
(N+1) / 4th value
43
How do you find the upper quartile?
3(n+1)/4
44
What is the middle line in the box of a box-whisker plot?
Median
45
Define specificity
Proportion of patients without the condition who have a negative test result
46
Define likelihood ratio for a +ve test result
How much the odds of the disease increase when a test is positive
47
Define +ve predictive value
The chance that the patient has the condition if the diagnostic test is positive
48
What does a 95% CI mean?
If the study was repeated then the mean value would be within this interval 95% of the time
49
What happens to SEM as sample size increases?
Gets smaller
50
What type of regression is used for dichotomous variables?
Logistic
51
What is the denominator for the incidence rate?
Total person time at risk during specific time period
52
What rate provides information on the number of new cases of a disease that occur over a period of time and also accounts for people who leave the population during the time period under study?
Incidence rate
53
Analytic techniques used in qualitative studies
Content analysis
| Constant comparison
54
Define cumulative incidence
Proportion of a candidate population that becomes diseased over a specified period of time
55
Define incidence rate
Occurrence of new cases of disease that arise during person-time observation
56
Calculation for prevalence
Incidence x duration of condition
57
How can one assess internal consistency?
Average inter-item correlation
Average item-total correlation
Split half correlation
Cronbachs alpha
58
What is attributable risk?
the rate in the exposed group minus the rate in the unexposed group.
59
What is the population attributable risk?
the reduction in incidence that would be observed if the population were entirely unexposed.
60
Methods for assessing validity of qualitative studies
Triangulation
Respondent validation/member checking
Bracketing
Reflexivity
61
Define p value
Possibility of obtaining a result at least as extreme, assuming the null hypothesis is true
62
What is triangulation?
Comparing results from 2+ different methods of data collection or sources
63
What is respondent validation/member checking?
When the investigator's account is compared with the research subjects
64
What is bracketing?
Deliberately putting aside ones own belief about the phenomenon under investigation
65
What is reflexivity?
Sensitive to the ways in which the researcher and research process have shaped the collected data including prior assumptions & experience
66
What form of analysis for qualitative data is based on grounded theory?
Constant comparison
67
Name the tests used to check for normal distribution
```
The Kolmogorov-Smirnov (Goodness-of-Fit) Test (when adapted specifically for this purpose it is sometimes referred to as the Lilliefor's test)
Jarque-Bera test
Wilk-Shapiro test
P-plot
Q-plot
```
68
Equation for post test probability
Pre-test probability/ (1- pre-test probability)
69
Which cost study uses a single clinical measure of effectiveness?
Cost-effectiveness analysis
70
What is the square root of the variance?
SD
71
Wilson & Junger criteria for sscreening
The condition is an important public health problem
There is acceptable treatment for patients with the recognised disease
Facilities for diagnosis and treatment should be available
There should be recognised latent or early sx stage
Natural hx of the condition should be adequately understood
Test/examination should be acceptable to the population
There should be agreed policy on who to treat
Cost of case-finding should be economically balanced in relation to possible expenditure
Case-finding should be a continuous process and not a 'once and for all'
72
How many levels in GRADE?
7
73
Level 7 of GRADE?
Case reports
74
Describe GRADE
Systematic r/vs and meta-analysis of RCTs w/ definitive results
RCTs w/ definitive results (CI that dont overlap threshold clinically significant effect)
RCTs with non-definitive results
Cohort studies
Case-control studies
Cross sectional surveys
Case reports
75
Define variance
Average of SD from mean
76
x axis of ROC
1- specificity
77
y axis of ROC
sensitivity
78
What fraction of people who stop clozapine due to neutropenia or agranulocytosis develop a blood dyscrasia on rechallenge?
1/3
79
Who developed group psychotherapy?
Moreno
80
Which antidepressants should be avoided in DM?
TCAs
| MAOIs
81
Risk of fatal agranulocytosis?
1 in 10,000
82
Primary metabolite of paracetamol?
Benzoquinoneimine
83
Defence mechanisms of phobias
Repression
| Displacement
84
Defence mechanisms of OCD
Isolation
Undoing
Reaction formation
85
Defence mechanisms of BPD
Projection
| Splitting
86
Defence mechanisms of Narcissistic PD
Projection
| Splitting
87
Defence mechanisms of Agoraphobia
Displacement
88
Antidepressants recommended for post-CVE depression?
SSRIs - Fluoxetine
Mirtazapine
Nortriptyline
89
How long should elderly continue antidepressants after remission of depression?
2 years
90
Over what time period should SSRIs be stopped?
6 weeks
91
Which therapy is based on Otto Kernberg's theory of BPD?
Transference-focused therapy
92
Is clozapine-induced constipation dose-related?
Yes
93
Which tool predicts violence?
VRAG
94
Which herbal remedy has good evidence for depression?
Hypericum perforatum
95
What must be checked prior to px Lithium?
Renal
Cardiac
Thyroid function
96
What must you do if amber result for a patient on clozapine?
Must have another blood test within a day or two and must have twice weekly blood tests until the result improves.
97
Which psych studies was based exclusively in England, Scotland & Wales?
National Psychiatric Morbidity Survey
98
Another name for St Johns Wort
Hypericum perforatum
99
Genetics of PKU
AR
100
Genetics of Hurlers
AR
101
Genetics of Tay-Sachs
AR
102
Genetics of Friedrich's ataxia
AR
103
What predicts poor outcome of schizophrenia?
Male gender
Early age of onset
Prolonged DUP
Severity of cognitive and -ve sx
104
Which antipsychotic is most likely to cause postural hypotension?
Risperidone
105
Kane criteria for treatment-resistant schizophrenia
No improvement after 3x periods of treatment with neuroleptics (from 2 or more different chemical classes) in previous 5 years equivalent to 1000mg per day of chlorpromazine for 6 weeks
Pa`tients had had no episodes of good functioning in the previous 5 years
106
What was the first fully structured instrument developed to be used by lay interviewers?
DIS
107
What scale is used to help detect Tardive Dyskinesia?
AIMS (Abnormal Involuntary Movement Scale)
108
Which diagnostic system divides conduct disorder into <10 (childhood) and >10 (adolescent)
DSM V
109
How does ICD 10 divide conduct disorder?
Socialised
Unsocialised
Family context only
ODD
110
What is eros?
Life instinct
111
Most common anxiety disorder in ECA?
Phobia
112
What is Vorbeigehen?
Approx answers
113
Which TCAs are associated with discontinuation sx?
Amitriptyline
| Imipramine
114
TCAs that can be used in pregnancy
Amitriptyline
imipramine
Nortriptyline
115
Items on RRASOR: Rapid Risk of assessment for sex offence recidivism
Number of past sex offence convictions or charges
<25 years
Gender of victim
Offender is unrelated to victim
116
SCOFF q's
Do you ever make yourself sick because you feel uncomfortably full?
Do you ever worry that have lost control over how much you eat?
Have you recently lost more than one stone in a 3 month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say food dominates you life?
117
Enuresis is normally only diagnosed after what age?
5
118
Who is associated with community therapy?
Rappaport
119
Which antidepressants shouldnt be used in those at risk of arrhythmia?
```
Moclobemide
Citalopram
Bupropion
Lofepramine
Venlafaxine
```
120
Which rec drug blocks dopamine transporters leading to an increase in dopamine levels in the synaptic cleft?
Cocaine
121
Which rec drugs target monoamine transporters?
Amphetamine
Ecstasy
Cocaine
122
How does GHB work?
G coupled receptors
123
Another name for GHB?
Y-hydroxybutyrate
124
Which mood stabiliser causes closed angle glaucome?
Topiramate
125
Who developed an enhanced form of CBT for ED?
Fairburn
126
What is the diagnosis if someone has sx of schizophrenia for >1 month but less than 6 months?
ICD: Schizophrenia
| DSM V: schizophreniform disorder
127
Percentage of people convicted of homicide in England and Wales (1996-1999), who were psychotic at the time of the offence.
5%
128
How many people who commit homicide have an abnormal state of mind at the time of the offence?
10%
129
The percentage of people convicted of homicide in England and Wales (1996-1999), who made contact with mental health services within 12 months prior to the offence.
9%
130
Rate of any mental disorder in those convicted of homicide
34%
131
Rate of schizophrenia in those convicted of homicide
5%
132
Rate of affective disorder in those convicted of homicide
7%
133
Rate of PD in in those convicted of homicide
9%
134
Rate of alcohol dependence in in those convicted of homicide
7%
135
Rate of drug dependence in those convicted of homicide
6%
136
How many suicides are patient suicides (contact with MH services in 12 months)
28%
137
How many patient suicides are IP?
10%
138
Most common drug to self-poison for MH patients resulting in suicide?
Opiates - 23%
139
How many patient suicides occur within 3 months of d/c?
18%
140
Which age group has highest rate of suicide?
40-400
141
Most common method of homicide?
Use of sharp instrument - 40%
142
Most common relationships of victim to offender in homicides
Acquaintance - 42%
Stranger - 26%
Partner - 20%
Other family member - 12%
143
How many perpetrators of homicide have a hx of schizophrenia?
6%
144
How many homicide perpetrators were known to MH services in last 12 months?
10%
145
Low lvels of what must be excluded in cases of Pica?
Iron and Zinc
146
What is geophagia?
Clay eating
147
What is amylophagia?
Starch eating
148
Equation for SD?
Square root of variance
149
Which type of depression involves reverse neurovegetative sx (hyperphagia/hypersomnia)?
Bipolar depression
150
1st line medication for bipolar depression
Fluoxetine with Olanzapine
| Quetiapine on its own
151
2nd line medication for bipolar depression
Lamotrigine on its own
152
Medication guidelines for bipolar depression of lithium not working and normal dose level
Add Fluoxetine with Olanzapine
Add Quetiapine
Stop additional treatment and add lamotrigine to lithium
153
1st kine medication guidelines for bipolar depression re Maudsley
Quetiapine
154
2nd line medication guidelines for bipolar depression re Maudlsey
Lathium or valproate
155
3rd line medication guidelines for bipolar depression re Maudsley
Lamotrigine
156
4th line medication for bipolar depression re Maudsley
Antidepressant + mood stabiliser or antipsychotic (olanzapine & fluoxetine)
157
1st line medication for ADHD in adults
Methylphenidate
158
1st line medication for ADHD in adults if concerns re stimulant abuse
Atomoxetine
| Bupropion
159
Medication guidelines for GAD if no effect with SSRIs or SNRIS
Pregabalin
160
How long to continue meds for GAD if successful?
1 year
161
1st line meds for panic disorder
SSRIS
162
2nd line meds for panic disorder
Imipramine
| CLomipramine
163
How long should meds be continued for panic disorder if helpful?
6 months
164
How long to try meds for panic disorder before switching?
12 weeks
165
Meds to use for psychosis in HIV
Atypicals - Risperidone
166
SSRI to use in depression with HIV
Citalopram
167
2nd line meds for depression in HIV
Mirtazapine
| Bupropion
168
Meds to use for bipolar in HIV
Valproate
Lamotrigine
Gabapentin
169
Which antitretrovials are non-nucleoside reverse-transcriptase inhibitors?
efavirenz
| nevirapine
170
Which anti-retrovirals are nucleoside reveres-transcriptase inhibitors?
abacavir
| didanosine
171
Which antiretrovirals are protease inhibitors?
retinovir
| indinavir
172
Which antiretrovirals cause agitation?
Efavirenz
173
Which antiretrovirals cause delusions?
Efavirenz
174
Which antiretrovirals cause mania and suicide?
Efavirenz
175
How to calculate pre test odds
Pre-test probability/1- pre-test probability
176
How to calculate pre-test probability
Prevalence
177
How to test post test probability
Post test odds/1+post-test odds
178
What is post test probability?
Proportion of patients with that test result who have the disease
179
What is post test odds?
Odds that the patient has the disorder after the test is done
180
How to calculate post test odds?
Pre-test odds x likelihood ratio
181
What mechanisms have been suggested to lead to weight gain from antipsychotics?
5HT2C antagonism
H1 antagonism
Hyperprolactinaemia
Increased serum leptin leading to leptin desensitization
182
What is the test for syphilis?
VDRL - venereal disease research lab test
183
Which LD has a down turned mouth?
Cri du Chat
| Wolf Hirschhorn
184
Describe features of Coffi-Lowry
Short
Slanting eyes
Broad, short nose
Severe LD
185
Describe systematic sampling
Every nth member of population gets selected
186
Name the tool used as structural professional judgement to assess risk of future sexual violence
RSVP - risk of sexual violence protocol
187
Which actuarial approach assess future risk of sexual recidivism with just 4 items?
RRASOR - rapid risk assessment for sex offence recidivism
188
What are the 4 items in RRASOR?
Prior sexual arrests
Age
Ever targeted male victims
Whether victims are unrelated to offender
189
Which sex offender risk tool incorporates PCL-R?
SORAG - sex offender risk appraisal guide
190
Name the actuarial tools for risk violence
```
Risk matrix 2000
Static 99
VRAG
SORAG
PCL-R
RRASOR
```
191
Which violence risk tool incorporates PCL-R?
VRAG
192
Which tool is used on adult male sex ofenders who will be released to the community?
Static 99
193
Scales of Risk Matrix 2000
Prediction scale for offending
Prediction scale for non-sexual violence
Combination of 1st two to predict sexual or other violence
194
Which risk tool is helpful to characterise an individuals risk and therefore target plans to manage them?
SVR-20
195
Terms used in structural therapy
```
Subsystems
Hierarchy
Boundaries
Alliances
Coalition
```
196
Terms used in Strategic therapy
Task setting
| Goal setting
197
Terms used in systemic therapy
```
Hypothesising
Neutrality
Positive connotation
Paradox/counter-paradox
Interventive questioning
Reflecting teams
```
198
What concepts make up transgenerational therapy?
```
Scale of differentiation
Nuclear family emotional system
Family projection processes
Multi-generational transmission processes
Sibling position profiles
Emotional cut-offs
Triangles
```
199
Who is associated with systemic therapy?
Mara Selvini-Palazolli
200
How do systemic therapists view the family?
Self-regulating system which controls itself through trial and error
201
What are systemic family therapists interested in?
Rule-maintaining of communication and behaviours
202
How do systemic therapists believe sx can change in families?
By changing the rules
203
How does systemic therapy work?
Therapist questions the entire family, with emphasis on exploring differences between members behaviours and responses
204
What does strategic therapy believe difficulties in families are due to?
Distorted hierarchies
205
Who is associated with strategic therapy?
Jay Hales
| Cloe Madanes
206
Who is associated with structural therapy?
Salvador Minuchin
207
Recommended medication for those with Tourettes who have ADHD
Atomoxetine
208
How many people with Tourettes have ADHD?
70%
209
Suicide rate in prisons in England and Wales?
133 per 100,00
210
Antipsychotic of choice in liver impairment
Haloperidol
