Practice Questions 3 Flashcards
How long does multisystemic therapy last?
3/12
Who developed IPT?
Klermann & Weismann
Indications for IPT
Bulimia
Mild-moderate depression
Dysthymia
Who developed transactional analysis?
Eric Bern
What is transactional analysis?
TA has elements of psychoanalytic, humanist and cognitive approaches. It is considered as a theory of personality and a systematic psychotherapy for personal growth and personal change.
What is the form of CBT that Fairburn created for bulimia?
Transdiagnostic
What is transdiagnostic CBT?
2 forms; a ‘focused’ form which focuses exclusively on the eating disorder and a ‘broad’ form which addresses some of the other issues commonly found in eating disordered patients
Principles of therapeutic communities
Communalism
Permissiveness
Democratisation
Reality confrontation
What is defence mechanism a function of?
Ego
Which therapy focuses on snags and dilemmas?
CAT
Who developed brief dynamic therapy?
Malan and Davanloo
Franz Alexander & Thomas French
Who developed Rational Emotive Therapy?
Albert Ellis
Which type of family therapy encourages clear and open boundaries between the parents and the children?
Structural
Which family therapy has a one-way mirror?
Milan systemic therapy
Which family therapy involves task setting?
Structural
Steps of systematic desensitization
relaxation training
hierarchy construction
desensitization of the stimulus.
Which conditions does ACT show good evidence for?
chronic pain, addictions, smoking cessation, depression, anxiety, workplace stress, diabetes management, weight management
What is a snag?
when appropriate roles are abandoned because the person makes an assumption that others would oppose them or because they are perceived as forbidden or dangerous
What is a trap?
repetitive cycles where consequences of the behaviour feedback into its perpetuation. Here negative assumptions generate acts that produce consequences that reinforce the assumptions
Who created systematic desensitization?
Wolpe
Who coined the term therapeutic community?
Main
Who created the four terms of therapeutic community?
Rapoport
Who established the therapeutic community model?
Jones
Who created CBT for delusions?
Turkington
Who created dual sex therapy?
Masters and Johnson
Who created reciprocal inhibition?
Wolpe
Who created progressive muscular relaxation?
Hacobson
Who created Gestalt therapy?
Fritz and Perls
Who created Primal Therapy?
Janov
Who created token economy?
Allyon, Azrin, Paul & Krasner
Factors seen in facilitating communication in a psychodynamic group?
Mirroring
Free-floating discussion
Exchange
Resonance
Translation
Theoretical basis of CAT
- Procedure sequence model
- Role repertoires
What percentage of people in police custody has a mental illness at the time of arrest?
2-5%
The prevalence of psychotic disorders in prisons compared to the general population is?
10x
2-15%
How many people in prison have PD?
65%
How many people in prison have depression?
10%
How many people in prison have psychosis?
3-7%
To be defined as a murder-suicide event, the suicide of a homicide perpetrator must occur within a period of?
1 week after the murder
The proportion of those discharged from medium secure units that are convicted for a violent offence within five years of discharge is?
1 in 6
What proportion of elderly offenders has a mental illness?
20%
What percentage of people who commit homicides have a mental illness?
10%
The percentage of violence in the population that can be ascribed to psychosis is?
5%
Define automatism
If an individual commits an offence when his body is not under the control of his mind (e.g. when asleep) he is not guilty of the offence.
Define insane automatism
due to an intrinsic cause (e.g. sleepwalking, brain tumours, epilepsy) results in an acquittal on the grounds of insanity.
Define sane automatism
Sane automatism- due to an extrinsic cause (e.g. confusional states, concussion, reflex actions after bee stings, dissociative states, night terrors, and hypoglycaemia) results in a complete acquittal.
Prevalence of LD in prison?
40%
Which offence are people with LD most likely to commit?
Offences against property
Legal term for killing ones wife?
Uxoricide
What is Corpus deliciti?
Evidence of a crime being committed
How many homicide perpretators have a MI?
30%
How many homicide perpretators have had contact with MH services in the last 12 months?
10%
How many homicide perpretators have MI have PD?
27%
How many homicide perpretators have a primary dx of schizophrenia?
5%
How many homicide perpretators with a dx of PD have had contact with MH services in the last 12 months?
29%
How many homicide perpretators with PD had ot been in contact with MH services?
43%
How many homicide perpretators with PD had a secondary MI?
55% - usually substance misuse
How many homicide perpretators with PD were imprisoned?
92%
How many homicide perpretators with PD recieved a hospital disposal?
4%
How many homicide perpretators with schizphrenia were sent to prison?
29%
HOw many homicide perpretators with schizophrenia had a hospital disposal?
71%
How many homicide perpretators overall receive a hospital disposal?
6%
How many convicted shop-lifters re-offend?
10%
Proportion of prisoners who self-harmduring their prison term
10%
Ice is the street name for a particularly strong and pure form of?
Amphetamine
What does Suboxone contain?
Buprenorphine and Naloxone
How long can LSD be detected in urine for?
1 day
How long should NRT last for?
12 weeks
Which drug withdrawal can cause kinaesthetic hallucinations?
Benzo withdrawal
What percentage of those with alcohol withdrawal experience delirium tremens?
5%
How many men drink over the drink limit?
27%
How many women drink over the drink limit?
15%
How many patients presenting to GP services drink a hazardous level?
20%
Lifetime risk of suicide for dependence drinkers?
10-15%
What is the minimum duration required to make a diagnosis of alcohol dependence according to ICD-10 criteria?
12 months
How many chronic alcoholics have cerebellar degeneration?
40%
How long does detox of EtOH last?
5-7 days
When do sx of delirium tremens peak?
72-96 hours after last drink
What treatments did the UKAT compare?
Motivational therapy vs. social behaviour and network therapy
Sensitivity of MRI for Wernickes
53%
Specificity of MRI for Wernickes
93%
How long should IP opioid detox last for?
7-14 days
Rx for Methadone OD?
Naloxone
When is risk of seizures highest after someone has stopped drinking?
First 24 hours
How does Acamprosate work?
Balancing GABA and glutamate system
Prevalence of psych disorder in long-term cocaine users?
80%
Sx of cannabis intoxication
Tachy
Postural hypotension
Red eyes
Lack of coordination
Amphetamine intoxication
Tachy
HTN
Tremor
Restlessness
Anorexia
Cocaine intoxication
Tachy
Tachypnoea
HTN
Headache
CP
Resp depression
Mental state in cocaine intoxication
Euphoria
Paranoia
Anxiety
Panic Attacks
Insomnia
Mental state in amphetamine use
Auditory hallucinations
Paranoia
Reduced concentration
Cocaine withdrawal sx
Lethargy
Decreased consciousness
Intense craving
How long does cocaine withdrawal last for?
12-18 hours
Cannabis withdrawal sx?
Restlessness
Irritability
Insomnia
Anxiety
Amphetamine withdrawal sx?
Extreme fatigue
Hunger
Depression
In which rec drug intoxication does one get synaesthesia?
LSD
What receptor does PCP work on?
Glutamate
Street name for Temazepam?
Jellies
How long does amphetamine stay in urine?
48 hours
What if family aggregation bias?
presence of a case in the family increases awareness of risk factors and exposure leading to more family members of cases reporting an exposure though controls have family members with less awareness.
Calculation for incidence
(Prevalence in the exposed)(Incidence in the exposed) + (1-Prevalence in the exposed)(Incidence in the non-exposed)
Which study can analyse multiple risk factors for a disease?
Case-control
Which studies are best for rare diseases?
Case-control
Which studies are best for common diseases?
Cohort studies
Define power
Power is the ability of a study to report a difference if that difference truly exists between two groups.
What is the name of the randomisation scheme in which the next randomisation depends on the one before it?
Minimisation scheme
Describe Quasi Randomisation
randomizing using even/odd numbers of the date of birth, day of the week patient was seen, etc. These are not reproducible methods, and the sequences cannot ensure equal distribution of variables.
What can we conclude if crude risk differs from stratified risk?
The stratified risk is a confounder
Which technique is used to adjust for confounding factors when analysing relationships between dichotomous outcomes or risk factors e.g. odds?
Mantel-Haenszel
What does it mean if stratified risk differs amongst strata?
It is an effect modifier
What is Pygmalion effect?
Mere awareness of the experimenter’s expectations regarding treatment effect may result in a change in subject behavior in the direction of experimenter hypothesis.
Describe Halo effect
first impressions or answers influence subsequent answers in a questionnaire or interview.
What bias is important to keep in mind in mortality studies?
Attrition bias
Describe theoretical sampling
uses categories that emerge during a qualitative interview (grounded theory process) to construct the theory. It is not an intuitive method; it does not involve randomisation or picking up of a convenient sample.
Describe reflexivity
sensitivity to the ways in which the researcher and the research process have shaped the collected data, including the role of prior assumptions and experience, which can influence the results.
What can help identify the sample number needed for a qualitative study?
Saturation
How to deal with methodological heterogeneity in meta-analysis?
Deal with two sets of data differently and carry out two independent meta-analysis
Whaat is effect size?
Effect size is the difference in mean scores between the treatment and control groups divided by the standard deviation of the scores in the control group
Benefits of effect size
this does not have units that vary with outcome scales; hence it is possible to pool data from various studies in a meta-analysis using effect-size.
Who coined the term meta-analysis?
Glass (1976)
How was meta analysis first described?
Analysis of analyses
Purpose of cost-effectiveness acceptaility curve?
represent uncertainty associated with economics of health interventions.
What does cost-effectiveness acceptability curve present?
Results of cost-effectiveness analysis
In which economic study does one use measures such as QALY/DALY?
Cost utility
In which economic analysis are interventions with different outcomes reduced to monetary values?
Cost-benefit
Describe average cost-effectiveness ratio
Cost/effect
Calculation for ICER
ICER = [Cost of proposed intervention - cost of control intervention.] divided by [ Effect of proposed intervention - effect of control intervention.]
What is ICER a measure of?
Additional cost per unit of health gained
What parameters are required to create a cost-effectiveness analysis curve?
Willingness to pay and probability of cost effectiveness
How is willingness to pay written?
Lambda value
In a cost-effectiveness plane which quadrant indicates best cost effectiveness of an intervention?
SE
Horizontal axis of cost-effectiveness plane?
Incremental cost
Vertical axis of cost-effectiveness plane?
Incremental effect
What does Northwest quadrant of cost-effectiveness plane suggest?
Positive costs, negative effects - no use of intervention
What does southeast quadrant of cost-effectiveness plane suggest?
-ve costs, +ve effects - intervention preferred
What does northeast quadrant of cost-effectiveness plane suggest?
+ve effects, +ve costs - needs further consideration before acceptance
What does southwest quadrant of cost-effectiveness plane suggest?
-ve costs, -ve effects - not clinically effective, needs further study
In which economic analysis are the outcomes of the comparators assumed to be equal?
Cost minimisation
Describe cost benefit analysis
Measures all positive and negative consequences of an intervention in monetary terms.
Benefits of cost benefit analysis?
Allows decision-makers to compare health outcomes of different health interventions
What are implicit or opportunity costs?
Benefits forgone by a particular use of resources
Most common level of prevention currently employed in psychiatric practice is?
Tertiary
Prevalence of chronic illnesses compared to acute?
Higher prevalence
When is cumulative incidence helpful?
When attrition is low
Why is cumulative incidence not helpful if attrition is high?
Because drop outs are excluded from being counted as new cases but the denominator of the population does take them into account.
How does one get over the diffculty of cumulative incidence being affected by attrition rates?
Using incidence denesity
What is incidence density?
Number of new cases per person-year of observation
Another name for incidence density?
Incidence rate
When are incidence rates used?
When reporting results that compare 2 groups - providing a ratio
What is a crude rate?
One that is applicable to the entire population
What is case fatality ratio?
Ratio between number of deaths due to specific disease and number of persons affected by that disease in the population
What is a measure of fatal severity of disease studies?
Case fatality rate
What is a measure of contribution of disease to societal mortality burden?
Proportionate mortality rate
Calculation of proportionate mortality rate?
Ratio between deathes due to specific cause and total number of deaths in a population
