Questions Flashcards
Which depot has better symptom control but cause mor EPSE
Zuclopenthixo
Facts Abt NMS
The risk for tardive dyskinesia is equal for depot and oral
But reversibility may be poor in depot
Which drugs may be the best for reducing suicide in
Schizophrenia and affective disorder
Schiz: Clozapine
Affective disorder: lithium
Best drug for body dismorphic disorder
Fluoxetine (usually started at 8-12 weeks of treatment)
add on therapy for negative symptoms with antipsychotics
D cyclosporine 50mg per
Selegiline also can day
Catie trial
Name of the first generation antipsychotic
% of drop out
Clinical antipsychotic trials of interventional effectiveness
-double blinded pragmatic RCT
-14k patient compared drugs
Loan, Quetia, risperidone, ziprasidone, perphenazine (only first generation drug)
Mean time of discontinuation is 4.6 months
Olanzapine has the lowest discontinuation rate but highest side effect burden - weight gain
Which antipsychotics has the best evidence of reducing aggressiveness
Clozapine > olanzapine > haloperidol
Expressed Emotions by brown and Ritter in wad interview and wad ratings (4)
Camberwell interview
Critical comments, positive remarks, emotional over involvement, hostility, emotional warmth
Anything more than 35 hours is bad
What kind of obstetric events can increased schiz (3)
Foetal hypoxia, Low birth weight, pregnancy induced hypertension
Premature rupture of membranes
Singe most important factor tat increases risk of hospitalisation for schiz is
Being no compliant
Risk of patient having schizophrenia if both parents has schizophrenia
40-50%
SSRI induced sexual probs is due to
5HT2 stimulation
ECT
Which increase efficacy (3)
Current, using bilateral ECT,
Number times per week does not affected,
STAR*D trial
Risk factors for non compliance (4)
Young age, Low education, High perceived mental health function, African American ethnicity
NNT for depression
4-5
For elderly: triycline:4, SSRI 8, MAOI 3
Wad is the scientific name for St. John wort
Hypericum perforatum
WHich drug cased visual field defects
Vigabatrin
Which benzodiazepine is good for improving manic symptoms s
Clonazepam at 1-4 weeks
Biggest predictor for bipolar disorder relapse
Residual symptoms
MEdian time to treat mania is
4-5 weeks
Untreated depression takes how Long
How abt treated
Untreated 6 months
Treated 3 months
Which antientiepileptic can easily caused SIADH
Carbamazepine
Wad is contraindication for zopidem
Sleep apnoea
Pregnancy/feast feeding
Unstable MG
Respiratory depression
Drugs for PTSD
Generalist use: paroxetine and mirtazepine
Specialist use: amitriptyline and phenelzine
MOst neuroimaging findings with OCD
Increased metabolism of orbitocingulate region
DIgnostic criterion of PANDAS (5) and the test that likely will be positive
Diagnosis
- presence of sig. OCD and /or tics
- abrupt o sent of symptoms or relapsing remitting course
- prepubertal onset
- association with strep infection
- associated with any neuropsychtric symptoms (anxiety, behavioural regression, sensory/motor abnormalities, somatic sits, depression)
est: anti DNAse B
What are the natural herb stuff for anxiety
Piper methysticum (kava)
Which OCD symptom is particularly resistant to treatment
Hoarding
What is the outcome used to show treatment expose in OCD trial
35% on the YBOCS
% of patient with restless legs syndrome can present with periodic limb movements during sleep
80-90%
Switch drugs When in 1) high prolactin 2) QTC prolongation 3) metabolic syndrome 4) Tardive dyskinesia 5) sexual dysfunction’ 6) sedation
1) olan and quetiapine, Aripiprazole, done give amisulpride
2) olan, Aripiprazole
3) amisulpride, Aripiprazole
4) lesser with clozapine and atypical
5) quetiapaine, Aripiprazole
6) haloperidol, amisulpride, Aripiprazole
Flupentixol
Normal dosage
Oso goo din wad
40mg in 2 weeks
Have antidepressant effect
Risperidone depot wads so special
How abt halo
Test dose is not required, need aqueous suspensions immediately
For halo
Useful for manic relapse, may need 3-6 months to reach steady state
Wad is treatment resistant schizophrenia
Lack of clinical response to use of at least adequate use of 2 antipsychotics for a period of 6-8 weeks, with on at least from aa atypical group
What to do if clozapine resistant
-augmentation with risperidone (4.5mg, owner dose a and longer trail shows better outcome), fluoxetine sulpiride and amisulpride
Also lamotigine which is good for positive symptoms but not egative ones
Fish omega oil (ethyl-eicosapentanoate )
CUTLASS trails
Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study
• It is an unblinded randomised controlled trial comparing first generation v. second generation antipsychotics
• The primary outcome was the quality of life at 1 year and symptom measures were the main
secondary outcome.
• 1, 227 people with schizophrenia included
• The second generation drugs were amisulpride, olanzapine, quetiapine or risperidone.
• The results showed no advantage of second generation drugs in terms of quality of life or symptom burden over 1 year with those on first generation antipsychotic doing relatively better.
• Participants reported no clear preference for either class of drug.
• The second phase CUtLASS 2 trial was of similar design and compared clozapine with other second generation drugs in 136 patients who had not responded well to two or more previous drugs. Results showed that there was a significant advantage for clozapine in symptom improvements over 1 year; moreover, patients significantly preferred it.
Wad to grate with schizoaffective disorder
Mood stabilisation
- : carbamazepine (best for depressive type)
- lithium and carbamazepine is not superior compared to one another for anis
Prevalence of psychotic disorder in prison is
10 Times
What percentage of people in police custody has a mental illness at the time of arrest?
2-5%
Most offenders charged with exhibitionism belong to the age group
15-25
The presence of mental illness increases the risk of being victimised with violent assault by
5 Times
The proportion of stalking incidents that are reported to the police is
1 in 3
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
Secure discharges suggest that nearly 25% will be readmitted within the 12 months after discharge. The reconviction rate for any offence in 2 years is 15%, but for violent offences this is 6%.
The risk of stalking by a patient or patient’s relative over the course of a psychiatrist’s career is;
20%
What proportion of elderly offenders has a mental illness?
20%
The proportion of all domestic violence victims that are male is
40%
What percentage of people who commit homicides have a mental illness?
10%
T he proportion of chronic domestic violence that gets reported by women in the UK to the police is
20%
What is insane automatism
Wad is sane automatisam
Sleepwalking, brain tumor, epilepsy
Sane: confusion at state, concussion, reflex actions after bee stings, night terrors, hypoglycaemia
Prevalence of learning disability in prisons is nearly
40%
Supervised discharge is most effective for
those with non-affective psychosis
What is the commonest diagnosis in perpetrators of arson?
Pd
87%
11% are LD
The MacArthur Competence Assessment Tool is most commonly used to evaluate which of the following?
Fit ness to plea
Which of the following personality traits is more commonly seen in elderly sexual offenders compared to non-offending older individuals?
2006). However, elderly sex offenders have increased rates of personality disorders (33% prevalence rates for any personality disorder), especially schizoid, obsessive –compulsive, and avoidant traits
most common offence in people with learning disability is
It is asserted that people with LD are more likely to commit sex or fire-raising offences with property offences being the most common (Hodgins).
Penrose Hypothesis refers to which of the following statements?
In 1939, Penrose described an inverse relationship between psychiatric bed numbers and the prison occupancy rate after considering cross-sectional data from 18 European countries. According to the Penrose hypothesis, decreasing psychiatric bed numbers are related to an increase in the prison occupancy rates.
multisystemic therapy, the treatment is usually given for a period of
3 months
The target age range for functional family therapy in the treatment of conduct disorder is
11-18
Cognitive analytical therapy usually lasts for
A CAT therapy is weekly for 50-60 minutes sessions. A course of therapy can be from 16-24 sessions
Interpersonal therapy has been particularly introduced by
Klermann & Weismann
time-limited treatment that lasts for 12-16 hour long weekly sessions, disorder focused which deals with symptoms in the ‘here and now
Jungian archetypes
Wad is
Animus
Anima
Archetype
Shadow
Anima’ refers to the unconscious feminine aspects of the male. ‘Animus’ refers to the unconscious masculine aspects of the female. ‘Shadow’ refers to the unacknowledged aspects of oneself that includes both creative impulses and destructive urges. ‘Self’ refers to the main archetype that gives the personality a sense of oneness. Persona refers to the outer concealed aspects of oneself.
In which of the following therapies does positive transference get addressed early?
Brief dynamic therapy
Transactional analysis was first developed by
Eric Bern first developed transactional analysis (TA
Availability of the therapist for telephone contact between appointments is one of the approaches used in
Dialectical behavioural therapy
Who creat dialectical behavioural therapy
Marsha line han
Who created patient centred therapy
Carl Rogers
Reformulation letters are characteristic features of
During CAT, by the third session, major maladaptive sequences and main reciprocal roles used by the patient are identified. . Between the third and fourth sessions the therapist writes a reformulation letter to the patient, which outlines the current situation and summarizes the repertoire of reciprocal roles and procedural sequences used by the patient. In the penultimate session, the therapist gives the patient another letter called goodbye letter that summarizes the therapy so far and outlines what remains to be achieved yet.
The major principles on which a therapeutic community is based includes all of the following except
The four major principles on which a therapeutic community is based are exemplified by the Henderson hospital model. According to this model, the major components are (mnemonic CPD-R) 1. Communalism (Staff are not separated from inmates by uniforms or behaviours, mutual helping and learning occurs) 2. Permissiveness (tolerating each other and realising unpredictable behaviour can happen within the community) 3. Democratisation (shared decision-making and joint running of the unit) and 4. Reality confrontation (self-deception or distortions from reality are dealt with honestly and openly by all members without formalities).
Who create community therapy
Henderson and Cassell
Tom main
Maxwell Jones
Klein’s depressive position is related to the process of learning to cope with which of the following conflicts?
Ambivalence
Cognitive analytical therapy was developed by which Therapists
Anthony Ryle
4 things of technique in CBT
Socratic questioning
Empirical reasoning
Collaborative empiricism
Homework tasks
4 modes of dbt
Was is it’s core therapeutic strategy
The four modes of treatment in DBT are (1) group skills training, (2) individual therapy, (3) phone consultations, and (4) consultation team.
Mindfulness.
Others distress tolerance, emotional regulation, interpersonal effectiveness
Defence mechanisms are a function of the
Ego
Cognition technique in cbt name 5
How abt behaviour
The cognitive techniques include psychoeducation, including reading assignments, identifying automatic thoughts, Socratic questioning, role play, thoughts diary, thought rehearsal, examining the evidence and working through the options.
behavioural techniques include activity scheduling, graded assignments, exposure, response prevention, distraction, relaxation training and assertiveness and social skills training.
Names tat are neoferudian
4
Erich from, Harry stack Sullivan, Alfred Adler, Karen hornet
Wad does cognitive analytical therapy focus on
How abt ipt
[cat focus on snags and dilemmas,
Ipt focus on grief and role transition
Object relations theory
Winnicott
Rational emotive therapy creat by who
Albert Ellis
Systemic family therapy by
Palazolli and Milan
The basis of object relations theory is that the primary motivational drive of an individual is to seek
Relationships
According to Bion, whenever a group gets derailed from its task, it deteriorates into one of the three basic states
dependency, pairing, or fight-flight. A 4th basic assumption was introduced by Hopper called massification/aggregation
Which of the following therapies uses techniques such as circular questioning, reflexive questioning and hypothesising?
Systemic family therapy
Primitive/immature defence
Neurotic defence
Mature defence
splitting, projection, projective identification, idealization, denigration, introjection, passive aggression and turning against the self.
Neurotic defences include repression, regression, denial, displacement, dissociation, isolation, reaction formation, intellectualisation, rationalization, externalisation and identification with the aggressor.
Humour, anticipation, sublimation, altruism and suppression (SASHA) are all mature defence mechanisms.
Strategic family therapy is offered to a dysfunctional family. What technique is mainly used in this therapy?
Task setting (homework tasks) are an essential component of strategic family therapy.
Which drug has evidence base for treating opioid withdrawal symptoms?
Methadone 2. Buprenorphine and 3. a2 adrenergic agonists (e.g. clonidine and Lofexidine)
Suboxone is a drug that contains
Buprenorphine and Naloxone
What percentage of patients taking benzodiazepines for nearly a year develop dependence syndrome
40%
The current prevalence of heroin use in the UK is
1%
How much of heroin does a typical heroin dependent user consume on a day
0.25-2.0 g per day
Wad is lofexidine
alpha-2 adrenergic agonist, licensed for the management of symptoms of opioid withdrawal. It can counteract the adrenergic hyperactivity associated with opioid withdrawal, demonstrated by characteristic signs and symptoms such as tachycardia, sweating, runny nose, shivering and goose bumps. Detoxification is much faster than with methadone or Buprenorphine, typically lasting 5-7 days and up to a maximum of 10 days.
Which one among the following drugs is recommended by NICE guidance as the first choice treatment for opioid dependence?
The 2007 NICE Guidance on the management of opioid dependence recommends oral methadone or buprenorphine as the preferred pharmacotherapeutic options for opioid dependence. The decision on which to use should be based on the patient’s preference. In cases where both methadone and buprenorphine appear equally suitable, the NICE Guidance advises prescribing methadone as first choice
Which of the following is the best period to undertake opioid detoxification in a pregnant woman?
Second trimester
The risk of seizures associated with bupropion use is estimated as
1 in 1000
In an average user, LSD can be detected in urine for up to
1 day
Untreated heroin withdrawal symptoms typically reach their peak within how many hours after the last dose?
32-72 hours
Kinaesthetic hallucinations are reported in cases with
Benzodiazepine withdrawal
The three main treatments licensed in UK for smoking cessation are
nicotine replacement therapy (NRT); the antidepressant Bupropion prolonged release tablets and Varenicline Tartrate.
Neonatal opioid withdrawal syndrome usually begin
24-48 hours after birth, depending on the time of last dose.
The percentage of men and women in the UK who drink excessively, above the recommended weekly limits for sensible drinking, is
27%
Cerebellar degeneration has been reported to occur in about ?% of alcoholics
40% of chronic alcoholics
Which of the following medication is better avoided for alcohol detoxification due to the risk of respiratory depression?
Chlormethiazole
Acamprosate appears to act centrally on which of the neurotransmitter systems?
What is it
Wad is the most common side effect
synthetic taurine analogue, which appears to act centrally on glutamate and GABA neurotransmitter systems, although the mechanism has not been fully established. It inhibits glutamatergic NMDA receptor function and balances GABA-glutamate imbalance seen in alcohol dependence. It is hypothesized to suppress the ‘urge to drink’ in response to learned cues. Gastrointestinal disturbance (e.g. nausea, diarrhoea) are the most common side effects reported.
common side effect reported by patients on taking disulfiram is
Halitosis is a common side effect of Disulfiram. Disulfiram can act as a helpful adjunct to alcohol detoxification therapy and allow the patient’s relatives regain confidence in their ability to remain abstinent. Rare reports of psychotic reactions and hepatotoxicity have been noted. Contraindication: Impulsivity, psychosis, Suicidality, severe hepatic dysfunction, peripheral neuropathies, cardiac diseases Ref: Oxford handbook of psychiatry- 522
The symptom/sign that responds earlier than others when thiamine is replaced in a patient with Wernicke’s encephalopathy is
Opthalmoplegia
The two interventions compared in UK Alcohol Treatment Trial (UKATT) were
Motivational Enhancement Therapy and Social Behaviour and Network Therapy in treating alcohol problems. SBNT was carried out over eight sessions each lasting 50 min. Components were drawn from network therapy, behavioural marital therapy, unilateral family therapy, social aspects of the community reinforcement approach, relapse prevention and social skills training. The novel social behaviour and network therapy for alcohol problems did not differ significantly in effectiveness from the comparator.
The symptoms of alcohol withdrawal usually subside within
5-7 days after the last drink
According to NICE guidelines, opioid detoxification with buprenorphine in an inpatient setting should last for
7-14 days
Which of the following is regarded as the most suitable screening tool for the hazardous use of alcohol in primary care settings
Alcohol use disorders identification test
Disulfiram inhibits which of the following enzymes?
Aldehyde dehydrogenase
Which one of the following is the drug of choice in patients with an uncomplicated alcohol withdrawal syndrome?
Chlordiazepoxide
Which of the following drugs often require direct supervision by the treating clinician when the treatment is commenced?
Disulfiram
If considering opioid detoxification, women who are pregnant or planning for pregnancy should consider treatment with which one of the following agents?
Methadone
Which is short acting
Naloxone or naltrexone
Naloxone
type II alcoholism name 3 citeria
The features of type II alcoholism includes inheritance of the condition from the father, onset of alcohol-related problems before the age of 25 years, being found primarily in males, prominent history of criminality and poor prognosis characterized by an inability to achieve meaningful abstinence.
Following sudden cessation of alcohol on a dependent patient, the risk of seizure is high during which of the following time periods?
First 24 hours
A man after completing his opioid detoxification is highly motivated to remain on treatment and wants advice about maintaining it. Which of the following drugs is best suited in this situation?
Naltrexone
The risk of developing alcohol problems for those with a positive family history compared to those without a family history of alcohol problems is increased by
4 Times
What percentage of patients with schizophrenia smoke?
60-75%
cocaine withdrawal
this can induce a pattern of repeated use. Dysphoria (crash), anhedonia, anxiety, irritability hypersomnolence, and sometimes agitation usually end within 18 hours though in heavy dependent users this can last up to a week, peaking in 3 days.
man who has been abusing multiple substances now complains of frequent urination and passing blood in the urine. The most likely offending drug is;
What type is it
Ketamine
Phencyclidine
Which of the following signs suggests advanced opioid withdrawal state?
Muscle spasms and twitching
Opioid withdrawal symptoms may include lacrimation, rhinorrhoea, agitation, perspiration, piloerection, vomiting, shivering, yawning and dilated pupils.
In patients using recreational drugs, which of the following feature is characteristic of phencyclidine intoxication?
Peripheral analgesia
PCP intoxication could cause the following features:
Clinically significant assaultative behaviour, impulsiveness, unpredictability, psychomotor agitation, impaired judgment that developed during, or shortly after, phencyclidine use. Within an hour (less when smoked, “snorted,” or used intravenously), two (or more) of the following signs: (1) vertical or horizontal nystagmus (2) hypertension or tachycardia (3) numbness or diminished responsiveness to pain (4) ataxia (5) dysarthria (6) muscle rigidity (7) seizures or coma (8) hyperacusis. Pupil size is variable with PCP use, depending on the degree of hypoxia and intoxication.
neuroimaging findings is most consistent with OC
Increased metabolism of orbitocingulate region
diagnostic criteria for an acute stress reaction?
Symptoms resolve within
2 days
Which of the following outcomes is often used to define treatment response in OCD treatment trials?
Ybcos 35%
REM sleep behavioural disorder, the associated lesions are situated in which part of the brain
Brain stem
Monozygotic concordance rate in anorexia is estimated to be around
Anorexia; 55
Bulimia 35%
But for dizygotic 30%
What is the chance for development of subsequent episodes of hypomania/mania?
7-12%
A 45-year-old lady with bipolar affective disorder develops sores in her mouth. Which of the following drugs is most likely to be implicated?
Lamotrigone
Calgary depression scale wad is it
Calgary depression scale was specifically developed to avoid measurement redundancy with negative symptoms while evaluating depression in schizophrenia patients.
The most commonly observed specific catatonic phenomenon in those with a diagnosis of schizophrenia is
Mannerism
You are seeing a 47 year old man in the outpatients clinic. He is taking a drug called Varenicline. It is used in the treatment of which drug addiction
Varenicline tartrate is a partial agonist binding with high affinity to alpha4beta2 nicotinic acetylcholine reecptor. It significantly reduces nicotine withdrawal symptoms and makes smoking less rewarding so it may help prevent ‘slips’ developing into full relapse.
Severe lithium toxicity presents with which of the following sig
Downbeat nystagmus
What side effect would you monitor closely in a patient taking Donepezil?
Reduced pulse rate
Wringing hand’ movements are associated with which of the following conditions
Rett syndrome
Sequential Diagrammatic reformulation’ (SDR) is seen in what type of therapy?
Cognitive analytical therapy
Talk abt benefit realisation plan
Focus
MFI
Statistical Process Charts
Benefit Realisation Plan is a table used as a tool to ensure that the intended benefits originally planned in a QI project are actually delivered to the stakeholders in a tiemly fashion. The FOCUS approach to QI is shown in the figure below. FOCUS stands for Finding a process to improve, Organising a team, Clarifying current knowledge, Understanding causes of variation and Selecting the process improvement procedures. Model for improvement (MFI) is commonly employed now by many NHS organizations. MFI is an extension of PDSA and describes reflections that need to occur before embarking on a PDSA cycle. To measure outcomes over time, tools are available to generate time series graphs or frequency charts. Commonly used time series graphs include ‘run charts’ or Statistical Process Control charts (SPC). SPC enables the use of simple statistical concepts to understand processes that are being studied or implemented. In essence, SPC helps to assess the ‘system’ for predictability of outcome when a change is implemented; if unexpected variations are present, this provides an opportunity to study the external factors that may influence the desired outcome
Of all reported parasomnias, the one that is more common in females than males is
Nightmares
Which of the following drugs is contraindicated in angle closure glaucoma?
Topiramate
What is the risk of depression in a cardiac patient with congestive heart failure compared to the general population
3 to 1
The mean age of onset of chronic fatigue syndrome is between
Duration of symptoms exceeds
: 29-35 years
3 months
An antidepressant with best evidence for use in post stroke depression is
Nortriptyline
Which of the following modes of psychotherapy has established evidence in HIV associated depression
iPT
Which of the following is true about suicide rates in patients with Huntington’s disease?
4 times higher
4 things in gander syndrome
approximate answers, clouded consciousness, pseudo-hallucinations and hysterical conversion symptoms.
What percentage of women with postpartum psychosis will go on to develop schizophrenia later in their lifetime?
16%
Which of the following MRI finding is characteristically seen in Huntington’s disease
Caudate atrophy
Fahr’s disease show wad in mri
MRI shows hypointensity of striatum
Meta-analysts typically use two statistical approaches to evaluate the extent of variability in results between studies (i.e., heterogeneity)
Cochran’s Q test and the I2 statistic. The basic intent of a meta-analysis is to include enough studies to narrow the confidence interval around the resulting pooled estimate. There are 2 criteria for not combining the results of studies in a meta-analysis: highly disparate point estimates and confidence intervals with little overlap - both these will result in a pooled estimate with wider confidence interval that beats the primary aim. Examining a forest plot, using Galbraith plot (choice B) and L’Abbe plot (
In a meta-analysis compiling outcome measure of continuous data measured using same rating scale, which of the following measure can be used to synthesize results
Weighted mean difference
Wad is Cohen d
Cohen’s d is a measure of effect size. It is obtained by using the data from each study that enters a meta-analysis.
The term effect size corresponds to
Standardised mean difference
The male: female ratio of hypothyroidism is
1:6
What is the mean duration of a major depressive episode that follows a stroke?
34 weeks
Post-traumatic epilepsy is seen in what proportion of patients with open head injury?
30%
The gene for Huntington’s disease (HD) is located on which chromosome?
short arm of chromosome four
During pregnancy, where continued use of Valproate is deemed essential, what is the maximum dose recommended?
1000mg
What is the lifetime risk of suicide in Huntington’s disease?
10-15%
75-year-old man with Parkinsons disease develops psychosis unrelated to levodopa use. Choose the best antipsychotic: (2)
Quetiapine n clozapine
She gave birth to a male child with Cleft palate. The most likely offending drug is;
Lamotrigine
To screen for Ebstein’s anomaly, pregnant mothers should undergo level 2 ultrasound and echocardiography of the foetus at
Which week
6 to 18
The rate of depression during pregnancy is
10%
If a patient continues to take Sodium Valproate throughout her pregnancy what is the risk of the baby having any birth defect?
1 in 10
If a patient continues to take Sodium Valproate throughout her pregnancy what is the risk of the baby having neural tube defect?
1 in 100
With respect to postpartum mental illnesses, a significant increase in new psychiatric episodes occur in
First 3 months of postpartum period
What percentage of new mothers develop postpartum depression?
10-15%
What percentage of women in reproductive age is affected by severe premenstrual syndrome?
3-8%
The prevalence of postpartum blues is reported to be as high as around
50% of all pregnancies
Which of the following neurotransmitters has a role in the pathogenesis of premenstrual syndrome?
Serotonin
What is the risk of developing spina bifida in the children of women treated with carbamazepine during pregnancy?
0.5-1%
Which sedative would be safe during breast feeding?
Zolpidem
According to the survey of psychiatric morbidities among adults living in private households, the lifetime prevalence of deliberate self harm in patients with a possible psychotic disorder is
25%
What percentage of people that die by suicide have recognizable psychiatric disorders at the time of death?
90%
The most common risk factor for suicide attempts according to the Psychiatric Morbidity Survey conducted by the Office of National Statistics is
Social class 5
What is the percentage of elderly patients with cognitive impairment that present with sexual disinhibition?
10-19%
Which among the following psychiatric diagnosis has a higher suicidal risk?
Mixed anxiety and depressive disorder Agitated depression Bipolar disorder type 1 Bipolar disorder type 2 Unipolar major depression
Bipolar type 2
With regard to surveys in those with suicidal ideas, the proportion of those who progress from having mere suicidal ideas to plans or attempts within one year is
60%
For each of the conditions given below choose male: female ratio from the drop-down list:
Anorexia nervosa
Major depression
Generalized anxiety disorder
Bipolar disorder type 1
Agoraphobia
The male: female ratio for anorexia is 1:10.
In major depression, the male: female ratio is 1:2. This is the post-puberty prevalence rate. Before puberty, boys have marginally more depression than girls.
Generalized anxiety disorder is twice more often seen in females.
Bipolar disorder type 1 is a disorder with equal sex distribution of 1:1. In bipolar disorder type 2, the male: female ratio is 1:1.3.
Agoraphobia is more often seen in females with male: female ratio of 1:3
Wad medication produces anticholinergic dryness in vagina leading to vaginismus.
Paroxetine
Identify the most appropriate depot medication using the properties described below
May have an antidepressant effect
Fewer incidence of extrapyramidal side effects
May induce depressed mood
Needs aqueous suspension to be constituted immediately before injection
Test dose is often not required
Flupenthixol depot may have an antidepressant effect.
Pipotiazine depot has a fewer incidence of extrapyramidal side effects.
Fluphenazine depot can induce depressed mood.
Risperidone depot needs aqueous suspension immediately before injection and in practice, a test dose is not required.
Poisoning & psychiatric presentations
45-year-old man with history of bloody stools, diarrhoea and vomiting. He appears restless, anxious and is unable to concentrate.
A 55-year-old man with loss of appetite and colicky pain. He also has cognitive impairment
A 49-year-old man with headache, irritability, joint pains and somnolence. She has tremors, rigidity, mask like face and dysarthria
A 63-year-old woman has vomiting and diarrhoea. She complains of hair loss and severe pain in the legs. She is paranoid and confused.
A 55-year-old man has worked in a pesticide factory for more than 20 years. He has poor concentration, recent memory impairment and impairment of new learning
Mercury poisoning is featured by CNS symptoms of lethargy and restlessness. The primary symptoms are secondary to severe gastrointestinal irritation, with bloody stools, diarrhoea and vomiting leading to circulatory collapse. It causes depression and mild cognitive impairment with poor attention and concentration with severe anxiety and agitation (Mad hatter’s disease).
Lead poisoning in children causes an encephalopathy that may be associated with permanent intellectual impairment. Adults exhibit anorexia and colic with cognitive impairment and with chronic exposure can cause psychosis.
Manganese poisoning produces symptoms such as headache, irritability, joint pains and somnolence (manganese madness). Lesions involving basal ganglia and pyramidal system result in gait impairment, rigidity, monotonous or whispering speech, tremor of extremities and tongue, masked facies, micrographia, dystonia, dysarthria and loss of equilibrium.
Thallium poisoning causes severe pain in the legs as well as diarrhoea and vomiting. Within a week people may develop delirium, convulsions, cranial nerve palsies, blindness, choreiform movements and coma may occur. Alopecia is a common and important diagnostic clue. Behavioral changes include paranoid thinking and depression, with suicidal tendencies. Thallium poisoning almost always follows accidental or intentional ingestion of a rat poison 5)
Arsenic poisoning most often occurs during industrial exposure, especially workers in production of pesticides, copper or lead smelting. Psychiatric symptoms include mild impairment of new learning, recent memory and concentration. This may manifest a few years after exposure. Recovery is possible on cessation of the exposure.
Farh’smdisease shows what in the mri?
Fahr’s disease is due to an idiopathic (autosomal dominant) progressive calcium deposition in the basal ganglia. An onset between the ages of 20 and 40 is associated with schizophreniform psychoses and catatonic symptoms. An onset between the ages of 40 and 60 is associated with dementia and choreoathetosis. Depression is also very common, but mania is uncommon. 50% patients report psychiatric problems. Psychiatric symptoms correlate with more extensive calcification. The pattern of cognitive impairment found in FD is of the frontosubcortical type. The commonest neurological features of FD are parkinsonism, chorea, dystonia, tremor, gait disturbance, dysarthria, seizures and myoclonus. MRI shows hypointensity of striatum. EEG is non specific - may show diffuse changes. Fahr’s disease is also called familial cerebral ferrocalcinosis.
The proportion of all episodes of self-harm that occur in people over the age of 65
Answer 1 Incorrect
The subsequent risk of suicide 10 or more years after an episode of self harm.
Answer 2 Incorrect
The proportion of individuals who will harm themselves again in their lifetimes
Answer 3 Incorrect
Proportion of individuals who self harm that will repeat at least 5 times in a given year
Following an act of self-harm the rate of suicide increases to between 50 and 100 times the rate of suicide in the general population (Hawton et al., 2003b; Owens et al., 2002). In other words, the subsequent risk of suicide is at least 3% after 10 or more years. The risk of repetition of self harm is extremely high; up to 40% will go on to repeat. About one in six people who attend an emergency department following self-harm will self-harm again in the following year (Owens et al., 2002); a small minority of people will do so repeatedly - 10% will repeat at least 5 times in a given year. This high-repetition group is one reason for the overall high repetition rate observed (40% repetition in 10 years or more). Self-harm can occur at any age but is most common in adolescence and young adulthood (Meltzer et al., 2002a). For example, based on a survey of 12,529 children and young people aged 5 years to 15 years, 1.3% had tried to harm themselves (data collected from parents) (Meltzer, 2002a). In contrast, only about 5% of all episodes of self-harm occur in people over the age of 65 (Dennis et al., 1997; Draper, 1996; Owens et al., 1991).
The correct answer is: The proportion of all episodes of self-harm that occur in people over the age of 65 – 5%, The subsequent risk of suicide 10 or more years after an episode of self harm. – 3%, The proportion of individuals who will harm themselves again in their lifetimes – 40%, Proportion of individuals who self harm that will repeat at least 5 times in a given year – 10%
Choose the lifetime prevalence for the following phenomena according to Office of National Statistics UK Household Survey in 2000 (aged 16 to 74).
Dish without suicide intent
Suicide attempts
suicide thoughts
4%
Attempts 2%
Suicide thoughts 15%
For each of the following antipsychotics, identify the UK licensed maximum doses of antipsychotics that could be prescribed for oral administration
Haloperidol
Chlorpromazine
Olanzapine
Quetiapine
Risperidone
Clozapine
Citalopram
Sertraline
Haloperidol : 30
Chlor 1000
Olan 20
Quetia 750-800
Risperidone 16
Clozapine 900
Citalopram 20-60
Setraline 50-200
Which is the most important predicting factor for full psychosis?
Other two factors?
Genetic history
Poor functioning, Long duration of prodromal symptoms
Antipsychotics
1. Which of the 2 drugs could be suggested as antipsychotic agents to treat psychosis in patients with dyslipidemia/glucose intolernce?
- Which 2 drugs are least likely to cause sexual side effects?
- Which drug is least likely to cause QT prolongation?
- Which 2 drugs are least likely to cause hyperprolactinaemi
The suggested drugs for patients with dyslipidemias/impaired glucose tolerance are amisulpride, aripiprazole and ziprasidone. The suggested drugs for patients with sexual dysfunction are Aripiprazole and Quetiapine. Aripiprazole is least likely to cause QT prolongation. The suggested drugs for patients with hyperprolactinaemia are Aripiprazole and Quetiapine.
What percentage of elderly patients with delirium will go on to develop dementia?
The prevalence of dementia in the general population older than 65 years of age is approximately
5%
5%
The prevalence of paraphrenia in elderly above the age of 65 is
1-2%
The prevalence of clinical depression in community samples over age 65 is
How abt nursing home
10 to 15%
15-30%
The estimated proportion of acute confusional states that develop during hospitalisation that are considered preventable is given by
30-40%
The risk of developing Tardive dyskinesia with older antipsychotics is increased in older people by
5-6 Times
Which of the following personality traits is associated with suicide in people aged over 60 years?
Anxious
Ocpd
Which one of the following is a proven protective factor in late onset familial dementia of Alzheimer’s type?
Apolipoprotein e2 allele
Which scale is useful to obtain a differential diagnosis of dementia among the elderly?
Camdex
Between the ages of 65 and 85, the prevalence of Alzheimer’s disease;
1% at 65
40% at 85
Risk doubles every 5 years
progressive supranuclear palsy onset is
6th decade
Which factor is most likely to increase the risk of paraphrenia?
Female gender
Hungtington’s disease located at
Short arm of chromosome 4
Name 4 cortical dementia
Wad r multifocal dementia
Ad CJD Prion Subdural hematoma Picks NPH
CJD
hyperhomocysteinaemia increase risk of
Dementia
The most common psychiatric side effect of levo-dopa among the following is
Nightmares
This is followed by 7% with night terrors, 5% with delirium and 3% with delusional disorder.
1/3 hav psych side effect
Compared to other subtypes, paranoid subtype of schizophrenia is more often associated with which of the following features?
Older age at onset
4 prognosis factors in Alzheimer s
4 prognosis factor (good) in old age depression
Later onset, female gender, an absence of behavioural symptoms, and lack of depressive episodes
Depression : Onset less than 70 years of age 2.a shorter duration of illness 3.Absence of physical illness 4.Good previous adjustment 5.Good previous recovery.
The most prevalent anxiety disorders among older adults is;
How abt the least
The most prevalent anxiety disorder among older adults is phobic disorder and the least common in this age group is the panic disorder.
Hachinski score is a way of looking into risk factors for
Vascular dementia
This scale is helpful for screening people with dementia
This scale is helpful to detect depression in people with dementia
BASDEC (Brief assessment schedule depression cards)
Cornell scale for depression is the best validated scale for detecting depression in dementing patients. It is an interviewer-administered scale that uses information both from the patient and an outside informa
Identify the side effects caused by anti-dementia drugs for each of the following descriptions
A predictable side effect of cholinesterase inhibitors that is related to excessive cholinergic stimulation
Commonest effect on the cardiovascular system
Insomnia
Bradycardia
A 67-year-old lady was taking treatment for swollen legs complaints of visual halos, which are green in colour and appears to be confused.
Wad drug is this
Digoxin
CJD can be seen in ct/mri
EEG
CT/MRI shows atrophy of both cerebrum and cerebellum.
Generalised periodic 1-2 Hz sharp waves are seen in nearly 90% patients with sporadic CJD. Less often in familial / hormonal
Identify the chromosome locus for each of the following genes implicated in Alzheimer’s disease
Presenilin 1 gene
Presenilin 2 gene
Beta-amyloid precursor protein gene
Apolipoprotein e4 gene
Presenilin 1 gene (Chromosome 14) is associated with early onset Alzheimer’s disease.
Presenilin 2 genes (Chromosome 1) is also associated with early onset Alzheimer’s disease.
Beta Amyloid precursor protein gene (Chromosome 21) is the gene for Amyloid precursor protein and is found on the long arm; it is associated with early onset Alzheimer’s disease.
Apolipoprotein e 4 (Chromosome 19) - Presence of e 4 alleles increases the risk of late-onset dementia of Alzheimer’s type.
Dementia & drug management
This is the only drug currently licensed in the UK for behavioural and psychological symptoms of dementia
This medication may increase the risk of bleeding and should be used with caution
The use of this drug was associated with increased mortality in patients with mild cognitive impairment when compared with placebo
This antidementia drug is prone to cause confusion and hallucinations in patients
This hormone may have actions that have preventive effect and potentially reduces the risk of Alzheimer’s disease
Risperidone is the only drug licensed in the UK for behavioural and psychological symptoms of dementia. It is indicated for the short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimer’s disease who are not responding to non-pharmacological measures and when there is a risk of harm to self or others.
2) Several reports have noted that the drug Gingko biloba may increase the risk of bleeding and should be used with caution.
3) The use of galantamine was associated with increased mortality in patients with mild cognitive impairment when compared with placebo. Although no specific cause was predominant, half the deaths reported were due to cardiovascular disorders. As a result, the FDA issued a warning restricting the use of galantamine in patients with mild cognitive impairment (MCI).
4) Memantine can cause confusion and hallucinations in patients although it is rare. The common side effects are headache, dizziness, constipation, somnolence and hypertension.
5) The hormone oestrogen may have actions that have a preventive effect and potentially reduces the risk of Alzheimer’s disease.
A 73-year-old man with Alzheimer’s dementia has read about the side effects of acetylcholinesterase inhibitors, He would like to try the drug with minimal side effects
A 79-year-old man has been diagnosed with Alzheimer’s disease. He has a significant history of cardiovascular disease and is on numerous medications.
Donepezil
Rivastigmine may be the safest choice in patients with cardiovascular disease given its lack of interaction potential with other drugs.
Dosage for
Donepezil
Rivastigmine
Galantamine
Memantine
Donepezil 10mg daily
Rivastigmine 6mg bd
It’s patch I s 9.5 per 24 hour
Galantamine 12mg bd
memantine 10mg bd
Male female ratio
Bulimia
Asperger
ADHD
Prepubertal depression
Tourette syndrome
1: 10
9: 1
3: 1
Depression 1:1
Tourette (mean age is)
7
3:1
This scale is helpful to measure severity of depressive symptoms in a 13-year-old girl
Children’s depression inventory
most important etiological factors associated with school refusal
Being youngest in the family
The most effective treatments for nocturnal enuresis
What drugs are useful name 3
Classic conditioning with the bell and pad apparatus is the most effective treatment for nocturnal enuresis, with dryness resulting in more than 60 percent of cases.
Desmopressin(intranasal)
Imipramine
Riboxetine (safe alternative than imipramine)
What to giv if adhd boy has tics
Atomoxetine and clonidine
3 things that are signs of emotional abuse
Low self-esteem, continual self-deprecation, Sudden speech disorder, Rocking, head-banging, or other neurotic behaviour
What need do check with atomoxetine name 2
Blood pressure and heart rate , Height and weight
Ratio time! Male to female
Reading disorder
Writing expression disorder
Maths disorder (% of school children)
Stuttering
Reading: male 4 to 1
Writing 3 :1
Math more female , 6% of school children
Stuttering 3 to 1
Which of the following childhood psychiatric disorder has the highest heritability factor?
Adhd
70-80%
Most common comorbidities in bipolar is
ADHD and ocd
The prevalence of ADHD in the UK is
Genes implicated are (3)
Concordance rate in monozygotic
The prevalence of ADHD among girls between the ages of 5-15 according to DSM-4 criteria is
2-5%
Genes: 5,6, 11
50%
0-1%
overall prevalence of psychiatric problems in adolescence is
16-20%
Reactive attachment disorder is generally diagnosed before the age of
5 years old
The most common co-morbid disorders seen in Tourette’s syndrome is
OCD and adhd
More so in ocd
commonest age of presentation for school refusal is
11 years
The percentage of reading difficulties in children in Britain is estimated to be around
5%
What is the most likely risk factor that predisposes to criminality at age 17 in a boy who has behavioural problems at the age of 8?
Inadequate parenting
Separation anxiety disorder (SAD) is defined as developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached. This condition occurs in about
% of children
3.5%
The condition commonly associated with autistic spectrum disorders is;
ADHD
Children with enuresis have shown improvement with which one of the following antidepressant?
Imipramine
The most common co-morbid psychiatric disorder seen in children with ADHD is
Co-morbid psychiatric illness is common in ADHD children and is seen in 50-80% of cases. 50% children may meet criteria for 2 comorbid conditions. Oppositional Defiant disorder in 35-50%, conduct disorder 25%, anxiety disorder 25% and depressive disorder 15%. Learning disability 15-40%, specific language impairment in 15-75% children.
The onset of autistic spectrum disorder occurs generally before the age of
3
In autistic spectrum disorder, the symptom that does not improve over time is
Ritualistic and repetitive behaviours.
early childhood, depression will manifest as clingy behaviour, school refusal and exaggerated fears. The percentage of adolescents up to 19 years of age who will have experienced a diagnosable episode of depression in the Europe is
20%
Which of the following disorders is among the most common psychiatric presentations seen in the adolescents?
Anxiety disorders
T he onset of oppositional defiant disorder is generally between the ages
3 and 8 years
What proportion of 15 to 16-year-old adolescents admit to incidents of deliberate self-harm in the UK?
Actual incidents of DSH are admitted by only 6.9% of adolescents. The prevalence of ideation is estimated to be far higher.
Diff between dilemma/ snags/ trap
This is introduced in which therapy (2)
Dilemma: When a person acts as though available action or possible roles were limited to polarized alternatives, this is referred to as a dilemma.
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.
Traps; repetitive cycles where consequences of the behaviour feedback into its perpetuation. Here negative assumptions generate acts that produce consequences that reinforce the assumptions.
This is introduced in ipt and cat
Who create Cognitive analytical therapy
Interpersonal therapy.
Mentalization based treatment
Brief psychodynamic psychotherapy
Cat: anothony Ryle
Ipt: klerman and weissman
Mentalisatiom : Bateman and fonagy
Franz Alexander & Thomas French
Who creat emdr
Shapiro
Who create systemic desensitisation
Rational emotive therapy
Albert Ellis
Who react motivational interviewing
Miller & Rollnick, 199
therapy uses cognitive therapy techniques with a psychodynamic framework
Cognitive analytical y
The focus areas in this therapy are transitions, disputes, grief and sensitivity
Interpersonal therapy
Talk abt
The systemic family therapy focus on wad
The structural model (Minuchin) focus on wad
Focuses mainly on the present functioning of the family rather than its past experiences. Strategies include employing paradoxical injunctions, circular questioning.
Focuses on a set of unspoken rules that organize ways in which family members relate to one another. Such a structure will have the hierarchy of power (parents in charge of children) and firm boundaries. involves hierarchies, redesigning, reframing the family systems so that it approximates a normative model of care but open boundaries between generational subsystems.
This therapy is based on the principle that current problems in the family originate from past experiences of its family members
Psychodynamic therapy
Developments in psychotherapy
With the descriptions given below, identify the proponents; who do wad
Expanded drive theory to include non-sexual drives
Introduced methods of play therapy
Proposed that gratification is obtained through relationships as well as through satisfaction of one’s desires
Examination of games and scripts that characterize relationships
Every individual has the motivation and ability to change, and he or she is the best person to decide on the direction of change.
1) Jung expanded the drive theory to include drives other than libido. He also introduced ideas of ‘collective unconscious’ and personality archetypes. Jung is also associated with concepts such as extroversion and introversion.
2) Melanie Klein introduced methods of play therapy. She is also associated with theories of childhood development including primitive defense mechanisms such as ‘splitting’.
3) Donald Winnicott was one of the proponents of the object relations theory. He argued that gratification could be obtained through relationships as well as through satisfaction of desires.
4) Eric Berne is associated with the transactional analysis. He emphasized the importance of therapeutic attributes of genuineness, accurate empathy and unconditional positive regard.
5) Client-centered psychotherapy is associated with Carl Rogers. This therapy is based on the principle that every individual has the motivation and ability to change, and he or she is the best person to decide on the direction of change. Client-centered therapy is nondirective as the therapists avoid directing the therapeutic process. It emphasizes the importance of ‘therapeutic attributes of genuineness’, ‘unconditional positive regard’ and ‘accurate empathy’.
Who suggest basic assumptions
Formulation matrix
1) Bion postulated that whenever a group gets derailed from its task, it deteriorates into one of three primary states, that are also called basic assumptions. It includes dependency, pairing, or fight-flight. These basic assumptions must be tackled to allow group work to proceed.
3) The formulation matrix in group therapy was described by Foulkes. It refers to a hypothetical web of communication and relationship in a given group. It is the common shared ground, which ultimately determines the meaning and significance of all events and upon which all communication and interpretations, verbal and nonverbal rest.
This therapy focuses on hidden rules and on disagreements about who makes these rules and on inconsistencies between these two levels of interaction.
What it is focus on?
In systems approach to couple therapy the focus of treatment is on hidden rules that govern the behaviour of the couple towards one another, on disagreements about who makes these rules and on inconsistencies between these two levels of interaction. Important concepts include enmeshment, which is excessive involvement with the other person and the idea of a cycle of ‘cause and effect’ such that neither person is whole to blame. These ideas are discussed in conflicts arising in the everyday life of the couple, and it is hoped to arrive at a more balanced and cooperative relationship.
This therapy employs communication training, reciprocity negotiation, structural moves requiring disagreement, reversed role-play and the use of paradox.
Creat by who
How many sessions
Behavioural systems couple therapy was developed by Crowe. It has two sets of components. The behavioural components are reciprocity negotiating and training in communication. The systems components are structural moves (include requiring disagreement, reversed role play & sculpting, timetables & tasks) and the use of paradox. Treatments usually last for 5-10 sessions over 3-6 months.
Wad is catharsis and abreation
Abreaction is the process by which repressed material, particularly a painful experience or conflict, is brought back to consciousness
Catharsis is the expression of ideas, thoughts, and suppressed material that is accompanied by an emotional response. It produces a state of relief in the patient.
Who
Coined the term Therapeutic Community
Described permissiveness and democratisation in group settings.
Described curative factors that help in the process of recovery in group therapies
Credited with the establishment of therapeutic community model
Tom Main coined the term therapeutic community.
Maxwell Jones established the therapeutic community, and
Rapoport explained the key features of Therapeutic communities that include communalism, democracy, permissiveness and reality confrontation.
Yalom cited 11 ‘curative’ factors responsible for a change in groups. The curative factors include the instillation of hope, universality, imparting information (feedback), altruism, corrective recapitulation, socialisation techniques, imitative behaviour, interpersonal learning, group cohesiveness, catharsis and existential factors. Of these, cohesiveness, and learning from feedback are valued positively though other factors may also be important.
Who creat cbt for eating disorder
CBT for delusions and hallucinations
Christopher G. Fairburn, originally intended for bulimia nervosa specifically; it was eventually extended to all eating disorders.
CBT for psychosis : Kingdon & Turkington in 1994
Who creat psychodrama
Jacob Levy Moren
Who creat duel sex therapy
Masters and Johnson –
Who term the term reciprocal inhibition
Joseph Wolpe
Who create will therapy
Progressive muscular relaxation
Otto rank
Jacobson for relaxation
Who creat token economy
The token economy was pioneered by Ayllon, Azrin, Paul & Krasner (Camarillo State Hospital, Calif.). The full range of self-care, social, and work behaviors were thought to be modifiable through systematic and preplanned use of antecedents and consequences of these actions. The “psychopathological” behavior of the mentally ill was conceptualized as being subject to the same “laws of learning” that influenced normal behavior. The tokens could be conveniently dispensed to patients contingent on their exhibiting improvements in their behavior. (Am J Psychiatry 157:9, September 2000).
Two theretical bases in CAT
Procedural sequence model and role repertoires
4 problems area I. Interpersonal therapy
interpersonal role disputes (conflicts with family member, colleague, or friend), role transitions (change from one role to other - includes graduation, beginning or end of career, migration, medical ill health etc.), grief (loss of a loved object/relation) and interpersonal deficits (social impoverishment, inadequate interpersonal relationships).
3 core technique in dialectical BT
distress tolerance, Interpersonal effectiveness training, Core mindfulness training and Emotion regulation skills.
4 things in therapeutic community
Permissiveness and reality confrontation are 2 of the four components of the therapeutic community (Rappaport / Henderson Hospital Model). Permissiveness is tolerating each other, and realizing unpredictable behaviour can happen within the community. Reality confrontation is self-deception or distortions from reality are dealt with honestly and openly by all members without formalities. The other two principles are communalism and democratization.
Three technique in solution focussed therapy
problem free talk, preferred future, exception finding and scales.
Early (3) and late (3) of opioid withdrawal
Symptoms include muscle aches, anxiety and agitation, sleep issues, running nose and yawning. Nausea and vomiting, diarrhoea, goose bumps, stomach cramps, depression or dysphoria and intense drug cravings start later (late onset symptoms)
Which of the following is the most common ECG finding in a patient with acute lithium toxicity?
3 symptoms during toxicity
T wave flattening
tremulousness, dystonia, hyperreflexia, and ataxia.
The most likely electrolyte abnormality of refeeding a grossly anorexic patient in a medical ward is
Hypophosphatemia
What is the chance of 40-year-old mother giving birth to a child with Down syndrome?
1 in 100
mainstream school with apparently normal IQ has visuospatial difficulties. The most likely id diagnosis is
It happen sin 1 in every wad women
Turner syndrome is relatively common (1/2,500 women) in a phenotypic female. It is associated with a cognitive profile of normal intellectual and verbal function but impairments in visual–spatial, executive, and social cognitive d
1 in 2500
What is most likely drug associated with gum bleeding?
Name 3
Carbamazepine can cause gingival bleeds due to their propensity to reduce platelet levels. Other antiepileptic drugs that can cause gingival bleed include levatiracetam and phenytoin.
Which of the following medications can cause fatal intestinal obstruction?
Rapidly fatal intestinal obstruction has been reported with clozapine, sometimes even without prior warning signs. Some case reports also implicate risperidone and olanzapine in intestinal obstructions.
Ebstein’s anomaly is sometimes associated with drugs other than lithium. Choose one such drug:
Diazepam
A major aim of interpersonal therapy for depression is
Aid in conflict resolution
. A medical student has noted that a specific scale has been repeatedly used in several controlled trials evaluating treatments for early onset schizophrenia. He is now keen to know the extent to which the observations using this scale can be generalized to a wider population of patients.
Wad validity is that
External validity
Who is associated with transorbital leucotomy?
Freeman performed the first transorbital lobotomy on a live patient in 1946; together with Watts, he popularised the procedure in the US.
Rose’s ‘Prevention Paradox’?
The correct answer is: An intervention aimed at high risk individuals is the best approach to help those individuals, but population wide benefits are best achieved via universal prevention
The levels of care in Care Programme Approach (CPA) are divided into
Standard and Enhanced
According to UK 700 study, the most important predictor of efficiency of assertive community teams is
Case load
Proportion of Europeans with mental health problems in past one year that attend general practitioners is
33%
What proportion of people seen in primary care settings has a major depressive disorder?
5-10%
According to AESOP study, which of the following groups has highest incidence rates of Bipolar Affective Disorder?
African Caribbean
The average time lag between onset and treatment of depressive disorder is
3 years
Prevalence of hallucinatory experiences in healthy British respondents from community samples is estimated to be around
4%
Number of adults experiencing at least one mental health problem in their lifetime
Number of people living with a mental health problem at any given time in the UK.
Number of persons aged >65 living in the community that have depression at any given time
1 in 4
1 in 6
1 in 7
Wad is the scale use for
static 99 (how many item) use for wad
Honos scale
Which scale entirely reliant on historical factors that is made of 12 items and includes PCL-R as a subscale.
This scale is a 14 item actuarial instrument that incorporates PCL-R.
The Static-99 is a ten item actuarial assessment instrument. It was created by Hanson and Thornton, for use with adult male sexual offenders who are at least 18 years of age at the time of release to the community.
Honos is crested by sugarman
HoNOS-secure is not a risk assessment tool, but a tool that enable the clinical risk assessment to be translated to need for care and clinical risk management.
Rating scales
3) VRAG (violence risk appraisal guide - Quinsley 1995) is entirely reliant on historical factors. It was originally validated at Canadian prisons. It is made of 12 items and includes PCL_R as a subscale.
4) SORAG (Sexual risk offender appraisal guide) is a 14 item actuarial instrument that incorporates PCL_R.
Types of stalker, name 5
rejected stalker is one who pursues an ex-intimate person, either in the hope of reconciliation or for vengeance.
Intimacy seekers who stalk someone they believe they love, and they think they will reciprocate.
Incompetent suitors, who inappropriately intrude, someone, usually seeking a date or brief sexual encounter.
The resentful stalker pursues victims to exact revenge for actual or perceived injury.
The predatory stalker stalks for a sexual offence.
Wad is hebeas corpus
How abt doli incapax
Larceny
corpus delicti
a writ requiring a person under arrest to be brought before a judge or into court, especially to secure the person’s release unless lawful grounds are shown for their detention.
Doli incapax: deemed incapable of forming the intent to commit a crime or tort, especially by reason of age (under ten years old).
Larceny is theft of personal property.
Corpus deliciti is the facts and circumstances constituting a crime.
concrete evidence of a crime, such as a corpse.
Which of the listed tools guide decisions regarding the need for secure placement
DUNDRUM
The lifetime rate of any mental disorder in perpetrators of homicide
30%
The proportion of shoplifters that will reoffend after conviction
10%
Proportion of prisoners that will self-harm during their prison term
10%
What scale can be use for political/social attitudes
A Guttmann Scalogram is a scale composed of several yes/no items in a manner such that if a respondent agrees to the one statement, he/she is likely to agree to the lower order statements as well. So the total score of the scale represents a single index for the continuum that is measured. In other words, a person’s entire set of responses to all items can be reconstructed from their score. This procedure is also called cumulative scaling. The Guttman scale is most suitable for hierarchical constructs e.g. social attitudes, political views, developmental stages, etc. E.g. Bogardus Social Distance Scale is a cumulative scale used to measure the willingness of people in accepting an immigrant into their social groups (E.g., family, work etc).
What type 1 error
Rejection of the null hypothesis
The ability to detect the true difference, if it exists, using the given sample. Wad is it call
Power
Multivariate techniques
It reduces a large number of variables that are highly inter-correlated into a smaller group of representative variables
It predicts the value of a single dependent variable based on the values of several independent variables
It predicts the value of a dichotomous variable based on the values of several independent variables
1) Factor analysis is essentially a method of data reduction - here groups of variables that are highly inter-correlated in a dataset are identified. Then simple correlation analysis of individual factors is carried out. A good example is factor analysis of positive symptoms by Liddle to describe three groups of variables - reality distortion, psychomotor poverty and disorganization syndromes.
2) Multiple linear regression is a linear regression model in which there is a single dependent variable and 2 or more independent variables. In multiple linear regression, several independent variables together predict a single dependent variable. Consider y = a+b1x1 + b2 x2+ b3x3+ b4x4………………….+ bnxn. Multiple regression is a multivariate technique.
3) Logistic regression is used to predict the relationship between a binary dependent variable and several independent variables. For linear regression, the dependent variable must be continuous. If the dependent variable is binary, then the logistic regression is used. It is commonly used to get OR, RR or hazard ratio for independent variables that affect the dependent variable.
What is PRISMA
How abt consort
quorum
STROBE
authors report a wide array of systematic reviews to assess the benefits and harms of a health care intervention.
CONSORT improve quality of rct
QUOROM was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs).
The STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology) is a good checklist for preparing a publication of observational studies such as cohort, case-control and cross-sectional studies.
What is SIGLE
CONAHL
The “System for Information on Grey Literature in Europe” (SIGLE) is an European initiative operated by a network of national information or document supply centres active in collecting and promoting grey literature (especially conference abstracts, doctoral thesis etc.).
The CINAHL database is a comprehensive and authoritative source of information for nurses, allied health professionals including OTs, and others interested in health care.
SAWS) Short Alcohol Withdrawal Scale
SAWS) Short Alcohol Withdrawal Scale
12
Otto Kernberg’s work contributed to the development of the concept of
Borderline
PCP
Wad the other name for it and wad is the duration in urine
How abt Cocaine
How abt heroin
PCP 3-8 days
Cocaine 6-8 hours
Amp thiamine 48 hours
Heroin 1-3 days
The life time prevalence of psychiatric disorder in long-term cocaine users is
80%
About ? percent of alcoholic patients recovering from Wernicke’s encephalopathy develop Korsakoff’s amnesic syndrome.
About 80 percent of alcoholic patients recovering from Wernicke’s encephalopathy develop Korsakoff’s amnesic syndrome.
The symptoms of alcohol withdrawal usually peak within
24-48 hours
The drug licensed to prevent relapse to alcohol use and has been found to have a modest treatment effect is
Acamprosate
The most common anxiety disorder according to National Psychiatric Morbidity Survey in UK is
mixed anxiety-depression followed by GA 25% of all GP consultations are for anxiety related symptoms.
The prevalence of OCD in general population is;
2%
Proportion of patients that do not respond to first trial of antidepressant is
1/3
dardised mortality ratio for patients with dysthymia is higher than the general population by a factor of
How abt depression
12
20
Which feature is commonly seen in patients with dominant parietal lobe dysfunction?
Gerstmann,s syndrome is associated with lesions of the dominant parietal lobe. This consists of dyscalculia, agraphia, finger agnosia and right-left disorientation. Anosognosia and dressing apraxia are often seen with non-dominant parietal lesions.
Mr P has been treated for non-psychotic depression with 40 mg of Paroxetine. There was a minimal response to this drug and augmentation with another drug was suggested. The drug of choice in this scenario would be
Mirtazapine
Mean age for Gad Panic OCD Social phobia
GAD = 20-30years, Panic disorder = 22 to 25 years, OCD= 20 years, social phobia = 15 years,
Which of the following is a life-threatening symptom of Neuroleptic Malignant Syndrome
Dysarthria
The prevalence of pathological crying in patients with multiple sclerosis is
10%
When compared to females, bipolar disorder occurs earlier in males by
5 years
The average duration of illness at the time of initial evaluation of Generalized Anxiety Disorder is around
20 years
In borderline personality disorder which of the following features will improve on its own after two years?
Self mutilation
Which of the following treatment is licensed to treat adult ADHD?
Atomoxetine
What is the rate of completed suicide in the age range of 10-14
How abt 15-19
1-2 per 100000
4-8 per 100000 in the age range of 15-19 years
The proportion of all homicides perpetrated by individuals with schizophrenia is
5%
Which of the following personality traits is more commonly seen in elderly sexual offenders compared to non-offending older individuals?
Schizoid
HGPRT deletion mutation is linked to which of the following conditions
Lesch-Nyhan Syndrome Correct
Which of the following genetic syndromes is known to have an association with the schizotypal disorder?
Fragile X syndrome
The one-year incidence of dementia in Parkinson’s disease is;
10%
therapies diagrammatic reformulations are used to represent the reciprocal roles that are dominant in one’s relationships with others?
Cognitive analytical therapy
Methods
Adjusted odds ratio when controlling for confounders in a cohort study
Summary odds ratio in meta-analysis when there is a substantial difference between the treatment and control group sizes
Summary odds ratio in meta-analysis when there is minimal difference between the treatment and control group sizes
Both Mantel-Haenszel method and Peto method are used to arrive at summary Odds Ratio in a meta-analysis of studies that report dichotomous outcome variables. Peto is often used when the ratio of the number of cases vs. controls or exposed vs. unexposed is not considerably different in individual studies. This is often the case in RCTs. In contrast meta-analysis of cohort studies and case-control studies often use Mantel-Haenszel procedure where there are considerable differences in the ratio of group sizes between individual studies. Also, Mantel-Haenszel is primarily used for stratifying odds ratios to analyse and control confounders in causal studies.
What drugs
Newborn with anencephaly
Newborn with defect of the tricuspid valve
Newborn with spina bifida
Newborn with ventral septal defects
Newborn with anencephaly – Valproate,
Newborn with defect of the tricuspid valve – Lithium, 9tricuspid valve abnormality is Epstein)
Newborn with spina bifida – Valproate,
Newborn with ventral septal defects – Paroxetine
This scale is a nine-item test to help detect depression in people with dementia
The depressive sign scale has nine items useful to detect depression in people with dementia.
The male: female conviction rate for any offence in the UK is approximately
5 to 1
actuarial tool for violence risk assessment?
Violence risk appraisal guide
The genetic heritability of antisocial behaviour is overlaps with which of the following conditions?
Alcohol use
% of delirium tremendous for alcoholic withdrawal dudes how abt When got seizure
Seizures?
5% if jr withdrawal, 30% if seizure
8% for seizure 3% if withdrawal is treated
Opioid intoxicatingly effects (4), comment on pupils
Euphoria, apathy after that }
Psychomotor agitation or retardation o Pupillary constriction (if pupillary dilation is seen the overdose may be very severe and anoxia has set in) o Drowsiness or coma o Slurred speech
Opioid withdrawal peaks in
Starts in
Name 4 symptoms, comment on pupils oso
2 days
Starts in 6-8 hours
Dysphoric mood o Nausea or vomiting o Muscle aches o Lacrimation or rhinorrhea o Pupillary dilation, piloerection (gooseflesh), or sweating o Diarrhea o Yawning o Fever o Insomnia
Intoxicating for cannabies
impaired motor coordination, euphoria, a sensation of slowed time, social withdrawal, conjunctival injection, increased appetite (munchies), dry mouth, tachycardia.
Mainly cough and red eye
Important distinction: heightened perceptual sensitivity, depersonalization and derealization
Amphetamine intoxication and withdrawal effects
Intoxication effects include tachycardia or bradycardia (sometimes these arrythmias can be fatal), pupillary dilation, elevated or lowered blood pressure, perspiration or chills , nausea or vomiting , evidence of weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias, confusion, seizures, dyskinesias, dystonias, or coma, psychological effects such as euphoria, changes in sociability, anxiety, tension, stereotyped behaviours and impaired judgment.
Withdrawal effects include dysphoric mood (crash) sometimes with suicidal ideation. fatigue, vivid, unpleasant dreams, hypersomnia, increased appetite, psychomotor retardation and small pupils.
PCP intoxication
Additional
nystagmus, numbness or diminished responsiveness to pain, ataxia and dysarthria with muscle rigidity. Pupil size is variable with PCP use, depending on the degree of hypoxia and intoxication.
PCP wad type of drugs
Bonds to wad receptors as well?
Noncompetitive NMDA antagonist binds to sigma receptors
Name drugs for these intoxicating symptoms
Tachycardia, red eyes, lack coordination, postural hypotension
Sedation, dizziness, respiratory depression
Tachycardia, hypertension, anorexia, tremor and restlessness
Tachycardia, tachypnea, hypertension, headache, chest pain and respiratory depression
Pinpoint pupils, clammy skin, respiratory depression
Cannabis intoxication- Tachycardia, red eyes, lack of coordination, postural hypotension.
2) Benzodiazepines intoxication- Sedation, dizziness, respiratory depression.
3) Amphetamine intoxication- Tachycardia, hypertension, anorexia, tremor and restlessness.
4) Cocaine intoxication- Tachycardia, tachypnea, hypertension, headache, chest pain and respiratory depression.
5) Heroin intoxication- Pinpoint pupils, clammy skin, respiratory depression
What drug condition will have synaesthesia
LSD intoxication
Massed practice is used as a therapy for which of the following conditions
Tourette’s syndrome
Cornelia de Lange syndrome
Wad can be seen
Which chromosome
Microcephaly, short stature, continuous eyebrows, hypertrichosis, prominent philtrum, small hands and feet, profound mental retardation
Chromosome 5
Wad specific thing u can notice for
Cornea clouding
Recurrent infection
Mousy odors
Self harm
LD, microcephalic, small limbs, continuous eyebrow
Hurler
Recurrent infection : hunter
Mousy Oder: PKU
Self harm
leach and Cornelia de Lange
Cornelia de Lange
Which of the following constitute the best source of sampling for a clinical survey in the general population
Random post codes
Which of the following is a late symptom of opioid withdrawal?
(3)
abdominal cramps, low-grade fever, diarrhoea, nausea and vomiting.
Caffeine antagonizes one of the following receptors
Adenosine Correct
3 drugs in class c
Tranquilisers, some painkillers, GHB (Gamma-hydroxybutyrate), ketamine. Cannabis was originally in class B but was downgraded briefly to class C between 2004 and 2009.
3 drugs for class b
Amphetamines, Methylphenidate (Ritalin), Pholcodine Class C drugs-
Mr. X was taken to A&E department following ingestion of a street drug and complained of a sensation of bugs crawling beneath the skin. This could be caused by intoxication with
Cocaine
The prevalence of OCD in community samples of adults is about
1%
The prevalence of borderline personality disorder in UK households is
% in outpatient ?
% among all pd in clinical sample?
Borderline personality disorder is seen in nearly 2% of general population, 10% outpatients, 15-20% inpatients and 30-60% of all personality disorders in some clinical samples. UK household survey estimated a 0.7% prevalence in the community.
The male to female ratio of suicides occurring between ages 15 to 24 is
4 to 1
The community prevalence of any personality disorder in the UK is
5%
Among patients with late-onset schizophrenia, what proportion are females?
Late-onset schizophrenia is more common in women. Gender distribution is estimated at 4-9:1 female: male predominance.
The correct answer is: 60-69%
The standardised mortality ratio in antisocial personality disorder compared to general population is estimated to be
How abt schizophrenia
8-9 Times
Schizophrenia : : 2-3 times
The mean age of onset of bipolar disorder in community-based studies is
How abt Hospital?
In hospital studies, the mean age of onset is 21 years while it is 17 years in community studies
Which of the following antidepressant must be avoided in a patient with breast cancer taking tamoxifen?
Paroxetine, fluoxetine, duloxetine and bupropion are strong CYP2D6 inhibitors, which should be avoided in tamoxifen users. Amitriptyline and its metabolite, nortriptyline, are metabolized by and can inhibit CYP2D6. Fluvoxamine and nefazodone both inhibit CYP3A, which could potentially affect the metabolism of tamoxifen.
The one-week prevalence of generalized anxiety disorder according to National Psychiatric Morbidity Survey is
3.1%
The lifetime prevalence of dysthymia is
4%
Which of the following SSRIs has an active metabolite?
Sertraline also has an active metabolite, N-desmethyl sertraline, which is ten times less potent than sertraline itself. Fluoxetine also has an active metabolite norfluoxetine with a long half-life.
Which of the following suggests life-threatening symptom of serotonergic syndrome?
Signs and symptoms include high fever, seizures, irregular heartbeat or unconsciousness
What is the threshold of considering a drug teratogenic compared to the spontaneous occurrence of major malformations among live-born neonates?
2-4%
The migrants-to-natives prevalence ratio for schizophrenia is estimated to be
1.8:1
The personality disorders associated with highest disability in terms of vocational functioning is
borderline PD and schizotypal PD had the highest impairment in baseline occupational functioning.
The annual risk of a healthcare professional being stalked by a patient or a patient’s relative is
10%
In the UK the number of infanticides reported per year is around
20 per year
anankastic personality disorder’s prevalence
1.9%
In females, which of the following age group is associated with the highest risk of committing a homicide?
How many %
‘30-39
40%
The incidence of fetal alcohol syndrome is;
1.9 per 1000 live births
Therapeutic regression is an important component of which of the following psychotherapies?
Psychoanalytic psychotherapy
If the sensitivity of a test increases which of the following occurs?
The false positive error rate increases.
When sensitivity increases, more number of cases will be diagnosed despite not having the disease (an increase in false positive rate). When you select a lower criterion value, then the true positive fraction and sensitivity will increase. On the other hand, the false positive fraction will also increase, and, therefore, the true negative fraction and specificity will decrease.
According to DSM-4, caffeinism is defined as recent consumption of caffeine usually in excess of
250 mg
Tolerance is least likely to develop for which of the following symptoms of amphetamine use?
Increased blood pressure
acute adverse effect of MDMA
3 MDMA withdrawal symptoms
increased sweating, nausea and vomiting, and diminished potency despite increased libido
Withdrawal
fatigue, loss of appetite, depression, anxiety, and trouble concentrating.
What percentage of patients on clozapine develop agranulocytosis?
How abt epilepsy
0.7
Clozapine is very epileptogenic. Among 5% who receive more than 600 mg/day develop seizures.
The mean age of onset of chronic fatigue syndrome is between
29-35
What proportion of those who take lithium develop hypothyroidism?
10%
The prevalence of psychotic illness in patients with epilepsy is;
3-7%
The risk of completed suicide in patients with history of deliberate self-harm is
How about repeated self harm
10%
The strongest risk factor of suicide is history of deliberate self harm. Prognosis of non-fatal DSH: 20% repeat and 1% die in next year.
Most cases of postpartum psychosis develop in which of the following postpartum periods?
: 0 to 2 weeks
Number of people suffering from mixed anxiety and depressive symptoms at any given time in UK is
9 in 100
The prevalence of epilepsy in patients with schizophreniform psychosis is:
0.7%
The prevalence of depression in patients with Coronary Heart Disease is
16-20%
According to CATIE study of patients with Schizophrenia, the number of patients meeting criteria for metabolic syndrome, ranges between what percentages
41-50%
Defects from carbamazepine
carbamazepine exposed pregnancies, craniofacial defects (11 percent), fingernail hypoplasia (26 percent), and developmental delay (20 percent) were recorded.
The prevalence of paraphrenia in elderly above the age of 65 is
1-2%
Binge eating is seen in what proportion of patients with Alzheimer’s disease
10%
Proportion of patients with variant for of CJD that present with cerebellar ataxia is given by
10%
The prevalence of schizophrenia in the learning disabled population is
3%
The prevalence of psychosis in prison population is
50 per 1000
What percentage of people convicted of indecent exposure have no previous record of sexual offences?
20%
Low rates of recidivism in a sexual offence are indicated by which of the following features?
Incestual sex offence against a child
Which of the following drugs has been associated with suicidal thinking?
Non depressive drugs I mean
Atomoxetine
What medication would you NOT prescribe to a child with ADHD and hepatic impairment?
Atomoxetine
In patients older than 70 years of age, the rate of progression from Mild Cognitive Impairment to full-blown dementia in a year is
10-15%
Solution focused therapy in children is based on
Strengths-based approach
What disulfiram is contraindicated in?
How abt lofexidine
Heart failure and sick sinus syndrome
Lefexidine: severe coronary insufficiency, recent myocardial infarction, cerebrovascular disease or chronic renal failure and patients with bradycardia or hypotension.
most accurate male: female prevalence ratio from the given list.
Post-traumatic stress disorder
Alzheimer’s disease
Borderline personality
Alcohol dependence
Antisocial personality disorder
Post-traumatic stress disorder – 1:2, Alzheimer’s disease – 1:2, Borderline personality – 1:3, Alcohol dependence – 5:1, Antisocial personality disorder – 5:1
‘Wad they report
Consort
Stard
Strobe
PRISMA
Moose
1 CONSORT: reporting of RCTs
STARD: reporting of diagnostic studies
STROBE: reporting of observational studies
PRISMA: reporting of meta-analyses of RCTs
MOOSE: reporting of meta-analyses of observational studies
‘Giant Panda sign’ is an MRI finding characteristic of
Wilson’s disease
qualitative research, the term recursive abstraction relates to
Summarising datasets repeatedly
In statistics, Cronbach’s alpha primarily measures which of the following
Internal consistency of an instrument
In which of the following situations a random effects analysis is indicated in a meta-analysis?
Presence of statistical heterogeneity
Multiple coding can be used in qualitative research in order to address the issue of
Inter rater reliability
Standardized difference is an expression of effect size of observations. This is used to determine
Sample size for a study
The medical database where you can obtain abstracts published since 1890 is
How abt 1949
Psychinfo
Medline
REM sleep behavioural disorder is characterized by
It is associated with disorders such as Parkinson’s disease, diffuse Lewy body disease, multiple system atrophy and Gullian-Barre syndrome. RBD may be the prodrome of neurodegenerative disease, such as DLB or Parkinson disease.
Which of the following is more often seen in bipolar depression than unipolar depression in hospitalised patients?
Psychomotor changes
The psychiatric disorder reported to be rare in post-stroke patients is
Psychosis
Among SSRIs, the least placental exposure is reported with which of the following drugs?
Sertraline
The most common side effect of SSRIs prescribed in psychiatric settings is
%?
Nearly 60% of patients on SSRI experience sexual side effects.
The correct answer is: Sexual side effect
A 31-year-old mother of 2 months old child is breastfeeding her baby. But she develops an episode of hypomania whilst free of mood stabilisers and requires a psychotropic medication now. Which of the following is best suited?
All psychotropic drugs enter breast milk but the ratio between infant and maternal plasma levels varies greatly. The rates of adverse effects are uncertain, but there are sporadic reports of problems with, for example, toxicity due to lithium, hepatic dysfunction due to CBZ and thrombocytopaenia or anaemia attributed to valproate. In general, the risks to the infant are the same as those for any patient exposed to the medicine, so clozapine is usually regarded as contraindicated because of the risk of agranulocytosis. Lamotrigine will carry the possibility of rash. Due to its narrow therapeutic index lithium is generally regarded as being a relative contraindication to breastfeeding because it is present in breast milk at 40% of the maternal serum concentration (American Academy of Paediatrics Committee on Drugs, 2000). Though valproate and carbamazepine are equally acceptable, valproate being a better antimanic drug it is recommended as the answer for this MCQ. Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for
‘Real-life test’ forms part of the treatment options for which psychiatric condition?
Transsexualism
Most centres require a successful real-life test of at least one year prior to consideration for surgery. During this time the patient undertakes to live full time and attempt to find employment in the new sex. Patients will change their name and come out to friends and family.
Which of the following cells in his brain are more likely to be directly affected by HIV?
perivascular macrophage and microglia
% of male for binge eating disorder
25%
Which one among the following should be avoided due to its effects upon Tamoxifen?
Name 3
bupropion, paroxetine and fluoxetine
For a patient suffering from first-time relapse of schizophrenia the most effective dose of risperidone is
4mg
%nof patient re-experiencing depressive disorder after forts episode in
% in 6 month s
In 2 years
5 years
About 25 percent of patients experience a recurrence of major depressive disorder in the first 6 months after release from a hospital, about 30 to 50 percent in the following 2 years, and about 50 to 75 percent in 5 years.
In patients with hepatic insufficiency, the best option available to prevent delirium tremens is
Oxepam
Reciprocal role repertoire’ is considered in which of the following therapies?
CAT
Which of the following treatments is effective in the management of childhood trauma?
CBT
The cognitive capacity of the therapist to maintain objectivity and focus on selected facts during a discourse is called
How abt The affective disposition of the therapist that helps in restraining oneself from retaliating to negative transferences
Containing
Holding
woman with borderline personality disorder is keen to know which of her symptoms will get better in the natural course of her life even if she does not take treatment. The correct answer will be
Impulsivity
Vascular dementia represents how much proportion of all dementias?
15-20%
In which of the following types of dementia ‘carbohydrate craving’ is frequently seen?
Frontotemporal dementia
Relative sparing of medial temporal lobes in CT/MRI is seen in a patient with dementia is likely to suggest a diagnosis of
In Lewy Body Dementia, a relative sparing of short-term memory and a relative sparing of medial temporal lobes on CT/MRI scan is noted. Medial temporal lobes are relatively preserved in SPECT-HMPAO scan too.
Infantile spasms, also called Salaam attacks, is a characteristic feature of;
Learning disability of various degrees can present along with intractable seizures, hamartomas of the central nervous system and depigmented skin patches (ash leaf spots) and fibromas of the nails in tuberous sclerosis. Patients also show salaam seizures and EEG reveals a hypsarrythmic pattern.
Over 80% of babies sleep right through the night by
6 months
Which one of the following antidepressant would you prefer to use for a child with OCD?
Sertraline
What percentage of patients taking benzodiazepines for nearly a year develop dependence syndrome?
40%
What is the lifetime risk of suicide in dependent drinkers?
How abt jz alcohol problems
10-15%
3-4%
A structured approach whereby research ethics committees review proposals for RCTs
ASSERT
The Inpatient suicides in first week of admission
The percentage of patients seen by psychiatrist in the last one week
The percentage of patients in contact with mental health services within a year of death
The rate of inpatient suicides occurring in the first week of admission is 25% of all inpatient suicides.
The percentage of patients seen by psychiatrist in the last one week is 12.5% and having seen a health worker in last 3 weeks is 33%.
The percentage of patients in contact with mental health services within a year of death is 25% and that on psychiatric outpatient registers is 25%.
The Inpatient suicides that occurred when under routine observation
%
The inpatient suicides that occurred when under routine observation (not constant or intermittent observations) is 80% of all inpatient suicides.
The percentage of suicide patients with major depression
and alcohol dependence
The number that will repeat DSH (deliberate self harm) within one year
The percentage of suicide patients with major depression (30-31%) and alcohol dependence is 17-24%. The number that will repeat DSH (deliberate self harm) within one year is 30%.
What is block randomisation for
Ensure equal numbers of participants in all arms
What does Cronbach’s alpha measure?
From wad score to wad score
Cronbach’s alpha will generally increase as the intercorrelations among test items increase, and is thus known as an internal consistency estimate of the reliability of test scores
infinity to 1
In countries with low suicide rates, what is the factor by which the lifetime risk of suicide is elevated in people who are alcohol dependent?
80
Regarding the length of community detoxification for opioid dependence, methadone reductions are typically carried out over a period of
How abt buprenorphine
3 months
Bu: 14 days to a few week
Which of the following medications is most suitable for opioid detoxification in a patient who aims for complete abstinence but develops hypotension with alpha two agonists?
Buprenorphine
Cortisol is low or high in ptsd
Low
Postnatal depression usually lasts for less than
1 month
% of patents with REM sleep behavior disorder eventually develop Parkinson disease.
20%
The prevalence of psychiatric symptoms at the first presentation of Huntington’s disease is
30%
The prevalence of somatoform pain disorder is;
8-10%
The suicide rates vary between European countries by a factor of about;
10
What is the percentage of patients with schizophrenia that discontinue antipsychotics within 18 months of treatment?
70-75%
Which among the following has the best evidence-based non-pharmacological treatment for insomnia?
Stimulus control therapy
Which of the following modes of psychotherapy has established evidence in HIV-associated depression?
Interpersonal therapy
How many repeats hungtinton’s need
> 35 of cag
The percentage of domestic violence incidents reported to general practitioners is
10%
The most common psychiatric disorder seen as a comorbidity of autism in children is
ADHD
Truancy is mostly associated with which of the following childhood conditions?
Conduct disorder
Demyelination of the corpus callosum is seen in
Associate with what
Marchiafava-Bignami syndrome
Red wine
Formula of
Positive predictive value
Negative predictive value
False positive rate
False negative rate
PPV = true positive/total positive = [16/30)]
NPV = true negative/total negative = [46/70)]
False positive rate = false positives / total nondiseased or (1-specificity)= 14/60
False negative rate = false negatives / total diseased or (1-sensitivity)= 24/40
This scale is helpful to obtain information from school on a variety of psychiatric problems
Strength and difficulties questionnaire
This scale measures aggression and conduct problems especially in age between 7 to 17 years.
The Child & Adolescent Functional Assessment Scale is a rating scale to assess the degree of impairment in functioning due to emotional, behavioural, or psychiatric problems. It is completed by a clinical staff and takes about 10 minutes. It measures aggression and conduct problems especially in age between 7 to 17 years.
PICO is an acronym used in reference to research practice. Which of the following elements of research does it refer to?
Framing a research question
Who creat PDSA cycle and what is it
The PDSA cycle was initially developed by Tom Nolan and colleagues. The PDSA Model for Improvement consists of: three fundamental questions; the plan-do-study-act (PDSA) cycle; and six areas of knowledge.
To make improvements, first ask: What are we trying to accomplish? This will focus the efforts.
Then ask: How will we know that a change is an improvement? Identifying criteria and collecting data will help.
The final question is: What changes can we make that will result in improvements? This requires testing, especially using the PDSA cycle.
Percentage of LD
A.William’s syndrome
B.Down’s syndrome
C.Angelman syndrome
D.Prader Willi syndrome
E.Fragile X syndrome
Fragile X is the second most common genetic cause for intellectual impairment, occurring in 1/4000 males and 1/8000 females. Down’s syndrome tops the list and occurs in 1/1000 children. Prader Willi occurs in 1/10-30,000 people; Angelman syndrome occurs in 1/12-20,000; William’s syndrome occurs in 1/7500-12000 people.
The Driving Vehicle Licensing Agency (UK) requests that they are informed if people are diagnosed with certain mental illnesses as these may impact on their ability to drive. Which of the following diagnoses is most commonly associated with dangerous driving?
Explanation: Dementia, except potentially in the very early stages, is associated with significant risks around driving and the DVLA generally advises that people stop driving after they receive a diagnosis.
3 examples of non degenerative dementia
Alcohol dementia, cancer with or without brain metastases; normal-pressure hydrocephalus; subdural haematoma; hypothyroidism; vitamin B12 deficiency; and neurosyphilis.
Which of the following is most associated with a positive prognosis in the short term in OCD?
Good response to SSRI
Lesch-Nyhan syndrome
prader willi
Rett
Fragile x
Male and female which is more
LN: exclusively male
PW: Same
RETT; EXCLUSIVELY FEMALE
FRAGILE X; MALE TO FEMALE 1:2
Which of the following is the strongest risk factor for an individual developing autism?
Genetic loading
Which of the following is most likely to increase the risk of developing depression among people with epilepsy?
Complex partial seizures and absence of secondary generalized tonic-clonic seizures are risk factors for depression. Treatment with clonazepam, frequent hospitalizations (drug resistance) and lack of occupational activity are additional significant contributing factors.
Donepezil is associated with wad kind of side effects
Donepezil can be associated with bradycardia, heart block and syncope. Heart rate must be monitored when this medication is started and when the dose is increased.
What percentages of people with Down’s syndrome have dementia by the age of 35 years?
How abt 65 years?
25%
75%
Which of the following psychotherapies uses circumscribed and hypothetical questions.
Psychodynamic psychotherapy makes use of hypothetical and circumscribed questions to gain a greater understanding of a patient’s underlying thought processes and defenses.
Jane Seymor is a 70-year-old woman who has difficulties understanding spoken language. Her own speech is incomprehensible but is produced without effort.
What other variant do ( 2things )
Ventromedial
Prefrontal dorsolateral
Orbitofrontal
This is likely to be Semantic Primary Progressive Aphasia, which tends to present with incomprehensible but fluent speech. Other variants are Agrammatic and Logopenic Primary progressive aphasia.
Ventamedial: apathy, hyperorality and perseveration dominates. There is sparse verbal output and paucity of spontaneous behaviour, eventually me come mute
The other variant where perseveration occurs is the prefrontal dorsolateral subtype, which is associated with executive dysfunction and working memory difficulties.
This is likely to be Orbitofrontal variant which is characterised by disinhibition, irritability, impulsivity, explosive outbursts and aggression
Which of the below is the most accurate estimate of the prevalence of intellectual disability amongst people with a diagnosis of an autism spectrum disorder?
50-60%
How much hiv and head injury increase suicide rate
8 folds in head injury
2 folds in hiv
Solution based therapy use ( name 3)
future-focused questions, past solution questions, miracle questions, except questions, coping questions, scaling questions, time-out, accolades and compliments.
Which of the following depot mediations requires at least 2 hours monitoring after it has been given? And y
Patients receiving olanzapine as a depot must be monitored for at least 2 hours after administration. Olanzapine post-injection syndrome has been estimated to occur after 0.07% of olanzapine depot injections and in approximately 1.4% of treated patients. Post-injection syndrome includes a range of signs and symptoms such as sedation and delirium that are consistent with olanzapine overdose.
It generally starts around 1 hour after administration and resolves after 24-72 hours.
Which of the following antipsychotic drug is most associated with hypertension?
Clozapine
What is Treponema pallidum
Wad kind of rash
Syphilis
There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles
What cause rash in form of red spots
Lyme disease (Borrelia burgdorferi)
Long term amphetamine can cause wad
Hypertension
Wad is a measure of measure of internal consistency of a test?
Split half reliability
Wad is cumulative incidence
Incidence density is expressed in person-time units
% of admissions to accident and emergency departments at peak times are alcohol-related.
70%
neonatal complication in babies who were born to mothers prescribed lithium in pregnancy?
(4)
Ebstein’s anomaly, ASD, VSD, Neonatal goiter, hypotonia, lethargy and cardiac arrhthymias.
% of nacrolepsy
0.02%
4 characteristics of nacrolepsy
% of people having all 4?
excessive daytime sleepiness, sudden sleep attacks (narcolepsy) - the sleep is refreshing as it is REM in nature, cataplexy (seen in 75% of patients), sleep paralysis (seen in 30%), hypnagogic hallucinations.
10%
Lucy is pregnant and is taking citalopram for her depression. What is the risk of her giving birth to a child with septal defects?
X ? Effect
% for fluoxetine
% for citalopram
% for setraline
2 folds
- 6% for fluoxetine
- 1% for citalopram
- 5% for sertraline
Which of the following ethnic groups are more susceptible to dose-dependent side effects of risperidone?
East Asians
Which of the following anti-epileptics may be especially associated with psychosis?
Vigabatrin
Which one of the following is associated with a clinical picture of schizophrenia-like psychoses?
Huntington’s disease
6% to 25%
One thing that increase lamotrigine level
One thing that decrease?
Oral contraceptive, cabarmazepine
Lithium increases
the proportion of general population (in percentage) who report sleep disturbances is
30%
Myoclonic seizures have been reported with which of the following antipsychotic medication?
Olanzapine
OCD like symptoms may occur in patients with Huntington’s disease due to the involvement of which area of the brain?
OCD like symptoms may occur due to basal ganglia involvement in patients with Huntington’s disease.
The percentage of reading difficulties in children in Japan is estimated to be around
How abt USA/uk
1%
4-7%
The rate of spontaneous congenital malformations associated with pregnancy is
2-3%
The sudden withdrawal of antiparkinsonian drugs could cause;
Neuroleptic malignant syndrome
Major depressive disorders are common in infarcts involving which part of the brain?
Basal ganglia especially on the left hemisphere
The rate of completed suicide in children and adolescents with bipolar disorder is
10%
What percentage of children with major depressive episode will later manifest bipolar disorder?
20%
What percentage of patients with learning disability suffers from a severe form of mental retardation?
How abt profound
Moderate?
Mild
4%
1-2% for profound
10% moderate
Mild 85%
What is the prevalence of depression among individuals with intellectual disabilities?
2-4%
Hypertelorism’ is a feature seen in which of the following conditions?
Wad other features
Digeorge
CATCH-22, with the 22 reminding us of chromosome 22, andCATCH referring to Cardiac Abnormality, Abnormal facies (palatal abnormalities, hypertelorism), Thymic aplasia, Cleft palate, Hypocalcemia/Hypoparathyroidism.
What is the one year prevalence of clinical depression among those who have alcohol dependence?
25-30%
Peak age of alcohol issues
For men and women
For women, prevalence was highest in the group aged from 16 to 19 years (32%), whereas for men the peak was found among those aged 20 to 24 (62%).
% of adult smoke cannabies regularly
Highest age ppl use drugs and it’s % of the age people to take drugs
% of poeple under 24 use cannabis
% of all school children use cannabis
10% of the adult population smoke cannabis regularly. The highest numbers of drug users are amongst young adults under 25. 45% have used drugs at some point. Half of all cannabis users are under 24. 12% of all school children used cannabis
The prevalence of antisocial personality among females prisoners in the UK is
30%
What proportion of offenders commit nearly 50% of all reported crime?
5%
This test is the non-parametric equivalent of the paired t-test
This test is the non-parametric equivalent of the 2 sample t-test
This test is the non-parametric equivalent of the one-way ANOVA
Wilcoxon signed rank test is the non-parametric equivalent of the t-test comparing paired observations.
2) Mann-Whitney U test is the non-parametric equivalent of the unpaired, 2-sample t-test, comparing the distributions two independent groups of observation.
3) Kruskal-Wallis test is the non-parametric equivalent of the one-way ANOVA, which is used to compare the distributions of more than two independent groups of observation.
Epidemiology
The proportion of homicide perpetrators with a primary diagnosis of a personality disorder that received prison sentence
What percentage of homicide perpetrators with a primary diagnosis of a personality disorder had no contact with the mental health services in the year before?
What percentage of PD patients had no other psychiatric illness at the time of committing the homicide?
What percentage of homicide perpetrators with a history of ‘mental disorder’ has personality disorders as a primary diagnosis?
1) 9%
2) 7%
3) 45%
4) 25-30%
