Mrpsychpaper 3 Demo

7/30/2019 Mrpsychpaper 3 Demo

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MRPSYCH PAPER 3 DEMO

1) Neyman bias is also known by which term?

A. Recall bias

B. Admission bias

C. Prevalence/incidence bias

D. Reporting bias

E. Non-response bias

Neyman bias occurs when a study is investigating a condition that is characterised byearly fatalities or silent cases. It results from missed cases being omitted fromcalculations.

Stats Bias

Bias is a systematic error that can lead to conclusions that are incorrect.

A confounding factor is a variable that is associated with both the outcome and theexposure but has no causative role. A well known example is carrying matches and lungcancer. People who have lung cancer are more likely to smoke and therefore more likelyto carry matches, but carrying matches does not cause lung cancer.

Confounding can be addressed in the design and analysis stage of a study. The mainmethod of controlling confounding in the analysis phase is stratification analysis.

The main methods used in the design stage are listed below.

Matching (e.g. By age and gender) Randomization Restriction of participants (e.g. If watching TV is a known confounder then

restrict participants to ones who don't watch TV)

The following table illustrates the main types of bias.

Selection bias Error in assigning individuals to groups leading to differences which may influence

outcome. Subtypes include sampling bias where the subjects are not representative of

the population. This may be due to volunteer bias. An example of volunteer bias would

be a study looking at the prevalence of Chlamydia in the student population. Students

who are at risk of Chlamydia may be more, or less, likely to participate in the study. A

similar concept is non-responder bias. If a survey on dietary habits was sent out in the

post to random households it is likely that the people who didn't respond would have

poorer diets than those who did. Other examples include loss to follow up bias,

prevalence/incidence bias aka Neyman bias, admission bias aka Berkson's bias,

healthy worker effect)

Information

bias

A form of bias that occurs when measurement of information differs among study

groups examples include recall bias, reporting bias, diagnostic bias, and Hawthorneeffect, errors in measurement


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Work-up bias

(verification

bias)

In studies which compare new diagnostic tests with gold standard tests, work-up bias

can be an issue. Sometimes clinicians may be reluctant to order the gold standard test

unless the new test is positive, as the gold standard test may be invasive (e.g. tissue

biopsy). This approach can seriously distort the results of a study, and alter values

such as specificity and sensitivity. Sometimes work-up bias cannot be avoided, in

these cases it must be adjusted for by the researchers.

Expectation

bias

Only a problem in non-blinded trials. Observers may subconsciously measure or

report data in a way that favours the expected study outcome

Publication bias Failure to publish results from valid studies, often as they showed a negative or

uninteresting result. Important in meta-analyses where studies showing negative

results may be excluded

Confounding

bias

Distortion of exposure, disease relation by some other factor

2) Which of the following models of family therapy is also known as the 'Milan model'?

A. Strategic

B. Transgenerational

C. Solution Focused

D. Systemic

E. Structural

Family therapy

Family therapy first began in the 1950's. This was a major shift in thinking and people'sproblems began to be considered in the context of their environments.There are five theories of family therapy to be aware of:-

Structural

Strategic Systemic Transgenerational Solution Focused

Transgenerational and solution focussed are less important and do not tend to

come up in the exams.

Structural (developed by Salvador Minuchin)

The main assumption is that the family's structure is wrong. Structural therapy

has clear ideas about what constitutes a healthy family system. It is one where

there are clear boundaries and no coalitions. The work is in the here-and-now.

Dysfunctional families are thought to be marked by impaired boundaries,inappropriate alignments, and power imbalances.


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Key terms include: subsystems, hierarchy, boundaries, alliances and coalitions.

Strategic (associated with Jay Haley and Cloe Madanes)

Strategic therapy claims that difficulties in families arise due to distorted

hierarchies.Dysfunctional families are believed to communicate in problematic repetitive

patterns (vicious cycles) that kept them dysfunctional. These patterns arise as

intended solutions by the family to some symptom. The intended solutions then

became the problem because the family had either over or under responded to the

symptom through their interactions.

Key terms include: task setting, and goal setting.

Systemic (associated with Mara Selvini-Palazolli aka 'The Milan model')

Milan-Systemic therapists see the family as a self-regulating system which

controls itself according to rules formed over a period of time through a process

of trial and error. They are interested in the rule-maintaining characteristics of

communication and behaviours, and assume that the way to eliminate a symptom

is to change the rules.

An interview consists almost entirely of questioning of the family by the therapist.

Questioning is a recursive and circular process, with each question building upon

the family's response to previous questions. Emphasis is placed on exploring

differences between family member's behaviours, emotional responses and their

beliefs at differing points in time.

Key terms include: hypothesising, neutrality, positive connotation, paradox andcounter-paradox, interventive questioning and the use of reflecting teams.

4) A patient you placed under section 5(2) of the MHA shouts at the new cleaner

on the ward, but behaves well with you. Which defence mechanism is being used?

A. Undoing

B. Suppression

C. Repression

D. Displacement

E. Splitting

Defense mechanisms

Denial - refusal to accept reality

Displacement - redirection of impulses onto a different target to the one who caused the

emotion


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Projection - attributing uncomfortable thoughts or feelings to others

Projective identification - a person projects a thought or emotion onto a second person.

Then the second person is changed by the projection and begins to behave as though he

or she is in fact actually characterised by those thoughts or emotions that have beenprojected

Reaction formation - acting in the opposite way to the thought or feeling

Supression - process of consciously avoiding thinking about something for example by

distracting oneself

Repression - process of keeping unwanted emotions or thoughts outside conscious

awareness

Undoing - an attempt to take back an unpleasant thought or emotion

Acting out - acting on thoughts or emotions forbidden by the superego

Intellectualization - focussing on details in an effort to avoid painful thoughts or emotions

Rationalization - the creation of false but credible justifications

Sublimation - redirecting negative thoughts or feelings into a more positive form

Regression - reverting back to an earlier stage of development when faced with an

unpleasant thought or emotion

Isolation - the disconnection of an event from the emotion attached to it.

4) Drugs recommended by NICE for the treatment of PTSD include all of the following

except?

A. Mirtazapine

B. Phenelzine

C. Reboxetine

D. Amitriptyline

E. Paroxetine

Drugs recommended for PTSD = paroxetine, mirtazapine, amitriptyline, and phenelzine

(NICE)


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Drug treatments for PTSD should not be used as a routine first-line treatment for adults(in general use or by specialist mental health professionals) in preference to a trauma-focused psychological therapy. Drug treatments (paroxetine or mirtazapine for generaluse, and amitriptyline or phenelzine for initiation only by mental health specialists)should be considered for the treatment of PTSD in adults who express a preference not to

engage in trauma-focused psychological treatment.

Post traumatic stress disorder (diagnosis and treatment)

Post traumatic stress disorder (PTSD) is an emotional reaction to a traumatic event.

The ICD-10 diagnostic criteria are as follows:-

Exposure to a traumatic event which would be likely to cause pervasive distress inalmost anyone.

The event must be persistently remembered or relived, as evidenced byflashbacks, vivid memories, or nightmares.

The patient must actively avoid situations which remind them of the event.

In addition it stipulates that either of the following must be presentPartial amnesia for part of the event

Persistent symptoms of psychological arousal such as, poor sleep, poorconcentration, hypervigilance, exaggerated startle response, irritability.

The above symptoms must occur within 6 months of the event.

NICE guidelines make the following recommendations about the treatment of

PTSD

Debriefing should not be offered Where symptoms are mild and have been present for less than 4 weeks watchful

waiting should be considered (follow up given within 1 month)

All people with PTSD should be offered a course trauma-focused cognitivebehavioural therapy (CBT) or eye movement desensitisation and reprocessing

(EMDR).

Drug treatments for PTSD should not be used as a routine first-line treatment foradults in preference to a trauma-focused psychological therapy.

Drug treatments (paroxetine or mirtazapine for general use, and amitriptyline orphenelzine for initiation only by mental health specialists) should be considered

for the treatment of PTSD in adults who express a preference not to engage in

trauma-focused psychological treatment.


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5) Which of the following would be most appropriate for a women who is hypomanic,breastfeeding, and does not currently require hospitalisation?

A. Carbamazepine

B. Valproate

C. Lorazepam

D. Lamotrigine

E. Lithium

Exam question from October 2010

Valproate can be used in breast feeding women but only when there is adequate

protection against pregnancy. An antipsychotic would of course be preferable if it were an

option.

Pregnancy and breastfeeding (Maudsley guidelines)

The spontaneous abortion rate in confirmed pregnancies is 10-20% and the risk of

spontaneous major malformation is 2-3% (1 in 40). Drugs account for approximately 5%

of all abnormalities.

Both valproate and carbamazepine are associated with an increased risk of spina bifida

(1-2% and 0.5-1% respectively). Valproate is considered more dangerous than

carbamazepine.

Lithium is associated with Ebstein's anomaly (relative risk 10-20 times that of control,

absolute risk 1:1000)

Benzodiazepines appear to be associated with oral clefts in newborns and floppy baby

syndrome.

Olanzapine is recommended by the Maudsley guidelines in the situation of a pregnant

patient in need of an antipsychotic.

Paroxetine is more commonly associated with neonatal withdrawal than other SSRIs, it is

also associated with an increased risk of congenital malformations compared with other

antidepressants (Thormahelen 2006)


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The following table shows the current Maudsley guidelines on prescribing in pregnancy

and breastfeeding.

Drug class Suggested in pregnancy Suggested in breastfeeding

Antidepressants Fluoxetine, amitriptyline, imipramine,(avoid paroxetine)

Sertraline, paroxetine

Antipsychotics Olanzapine, haloperidol, clozapine,

chlorpromazine

Olanzapine, sulpride

Mood

stabilisers

Avoid if possible Avoid if possible and use antipsychotics instead.

Valproate is recommended if essential

Sedatives Promethazine For anxiety - Lorazepam

For insomnia - Zolpidem

Thormahelen G. Paroxetine Use During Pregnancy: Is it Safe? Ann Pharmacother

October 2006 vol. 40 no. 10 1834-1837.

6) Regarding neuroleptic malignant syndrome (NMS), which of the following is true?

A. The mortality rate is estimated to be up to 2%

B. Serum CPK is raised

C. SSRI's are not associated with NMS

D. Hypothermia is a common symptom

E. LFT's are not normally abnormal

Serotonin syndrome and neuroleptic malignant syndrome

Serotonin syndrome

Serotonin syndrome is a consequence of excess serotonergic activity in the CNS and canbe conceptualised as serotonin toxicity. It is characterized by the triad of neuromuscular

abnormalities (myoclonus, and clonus), altered mental state, and autonomicdysfunction.

The clinical picture ranges from mild agitation and tremor to extreme muscle rigiditywith hyperthermia that demands immediate intervention. Analysis of a series of casesfound neuromuscular abnormalities to be the most reliable diagnostic finding. Clonus(the involuntary muscular contraction following sudden stretching of the muscle),hyperreflexia, and muscular rigidity are nearly always present. The onset of symptoms istypically acute and rapidly progressive, following shortly after one or two doses of theoffending medication.

The most frequent cause of severe reaction is the co-administration of an MAOI with aSSRI.

Treatment consists of withdrawing the cause, supportive care, control of agitation, and


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administration of a 5HT-2A antagonist such as cyproheptadine. Mild cases may onlyrequire benzodiazepines and fluids but more severe cases can require an intensive careenvironment.

Neuroleptic malignant syndrome (NMS)

NMS is not fully understood. There is some agreement however that it probably resultsfrom the result of dopamine blockade at the hypothalamus which messes up the thermo-regulatory system and hence results in hyperthermia (a core feature). It is also suggestedthat the use of antipsychotics (neuroleptics) causes calcium uptake into muscles resultingin muscle rigidity (another core feature, lead pipe rigidity) which results inrhabdomyolysis and so elevated levels of creatinine phosphokinase (CPK).

It is almost exclusively caused by antipsychotics (but is also associated withantidepressants and lithium). Rapid and large dose increases often trigger it, along withrapid dose reductions, and abrupt withdrawal of anticholinergics. It typically developswithin 2 weeks of initial treatment but may occur at any time the drug is being taken. Itcan also be precipitated by agitation and/or dehydration.

Treatment is not always necessary. The first step is removal of the antipsychotic and thetreatment of fever in addition to the use of a benzodiazepine. Other options which may benecessary include ECT, bromocriptine, and dantrolene.

The mortality rate is estimated to be up to 20%.

The following table lists the common risk factors for NMS.

Risk factors for NMS

General Younger age

Being male

Physical exhaustion

Dehydration or electrolyte imbalance

Previous and family history of NMS

Organic mental disorders

Low serum iron levels

Raised creatine kinase levels

Comorbid substance misuse

Related to antipsychtoic High loading dose

Faster rate of loading

High potency

Sudden withdrawal

Serotonin syndrome versus Neuroleptic malignant syndrome.

NMS and serotonin syndrome are easily confused. They are in fact very different and

require different treatments. Common features include alteration in consciousness,

sweating, autonomic instability, hyperthermia, and elevated CPK levels.

The history gives important clues about the diagnosis. Serotonin syndrome typically has

an acute onset (within 24 hours of drug administration), whereas that of NMS is more

insidious (typically taking up to 2 weeks to appear). Any recent change to the medication

is also very important.


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7) Which of the following is most likely to lead to neural tube defects?

A. Carbamazepine

B. Lorazepam

C. Olanzapine

D. Sodium valproate

E. Lithium

Pregnancy and breastfeeding (Maudsley guidelines)

The spontaneous abortion rate in confirmed pregnancies is 10-20% and the risk ofspontaneous major malformation is 2-3% (1 in 40). Drugs account for approximately 5%of all abnormalities.

Both valproate and carbamazepine are associated with an increased risk of spina bifida(1-2% and 0.5-1% respectively). Valproate is considered more dangerous thancarbamazepine.

Lithium is associated with Ebstein's anomaly (relative risk 10-20 times that of control,absolute risk 1:1000)

Benzodiazepines appear to be associated with oral clefts in newborns and floppy babysyndrome.

Olanzapine is recommended by the Maudsley guidelines in the situation of a pregnantpatient in need of an antipsychotic.

Paroxetine is more commonly associated with neonatal withdrawal than other SSRIs, it isalso associated with an increased risk of congenital malformations compared with otherantidepressants (Thormahelen 2006)

The following table shows the current Maudsley guidelines on prescribing in pregnancyand breastfeeding.

Drug class Suggested in pregnancy Suggested in breastfeeding

Antidepressants Fluoxetine, amitriptyline,

imipramine, (avoid paroxetine)

Sertraline, paroxetine

Antipsychotics Olanzapine, haloperidol, clozapine,

chlorpromazine

Olanzapine, sulpride

Mood

stabilisers

Avoid if possible Avoid if possible and use antipsychotics instead.

Valproate is recommended if essential

Sedatives Promethazine For anxiety - Lorazepam

For insomnia - Zolpidem

Thormahelen G. Paroxetine Use During Pregnancy: Is it Safe? Ann PharmacotherOctober 2006 vol. 40 no. 10 1834-1837.


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8) Which of the following is the best predictor of the effectiveness of a psychologicaltherapy?

A. Patients ability to think psychologically

B. Therapeutic alliance

C. Location that therapy takes place

D. Patients age

E. Age of the therapist

Psychological therapy (evidence)

The DoH undertook a large systematic review of the literature on psychological therapiescalled 'Treatment Choice in Psychological Therapies and Counselling'. It recognised thefact that very few pure forms of therapy existed and instead produced some generalevidence based recommendations.

Here are the edited highlights. It's worth reading them as you'll find they are the basis ofa number of questions.

'Therapeutic alliance' is the single best predictor of benefit Therapies of fewer than eight sessions are unlikely to be optimally effective for

most moderate to severe mental health problems

Often 16 sessions or more are required for symptomatic relief, and longertherapies may be required to achieve lasting change in social and personality

functioning

The patient's age, sex, social class or ethnic group are generally not importantfactors in choice of therapy and should not determine access to therapies

Interest in self-exploration and capacity to tolerate frustration in relationshipsmay be particularly important for success in interpretative (psychoanalytic and

psychodynamic) therapies, compared with supportive therapy

Treatment choice in psychological therapies and counselling: Evidence based

clinical practice guideline. Department of Health 2001.


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9) Which of the following is a risk factor for repetition of self harm?

A. Being single

B. Alcohol dependency

C.Not having children

D. Absence of a psychiatric history

E. Having a family history of schizophrenia

Risk factors for completed suicide include:-

Psychiatric history Male Older age Previous attempts Unemployment Poor physical health Living alone Medical severity of the act - especially near-fatal self-harm Hopelessness Continuing high suicidal intent

Risk factors for non-fatal repetition of self-harm include:-

A history of self-harm prior to the current episode Psychiatric history, especially as an inpatient Current unemployment Lower social class Alcohol or drug-related problems

Criminal record Antisocial personality Uncooperativeness with general hospital treatment Hopelessness High suicidal intent

Note there is significant overlap between the two groups. Questions on this topic

are common in the MRCPsych exam.


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10) Which of the following is a feature of normal grief?

A. Anger towards the deceased

B. Psychomotor retardation

C. Generalised guilt

D. Suicidal thoughts

E. Feelings of worthlessness

Exam question August 2009

Grief

Current thinking on grief stems from the work done by John Bowlby. He outlined thenatural phases of grief as seen in the table below. He did not specify a time period foreach stage and added that people can go backwards and forwards from one stage toanother.

Normal grief

Phase Features Typical time course

I Shock and protest - including disbelief Few days

II Preoccupation - involves yearning and anger Few weeks

III Disorganisation - includes despair and acceptance of loss Several months

IV Resolution 1-2 years

A similar system was suggested by Kubler-Ross in 1969.

Stage I = Denial

Stage II = Anger

Stage III = Bargaining

Stage IV = Depression

Stage V = Acceptance

Abnormal grief

Abnormal grief is often divided in to three categories (see table below)

Inhibited Absence of expected grief symptoms at any stage

Delayed Avoidance of painful symptoms within 2 weeks of loss

Chronic/ prolonged Continued significant grief related symptoms 6 months after loss


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Grief and depression

A high proportion of people will meet the criteria for major depression in the first yearfollowing bereavement. These episodes usually resolve within 6 months.

Features useful for distinguishing normal grief from major depression include:-

Generalised guilt (rather than guilt specifically related to actions taken aroundthe time of death.

Thoughts of death (except in relation to the deceased) Feeling worthless Psychomotor retardation Prolonged functional impairment Hallucinations (except in relation to the deceased)

Working with grieving adults. Advances in Psychiatric Treatment. 2004, vol. 10,

164-170.

11) What is the median value from the following data set 2, 9, 4, 1, 23?

A. 7.8

B. 4

C. 2

D. 1

E. 9

The median is the middle number of a set of numbers arranged in numerical order. It isnot affected by outliers.

To calculate the median, the data set is arranged into numerical order 1 2 4 9 23 and themiddle value selected.

The mean value is calculated by adding all the values together and dividing by 5 and isequal to 7.8.

Stats Measures of central tendency

Descriptive statistics are used to describe the basic features of the data in a study. Theyare typically distinguished from inferential statistics which help to form conclusionsbeyond the immediate data. Descriptive statistics help us to simplify data.


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Measures of central tendency

There are three measures of central tendency, the mean, median, and mode.

Median The median is the middle number of a set of numbers arranged in numerical order. It is not

affected by outliers

Mode The mode is the most frequent value

Mean The mean is calculated by adding all the scores together and dividing by the number of scores.

Unlike the median or the mode, the mean is sensitive to a change in any value of the data set.

The mean is very sensitive to outliers

The Range is the difference between the largest and smallest observed value.

The table below summarises the appropriate method of summarising the middle ortypical value of a data set depending on the measurement scale.

Measurement scale Measure of central tendency

Categorical Mode

Nominal Mode

Ordinal Median or mode

Interval (Normal distribution) Mean (preferable), median, or mode

Interval (Skewed data) Median

Ratio (Normal distribution) Mean (preferable), median, or mode

Ratio (Skewed data) Median

12) Which of the following is most likely to cause amenorrhoea?

A. Quetiapine

B. Clozapine

C. Olanzapine

D. Aripiprazole

E. Amisulpride


Amenorrhoea can result from high prolactin levels as a result of antipsychotic use.

Aripiprazole , quetiapine, and olanzapine are all recommended in hyperprolactinemia.Clozapine does not tend to have an effect on prolactin release.


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Antipsychotics (hyperprolactinaemia)

Hyperprolactinemia is associated with the use of antipsychotics (and very occasionallyantidepressants). Dopamine inhibits prolactin and so dopamine antagonists increaseprolactin levels.

It is often asymptomatic but is associated with the following:-

Galactorrhoea Amenorrhoea Gynaecomastia Hypogondism Sexual dysfunction

Psychiatric patients with long standing hyperprolactinaemia have an increased risk of:-

Osteoporosis Breast cancer (females only)

Antipsychotics known to cause significant hyperprolactinaemia include:-

All the typical antipsychotics

Risperidone Amisulpride Zotepine

Drugs suggested in the situation of hyperprolactinaemia include:-

Aripiprazole Quetiapine Olanzapine

Maudsley Guidelines.


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Questions 13 to 15 of 20

Theme: Dementia

A. Chronic subdural haematoma

B. Vascular dementia

C. Alzheimer's disease

D. Fronto temporal dementia

E. Normal pressure hydrocephalus

F. Huntington's disease

G. Lewy body dementia

H. Steele-Richardson-Osliewski syndrome

I. Binswanger's disease

J. Korsakoff's syndrome

From the following select the most appropriate condition

13. Presents as cognitive impairment accompanied by falls, tremor, hallucinations, and

sensitivity to neuroleptics

Lewy body dementia

14. A score of 7 or more on the Hachinski Ischaemic Score supports a diagnosis of this

Vascular dementia

15. Commonly presents with ataxia, dementia, and urinary incontinence

Normal pressure hydrocephalus

Dementia (types and clinical characteristics)

Dementia is a progressive impairment of cognitive functions occurring in clear

consciousness (the clear consciousness aspect differentiates it from delirium).

There are over 100 different causes of dementia. A detailed knowledge is required for the

more common types.


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Alzheimer's

Late onset

Progressive cognitive impairment Gradual onset

Vascular dementia

Sudden onset, often following a stroke Stepwise progression

Lewy body dementia

Fluctuating cognitive impairment Hallucinations Neuroleptic sensitivity (sensitivity to the side effects of antipsychotics such as

sedation and EPSE's)

Falls Rigidity, stiffness and movement difficulties

Picks's disease (aka fronto temporal dementia)

Gradual onset Frontal lobe symptoms such as disinhibition, decline in personal hygiene, and

personality change

Speech and language dysfunction including poverty of speech and echolalia

Huntington's disease

Early onset 35-44 Associated with abnormal movements (chorea) Autosomal dominant

Pseudodementia

Cognitive problems result from depression Often reply 'don't know' to questions (compared to people with true dementia

who tend to attempt an answer but give incorrect responses)


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Progressive supranuclear palsy

Shares many features of Parkinson's disease apart from tremor

Presents with loss of balance and falls Those affected have problems with voluntary eye movements.

16) What fraction of violent crimes is committed by people with severe mental illness?

A. 1 in 20

B. 1 in 1000

C. 1 in 5

D. 1 in 100

E. 1 in 200

This figure of 5% of crimes are committed by people with severe mental illness/schizophrenia comes up in the exams frequently.

Mental health risk - Sweden's data

Data from Sweden's national register suggest 2.4% of violent crimes were

attributed to people with severe mental illness. Overall, the population

attributable risk fraction of patients was 5%, suggesting that patients with severe

mental illness commit 1 in 20 violent crimes.

17) According to NICE, which of the following is considered first line treatment for PTSD?

A. Trauma focussed CBT

B. Mirtazapine

C. Fluoxetine

D. Paroxetine

E. Rational emotive therapy


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Post traumatic stress disorder (diagnosis and treatment)

Post traumatic stress disorder (PTSD) is an emotional reaction to a traumatic event.

The ICD-10 diagnostic criteria are as follows:-

Exposure to a traumatic event which would be likely to cause pervasive distress inalmost anyone.

The event must be persistently remembered or relived, as evidenced byflashbacks, vivid memories, or nightmares.

The patient must actively avoid situations which remind them of the event.

In addition it stipulates that either of the following must be present

Partial amnesia for part of the event Persistent symptoms of psychological arousal such as, poor sleep, poor

concentration, hypervigilance, exaggerated startle response, irritability.

The above symptoms must occur within 6 months of the event.

NICE guidelines make the following recommendations about the treatment of

PTSD

Debriefing should not be offered

Where symptoms are mild and have been present for less than 4 weeks watchfulwaiting should be considered (follow up given within 1 month)

All people with PTSD should be offered a course trauma-focused cognitivebehavioural therapy (CBT) or eye movement desensitisation and reprocessing

(EMDR).

Drug treatments for PTSD should not be used as a routine first-line treatment foradults in preference to a trauma-focused psychological therapy.

Drug treatments (paroxetine or mirtazapine for general use, and amitriptyline orphenelzine for initiation only by mental health specialists) should be considered

for the treatment of PTSD in adults who express a preference not to engage in

trauma-focused psychological treatment.


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18) Which of the following is the method of choice for detecting alcohol

dependence in primary care?

A. AUDIT

B. MAST

C. CAGE

D. FAST

E. PAT


AUDIT is used in primary care settings as it accurately detects both alcohol dependenceand hazardous drinking. CAGE is good at detecting dependence only.

Alcohol screening tools

A variety of tools have been devised to assist in the diagnosis of alcohol problems.

AUDIT (Alcohol Use Disorders Identification Test), was developed by the WHO as asimple method of screening for excessive drinking. The test consists of 10 questions andattempts to cover the three domains of harmful use, hazardous use, and dependence.

10 item questionnaire Takes about 2-3 minutes to complete Has been shown to be superior to CAGE and biochemical markers for predicting

alcohol problems

Minimum score = 0, maximum score = 40 A score of 8 or more in men, and 7 or more in women, indicates a strong

likelihood of hazardous or harmful alcohol consumption

A score of 15 or more in men, and 13 or more in women, is likely to indicatealcohol dependence

AUDIT-C is an abbreviated form consisting of 3 questions

http://whqlibdoc.who.int/hq/2001/WHOMSDMSB01.6a.pdf

FAST (Fast Alcohol Screening Test), is a short and rapid test with just 4 questions thatwas developed to be used in a busy medical setting.

4 item questionnaire (see table below) Minimum score = 0, maximum score = 16 The score for hazardous drinking is 3 or more


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With relation to the first question 1 drink = 1/2 pint of beer or 1 glass of wine or 1single spirits

If the answer to the first question is 'never' then the patient is not misusingalcohol

If the response to the first question is 'Weekly' or 'Daily or almost daily' then thepatient is a hazardous, harmful or dependent drinker. Over 50% of people will be

classified using just this one question

1 MEN: How often do you have EIGHT or more drinks on one occasion?

WOMEN: How often do you have SIX or more drinks on one occasion?

2 How often during the last year have you been unable to remember what happened the night before

because you had been drinking?

3 How often during the last year have you failed to do what was normally expected of you because of

drinking?

4 In the last year has a relative or friend, or a doctor or other health worker been concerned about your

drinking or suggested you cut down?

http://alcoholism.about.com/od/tests/a/fast.htm

CAGE is a 4 question screening tool. Two or more positive answers suggests problemdrinking.

The CAGE is a well known but recent research has questioned its value as a screening testtwo or more positive answers is generally considered a 'positive' result.

C Have you ever felt you should Cut down on your drinking?

A Have people Annoyed you by criticising your drinking?

G Have you ever felt bad or Guilty about your drinking?

E Have you ever had a drink in the morning to get rid of a hangover (Eye opener)?

SASQ (Single alcohol screening questionnaire), asks only one question, when

was the last time you had more than x alcoholic drinks in one day? (Where x is 8

for men and 6 for women). An answer of within 3 months indicates harmful or

hazardous drinking.

PAT (Paddington Alcohol Test), was developed for use in a busy A&E department

to detect hazardous drinking.

MAST (Michigan Alcoholism Screening Test) is useful for detecting dependent

drinkers.


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19) Which of the following drugs of abuse is detectable in the urine for the longestamount of time?

A. Cannabis

B. Methadone

C. Benzodiazepines

D. Amphetamine

E. Cocaine

Drug (screening)

Note that detection times vary considerably from person to person. That being said thefollowing table serves as a rough guide. As a general rule most substances remain positivein the urine for 1-3 days with the exception of heavy users of cannabis who can remainpositive for up to 14-28 days.

Drug of abuse Length of time detectable in urine

Cannabis 14-28 days

Phencyclidine 8 days

Methadone 3 days

Morphine 3 days

Benzodiazepine 3 days

Heroin 3 days

Cocaine 1-3 days

Amphetamine 1-3 days

LSD 1-3 days

Codeine 2 days

Alcohol 12 hours

(Adapted from Synopsis of Psychiatry, Kaplan & Sadock's)

Standard drugs included in a urinalysis screen include:-

Cannabis

Amphetamine Cocaine Methadone Benzodiazepines Opiates


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20) What percentage of people with learning difficulties are classed as profoundly

learning disabled?

A. 55%

B. 15%

C. 1%

D. 90%

E. 20%

Learning disability (Classification)

Approximately 2% (985,000 people) of the general population is estimated tohave a learning disability (IQ

Mrpsychpaper 3 Demo

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