Paper B Mock Exam 8: 2024

A 34-year-old woman being treated for seizures has irregular menstrual periods, at which time her seizures worsen. It is most likely that she has which of the following?

A 45-year-old patient with bipolar I disorder has recently started taking a new medication. He develops sudden and severe epigastric pain that radiates to his back, as well as vomiting. Which of the following medications is most likely to be responsible?

A 52-year-old patient on maintenance treatment for bipolar I disorder is noted to have hypercalcemia on routine blood work. Which of the following agents is most likely to be responsible?

A 58-year-old woman presents with confusion, nystagmus, and unilateral paresis of eye abduction. Though her drug screen is negative, her daughter suspects that the woman is drinking alcohol frequently. Which of the following is the most likely diagnosis?

A pregnant woman with bipolar I disorder is scheduled for induction of labour next week. Her lithium dose has been increased in recent weeks, and she has a current level of 0.75 mmol/L. She is not planning to breastfeed. What is the most advisable course of management?

A 55-year-old man presents with low mood and associated depressive symptoms two weeks after a myocardial infarction. Which of the following would be the best choice for his treatment?

A man diagnosed with HIV and a history of epilepsy is depressed. Which of the following would be the best choice for treatment of his depression?

With respect to prophylaxis in bipolar disorder, the BALANCE study showed which of the following findings?

With respect to first-generation antipsychotics (FGAs) compared to second-generation antipsychotics (SGAs), which of the following was a major finding of the CUtLASS study?

In a community-based cohort study, 154,549 postmenopausal women without dementia at enrolment (between 2006 and 2010) from the UK Biobank were followed up until June 2021. Age at menopause (<40, 40-49, and =50 years) was used to predict the primary outcome of allcause dementia in a time-to-event analysis. In total, 2266 incident cases of dementia were observed over a median follow-up period of 12.3 years. After adjusting for confounders, women with earlier menopause showed a higher risk of all-cause dementia compared with those ≥50 years (adjusted-HRs [95% CIs]: 1.21 [1.09-1.34] and 1.71 [1.38-2.11] in the 40-49 years and <40 years groups, respectively; P for trend <0.001). Which of the following is an accurate interpretation of the reported results?

What type of graph will estimate the probability of survival over time?

A recent mediation analysis study examined the direct effect of clozapine on the dopaminergic pathways related to motivation and pleasure in patients with treatment-resistant schizophrenia. The study aimed to determine whether clozapine’s impact on negative symptoms, such as avolition and anhedonia, could be partially attributed to its modulation of the mesolimbic dopamine system. Which of the following findings would most likely support the hypothesis that clozapine directly improves motivation and pleasure by acting on this pathway?

In considering the clinical use of clozapine for the management of treatment-resistant schizophrenia, the medication’s profile must be carefully weighed against potential side effects. One significant concern is the risk of clozapine-induced sedation, which can exacerbate symptoms of low motivation commonly observed in schizophrenia. What is the primary reason clozapine should be used cautiously or avoided in patients with preexisting low motivation?

A screening instrument has a pre-test probability of 1 in 8 with 80% sensitivity and 80% specificity. Calculate the post-test odds of a positive test result.

A researcher spends one month collecting the published news from all British tabloids since the Covid pandemic started that contained the term “mental health” and analyses the patterns of reporting. What is the appropriate term to describe this type of research?

A research team is evaluating the performance of a newly developed diagnostic test for psychotic relapse in established schizophrenia using speech samples. The prevalence of relapses per year)in the observed population is estimated to be 37% of individuals. The researchers recruit a sample of 1,000 individuals, all of whom are at a higher risk of relapse due to recent discontinuation of their treatment. The initial sensitivity of the new speech-based test is found to be 80%. This means that out of those individuals who have relapse, the test correctly identifies 80% as relapsed. However, the specificity of the test is very high, indicating that it accurately identifies individuals without relapse as negative. Using the collected data, the research team wants to assess how an increase in sensitivity of the speech test might impact various statistical measures, including Positive Predictive Value (PPV), Negative Predictive Value (NPV), and statistical power of studies that employ this speech test to select patients that are relapsing. They plan to use a machine learning approach that increases the sensitivity of their test notably, increasing the test’s clinical utility and its potential to detect relapse more effectively. When the sensitivity of a test increases…

What minimizes type 2 error?

In which of the following scenarios is it more appropriate to use the McNemar test instead of the chi-square test?

In a longitudinal study assessing the progression of amnestic mild cognitive impairment (MCI) in older adults, subjects were randomized to receive either lithium or a placebo. Over the study period, clinical assessments were conducted to evaluate the therapeutic impact of lithium on cognitive stability and conversion to dementia. Based on the neuroprotective properties of lithium, which of the following outcomes would most likely be observed in the lithium-treated group compared to the placebo group?

A Kaplan-Meier survival analysis was employed in a clinical study to compare the progression of amnestic mild cognitive impairment (MCI) to dementia in older adults treated with lithium versus a placebo. The survival curve was used to illustrate the probability of remaining free from dementia over time. If the Kaplan-Meier curve for the lithium group shows a slower decline towards the endpoint of dementia compared to the placebo group, what could be inferred about the efficacy of lithium based on this analysis?

In a clinical study assessing the long-term effects of lithium in patients with amnestic mild cognitive impairment (MCI), researchers conducted a Kaplan-Meier survival analysis to determine the rate of conversion to dementia. The study found that the lithium-treated group had a marginally statistically significant reduction in the risk of conversion to dementia over the placebo group. What does the term “marginal statistical significance” imply about the study’s findings regarding lithium treatment?

In a Kaplan-Meier survival analysis, a chi-square test has been conducted with degree of freedom being 1. What does this degree of freedom represent?

Low physical activity and sedentary behaviour significantly impact the mental health and overall health of individuals with schizophrenia. A research study [Pieters LE, et al. Schizophrenia Bulletin. 2021 Jul 1;47(4):906-14] explored the connection between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and physical activity in 216 schizophrenia patients. Adult patients who lived at long-term mental healthcare units for more than 1 year or sheltered housing facilities of a mental health care institution were included, if they had at least 3 days of actigraphy data for 6hrs/day and validated measures of extrapyramidal symptoms and psychopathology at the same time. To investigate the statistical relationship between movement disorders and actigraphy data the authors performed multiple linear regression analysis. Parkinsonism was significantly associated with decreased physical activity (β = -0.21, P < .01) and increased sedentary behaviour (β = 0.26, P < .001). For dystonia, only the relationship with sedentary behaviour was significant (β = 0.15, P < .05). Akathisia was associated with more physical activity (β = 0.14, P < .05) and less sedentary behaviour (β = -0.15, P < .05). For dyskinesia, the relationships were nonsignificant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted physical activity (F(5,209) = 16.6, P < .001, R-squared adjusted = 0.27) and sedentary behaviour (F(4,210) = 13.4, P < .001, R-squared adjusted = 0.19). What is the most likely study design employed here?

Low physical activity and sedentary behaviour significantly impact the mental health and overall health of individuals with schizophrenia. A research study explored the connection between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and physical activity in 216 schizophrenia patients. Adult patients who lived at long-term mental healthcare units for more than 1 year or sheltered housing facilities of a mental health care institution were included, if they had at least 3 days of actigraphy data for 6hrs/day and validated measures of extrapyramidal symptoms and psychopathology at the same time. To investigate the statistical relationship between movement disorders and actigraphy data the authors performed multiple linear regression analysis. Parkinsonism was significantly associated with decreased physical activity (β = -0.21, P < .01) and increased sedentary behaviour (β = 0.26, P < .001). For dystonia, only the relationship with sedentary behaviour was significant (β = 0.15, P < .05). Akathisia was associated with more physical activity (β = 0.14, P < .05) and less sedentary behaviour (β = -0.15, P < .05). For dyskinesia, the relationships were nonsignificant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted physical activity (F(5,209) = 16.6, P < .001, R-squared adjusted = 0.27) and sedentary behaviour (F(4,210) = 13.4, P < .001, R-squared adjusted = 0.19). In the above question, what does R-squared refer to?

Low physical activity and sedentary behaviour significantly impact the mental health and overall health of individuals with schizophrenia. A research study explored the connection between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and physical activity in 216 schizophrenia patients. Adult patients who lived at long-term mental healthcare units for more than 1 year or sheltered housing facilities of a mental health care institution were included, if they had at least 3 days of actigraphy data for 6hrs/day and validated measures of extrapyramidal symptoms and psychopathology at the same time. To investigate the statistical relationship between movement disorders and actigraphy data the authors performed multiple linear regression analysis. Parkinsonism was significantly associated with decreased physical activity (β = -0.21, P < .01) and increased sedentary behaviour (β = 0.26, P < .001). For dystonia, only the relationship with sedentary behaviour was significant (β = 0.15, P < .05). Akathisia was associated with more physical activity (β = 0.14, P < .05) and less sedentary behaviour (β = -0.15, P < .05). For dyskinesia, the relationships were nonsignificant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted physical activity (F(5,209) = 16.6, P < .001, R-squared adjusted = 0.27) and sedentary behaviour (F(4,210) = 13.4, P < .001, R-squared adjusted = 0.19). What can you conclude from this study?

A cross-sectional study examined the relationship between dietary fiber intake and mental health in a large population of adults, using a cross-sectional study among 3,362 Iranian adults working in 50 health centers. After adjustment for potential confounders, participants in the top quartile of total dietary fiber intake had a 33% and 29% lower risk of anxiety and high psychological distress [odds ratio (OR): 0.67; 95% CI: 0.48, 0.95 and OR: 0.71; 95% CI: 0.53, 0.94, respectively] compared to the bottom quartile of intake. The highest total dietary fiber intake was also inversely related to a lower risk of depression in women (OR: 0.63; 95% CI: 0.45, 0.88) but not in men. Among overweight or obese participants, higher intake of dietary fiber was related to a decreased risk of high psychological distress (OR: 0.52; 95% CI: 0.34, 0.79). A high level of dietary fiber intake was related to a lower risk of anxiety in normal-weight individuals (OR: 0.50; 95% CI: 0.31, 0.80). These results highlight the presence of significant inverse associations between total dietary fiber intake with anxiety and high psychological distress. What is the single most important factor that will enable you to establish a causal factor between the dietary fiber and psychiatric outcomes?

Long-term use of antipsychotics that increase prolactin levels is associated with an elevated risk of breast cancer. After a review of longitudinal studies over a 5-year period, researchers found that certain antipsychotics with high prolactin-elevating potential contribute to this risk. Which of the following mechanisms most likely explains why antipsychotics that elevate prolactin levels are linked to an increased risk of breast cancer?

A 2021 study examined Finland’s health databases to investigate the association between prolactin increasing antipsychotic use in women with schizophrenia and breast cancer risk, while considering established risk factors. Using a case-control design within a patient cohort, the study included women diagnosed with schizophrenia or schizoaffective disorder between 1972 and 2014. “Cases” were those diagnosed with breast cancer from 2000 to 2017, matched with “controls” without breast cancer in this patient cohort. Both groups had a history of inpatient mental health care, and matching considered age and time since schizophrenia diagnosis. 1,069 women were identified as breast cancer cases and matched with 5,339 controls. In the context of the information presented here, which of the following descriptions captures the 5,339 individuals defined as “controls”?

In epidemiological studies, researchers often use statistical methods to estimate the relationship between an exposure and an outcome. When studying the association between smoking and lung cancer, researchers calculated both adjusted and unadjusted odds ratios (ORs). If the unadjusted OR was 2.5 and the adjusted OR, after controlling for age, sex, and occupational exposure to carcinogens, was 1.8, what does the difference between these odds ratios suggest about the relationship between smoking and lung cancer?

A research study based on the QResearch primary care database used by UK general practices aimed to investigate associations between different antidepressant treatments and the incidence of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in individuals diagnosed with depression. The study included 238,963 patients aged 20 to 64 years with an initial diagnosis of depression between January 1, 2000, and July 31, 2011. The research assessed various factors, including antidepressant class, dose, duration of use, and individual antidepressant drugs. Cox proportional hazards models were used to estimate hazard ratios while adjusting for potential confounding variables. The results indicated that there were no significant associations between antidepressant class and myocardial infarction over five years of follow-up. However, during the first year of follow up, patients treated with selective serotonin reuptake inhibitors had a significantly reduced risk of myocardial infarction (adjusted hazard ratio 0.58, 95% confidence interval 0.42 to 0.79) compared with no use of antidepressants, particularly fluoxetine (0.44, 0.27 to 0.72). Lofepramine, on the other hand, was associated with an increased risk (3.07, 1.50 to 6.26). No significant associations were found between antidepressant class or individual drugs and the risk of stroke or transient ischaemic attack. Antidepressant class was not significantly associated with arrhythmia, although there was an increased risk during the first 28 days of treatment with tricyclic and related antidepressants (adjusted hazard ratio 1.99, 1.27 to 3.13). Fluoxetine was associated with a reduced risk of arrhythmia over five years (0.74, 0.59 to 0.92), while citalopram was not significantly associated with arrhythmia risk, even at high doses (1.11, 0.72 to 1.71 for doses =40 mg/day). What type of study design was employed in this research?

A research study based on the QResearch primary care database used by UK general practices aimed to investigate associations between different antidepressant treatments and the incidence of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in individuals diagnosed with depression. The study included 238,963 patients aged 20 to 64 years with an initial diagnosis of depression between January 1, 2000, and July 31, 2011. The research assessed various factors, including antidepressant class, dose, duration of use, and individual antidepressant drugs. Cox proportional hazards models were used to estimate hazard ratios while adjusting for potential confounding variables. The results indicated that there were no significant associations between antidepressant class and myocardial infarction over five years of follow-up. However, during the first year of follow up, patients treated with selective serotonin reuptake inhibitors had a significantly reduced risk of myocardial infarction (adjusted hazard ratio 0.58, 95% confidence interval 0.42 to 0.79) compared with no use of antidepressants, particularly fluoxetine (0.44, 0.27 to 0.72). Lofepramine, on the other hand, was associated with an increased risk (3.07, 1.50 to 6.26). No significant associations were found between antidepressant class or individual drugs and the risk of stroke or transient ischaemic attack. Antidepressant class was not significantly associated with arrhythmia, although there was an increased risk during the first 28 days of treatment with tricyclic and related antidepressants (adjusted hazard ratio 1.99, 1.27 to 3.13). Fluoxetine was associated with a reduced risk of arrhythmia over five years (0.74, 0.59 to 0.92), while citalopram was not significantly associated with arrhythmia risk, even at high doses (1.11, 0.72 to 1.71 for doses =40 mg/day). One of your patients who come across this study asks you if this means that fluoxetine does not cause adverse cardiovascular events in those with depression. What issue pertaining to the study design in this research limits your ability to endorse her statement?

A research study based on the QResearch primary care database used by UK general practices aimed to investigate associations between different antidepressant treatments and the incidence of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in individuals diagnosed with depression. The study included 238,963 patients aged 20 to 64 years with an initial diagnosis of depression between January 1, 2000, and July 31, 2011. The research assessed various factors, including antidepressant class, dose, duration of use, and individual antidepressant drugs. Cox proportional hazards models were used to estimate hazard ratios while adjusting for potential confounding variables. The results indicated that there were no significant associations between antidepressant class and myocardial infarction over five years of follow-up. However, during the first year of follow up, patients treated with selective serotonin reuptake inhibitors had a significantly reduced risk of myocardial infarction (adjusted hazard ratio 0.58, 95% confidence interval 0.42 to 0.79) compared with no use of antidepressants, particularly fluoxetine (0.44, 0.27 to 0.72). Lofepramine, on the other hand, was associated with an increased risk (3.07, 1.50 to 6.26). Fluoxetine was associated with a reduced risk of arrhythmia over five years (0.74, 0.59 to 0.92), while citalopram was not significantly associated with arrhythmia risk, even at high doses (1.11, 0.72 to 1.71 for doses =40 mg/day). What can be concluded regarding the risk of arrhythmia associated with citalopram use at high doses?

A research study based on the QResearch primary care database used by UK general practices aimed to investigate associations between different antidepressant treatments and the incidence of three cardiovascular outcomes (myocardial infarction, stroke or transient ischaemic attack, and arrhythmia) in individuals diagnosed with depression. The study included 238,963 patients aged 20 to 64 years with an initial diagnosis of depression between January 1, 2000, and July 31, 2011. The research assessed various factors, including antidepressant class, dose, duration of use, and individual antidepressant drugs. Cox proportional hazards models were used to estimate hazard ratios while adjusting for potential confounding variables. The results indicated that there were no significant associations between antidepressant class and myocardial infarction over five years of follow-up. However, during the first year of follow up, patients treated with selective serotonin reuptake inhibitors had a significantly reduced risk of myocardial infarction (adjusted hazard ratio 0.58, 95% confidence interval 0.42 to 0.79) compared with no use of antidepressants, particularly fluoxetine (0.44, 0.27 to 0.72). Lofepramine, on the other hand, was associated with an increased risk (3.07, 1.50 to 6.26). No significant associations were found between antidepressant class or individual drugs and the risk of stroke or transient ischaemic attack. Antidepressant class was not significantly associated with arrhythmia, although there was an increased risk during the first 28 days of treatment with tricyclic and related antidepressants (adjusted hazard ratio 1.99, 1.27 to 3.13). Fluoxetine was associated with a reduced risk of arrhythmia over five years (0.74, 0.59 to 0.92), while citalopram was not significantly associated with arrhythmia risk, even at high doses (1.11, 0.72 to 1.71 for doses =40 mg/day). Which of the following conclusions is valid?

What statistical test is most appropriate for analyzing the relationship between PANSS item P2 scores (conceptual disorganisation) and Thought and Language Index scale scores (positive and negative formal thought disorder) in a clinical research study?

You are conducting a study to understand the relationship between cortisol levels in saliva and melatonin levels in a help-seeking adolescent population. You recruit a group of participants and collect morning salivary levels for both hormones. What statistical test is most appropriate for analyzing the relationship between these two measures?

In a research study examining the relationship between daily screen time (hours) and sleep quality (scored on a scale from 1 to 10), data from 200 participants are plotted on a scatterplot. What key insight can a scatterplot provide about the relationship between daily screen time and sleep quality?

Researchers used mediation analysis to explore how clozapine impacts motivation and pleasure (MAP) in patients with schizophrenia, specifically investigating whether changes in daytime sedation act as a mediator. Given this focus, which of the following outcomes from the study is most likely to explain the mechanism by which clozapine influences MAP?

In research, understanding the mechanisms through which independent variables influence dependent variables is crucial. Mediation analysis is often employed to elucidate these pathways. Which of the following research scenarios correctly illustrates the application of mediation analysis?

To understand the relationship between childhood traumatic experiences and the sensory complexity of hallucinations, a cohort of 75 children and adolescents seeking help for hallucinations were studied. To determine the extent by which the various sensory modalities could predict the probability of a previous early trauma, the authors employed a hierarchical binomial logistic regression with history of childhood trauma as the binary dependent variable with control variables (i.e., age, educational level and number of ICD-10 diagnoses, the presence of suicidal ideation), and the number of hallucinatory modalities as predictors. The number of hallucinatory modalities appeared to be the only significant predictor of childhood trauma (estimate (i.e. the log odds of ‘history of childhood trauma’ = 1 v. 0) 0.81, s.e. = 0.34, z = 2.39, P = 0.017, OR = 2.24 (95% CI 1.16–4.33). The predictor that emerged as statistically significant variable is most likely a/an?

In a statistical analysis, researchers often visualize their results with graphs, one of which may include the use of shaded areas around a line in a plot. When observing a graph where the shaded area around a line represents confidence intervals, what does this shaded area primarily indicate?

In the context of statistical analysis, recognizing different types of regression plots can be critical for accurate interpretation of data. When examining a plot intended to represent a logistic regression analysis, which characteristic feature should you look for to identify it correctly?

To understand the relationship between childhood traumatic experiences and the sensory complexity of hallucinations, a cohort of 75 children and adolescents seeking help for hallucinations were studied. To determine the extent by which the various sensory modalities could predict the probability of a previous early trauma, the authors employed a hierarchical binomial logistic regression with history of childhood trauma as the binary dependent variable with control variables (i.e., age, educational level and number of ICD-10 diagnoses, the presence of suicidal ideation), and the number of hallucinatory modalities as predictors. The number of hallucinatory modalities appeared to be the only significant predictor of childhood trauma (estimate (i.e. the log odds of ‘history of childhood trauma’ = 1 v. 0) 0.81, s.e. = 0.34, z = 2.39, p = 0.017, OR = 2.24 (95% CI 1.16–4.33). The term ‘p’ most likely refers to which of the following?

When conducting qualitative research, a researcher makes active attempts to withhold her biases and individual ideas regarding the phenomena of interest. This is known as…

The Declaration of Helsinki is a set of ethical guidelines relating to which of the following?

A recent clinical study explored the relationship between clozapine dosage and motivation levels in patients with treatment-resistant schizophrenia, after controlling for the sedative effects of the medication. What conclusion will most likely be drawn from the results of this study?

In ICD-11, which of the following are trait domain qualifiers that may be applied to personality disorders or personality difficulty?

In ICD-11, which of the following differentiates anorexia nervosa from bulimia nervosa?

In the UK, what is the most common type of mental disorder in patients on mental health rehabilitation units?

The male to female ratio of the prevalence of obsessive-compulsive disorder (OCD) in adults is approximately

What is the most common mental disorder in stalking offenders?

Which of the following behaviours is most unlikely to be involved in factitious disorder?

What is the likelihood of an individual completing suicide within two years following an initial act of deliberate self-harm?

Research has shown that individuals with schizophrenia have an increased risk of mortality compared to the general population. What factors are primarily responsible for this elevated mortality risk in schizophrenia patients?

Which of the following most increases the risk of reoffending in indecent exposure offenders?

In the UK, which of the following is characterised by a pattern of acts of assaults, threats, humiliation, degradation, and intimidation that is used to harm, punish, isolate, and/or frighten a victim?

Of the following, which is the most likely to be seen in malingering or feigning, as opposed to a case of PTSD?

What neuroimaging finding is most common in individuals with both Down syndrome and Alzheimer dementia?

Psychosis is seen in what percentage of people with Fragile X syndrome?

What type of Down syndrome is inherited?

Which of the following is most likely to be seen in the neonate if paroxetine is taken by the mother late in pregnancy?

A 62-year-old man has a 1-year history of rigidity and difficulty with his gait, with the recent development of fluctuating cognitive impairment. He also reports seeing intruders in his apartment and is suspicious that one of them has replaced his son. Which of the following is the most likely cause of his presentation?

A 68-year-old woman who has been taking flupenthixol and procyclidine for 20 years develops moderate tardive dyskinesia (TD). Which of the following is the only licensed treatment for moderate to severe TD in the UK?

Which of the following tests is most likely to be useful in the identification of Korsakoff syndrome?

While taking a dopamine agonist for the treatment of Parkinson disease, a patient develops psychosis. Which of the following should be the first step with respect to medication management?

How much higher is the risk of dementia at 85 years of age, compared to 65 years of age?

Which of the following are included in the pre-treatment stage of dialectical behaviour therapy (DBT)?

Which of the following is considered a primitive defence mechanism?

Which of the following is considered the first stage of cognitive analytic therapy?

Which of the following types of family therapy introduced the concepts of re-framing and hypothesising?

Approximateley 24 hours after birth, a baby is irritable with high-pitched crying. The infant is also noted to be jittery and excessively wakeful. Which of the following substances is the mother most likely to be abusing?

For what duration are amphetamines usually detectable in the urine?

A 15-year-old adolescent is seen in an outpatient clinic and diagnosed with mild depression. Which of the following would be the most appropriate first line of management?

In the management of oppositional defiant disorder, which of the following is a model of parent management training that is effective with adolescents as well as younger children?

On receiver-operating characteristic (ROC) curves, which of the following screening tests has the best cut-off for identifying at-risk drinkers?

A man in his early thirties takes an overdose of prescribed medication and presents with altered consciousness and seizures. Which of the following is he most likely to have taken?

According to NICE guidelines, what is the youngest age that a child that may be considered for antidepressant treatment of depression?

According to ICD-11, in order to diagnose a child with autism spectrum disorder, they must have demonstrated developmental issues prior to what age?

A 17-year-old girl presents with recurrent episodes of overeating and loss of control over food consumption. She has recently gained weight and her BMI is 27. She is interested in psychological therapies. Which of the following is a first-line treatment for her condition?

Which of the following is a pre-requisite for providing a psychiatric report in criminal proceedings?

The prevalence of depression in older adults living in institutions is…

Which of the following is true regarding the progression of mild cognitive impairment (MCI) to dementia?

Which of the following is characteristic of late-onset schizophrenia (LOS) and very-late-onset schizophrenia-like psychosis (VLOS), as compared to early-onset schizophrenia (EOS)?

Which of the following personality disorders is associated with death by suicide in older adults?

Most of the heritability in frontotemporal dementia is accounted for by what type of mutations?

What is the most important indicator of cognitive performance in depression?

Compared to the depression of younger adults, which of the following responds less well to antidepressants?

An 80-year-old man with late-onset psychosis has a history of falls due to postural hypotension. Which of the following drugs is most likely to cause orthostatic hypotension?

A 60-year-old man with Parkinson disease and depression starts spending large amounts of money on gambling. His distressed wife reports that in the past, he only gambled on occasion, and never spent much money at all. Which of the following drugs is most likely to account for his current presentation

Overall, what percentage of Alzheimer disease patients carry an APOE4 allele?

For the past 5 months, a 78-year-old man with dementia has displayed agitation and behavioural problems. He has been taking risperidone 1mg twice a day for the past few months. In addition, he was prescribed citalopram 20mg a few days ago. His behavioural problems and agitation are unchanged. What should be the next step in his management?

In large epidemiological studies, which of the following is the biggest modifiable risk factor in later life contributing to population attributable risk (PAR) for dementia?

Which of the following is an irreversible cause of dementia?

A 75-year-old man presents with a triad of cognitive impairment, urinary incontinence, and gait disturbance. His symptoms have progressively worsened over the past year. Neuroimaging is ordered to evaluate for normal pressure hydrocephalus (NPH). Which of the following neuroimaging findings is most consistent with a diagnosis of normal pressure hydrocephalus?

A 68-year-old woman presents with progressive memory loss and difficulty finding words. Her family reports that she is increasingly forgetful, often misplacing items and repeating herself. A neuropsychological evaluation confirms the presence of significant cognitive decline. Neuroimaging is ordered to evaluate for Alzheimer’s disease (AD). Which of the following neuroimaging findings is most consistent with a diagnosis of Alzheimer’s disease?

A 70-year-old man presents with fluctuating cognitive impairment, visual hallucinations, and parkinsonism. He has a history of acting out his dreams (REM sleep behavior disorder). Neuroimaging is ordered to evaluate for dementia with Lewy bodies (DLB). Which of the following neuroimaging findings is most consistent with a diagnosis of dementia with Lewy bodies?

A 45-year-old woman presents with progressive involuntary movements, personality changes, and cognitive decline. She reports a family history of similar symptoms affecting her mother. Genetic testing confirms a diagnosis of Huntington’s disease (HD). Which of the following neuroimaging findings is most consistent with a diagnosis of Huntington’s disease?

A 65-year-old man presents with progressive bradykinesia, resting tremor, and rigidity. He also reports a history of REM sleep behavior disorder (RBD) and mild cognitive impairment. Neuroimaging is ordered to evaluate for Parkinson’s disease. Which of the following neuroimaging findings is most consistent with a diagnosis of Parkinson’s disease?

A 19-year-old male who has been identified as having an “at-risk mental state” for psychosis is offered Cognitive Behavioural Therapy (CBT) as part of a prevention strategy. What type of preventative method is this?

A school program is implemented to provide educational and support services to low-income families to reduce the risk factors associated with mental health problems in children. What type of preventative method is this?

A one-day school-wide retreat program is designed to prevent bullying among students. What type of preventative method is this?

A 35-year-old patient with treatment-resistant schizophrenia is taking clozapine and has gained substantial weight over the past six months. His current BMI is 33 kg/m², and he is concerned about further weight gain. Which of the following medications should be added to his treatment regimen to address weight gain?

A 45-year-old man with schizophrenia and diabetes develops subjective restlessness in his legs after being started on risperidone. He finds it difficult to sit still and often paces around the room. Which of the following medications should be added to his treatment regimen to address this side effect?

A 30-year-old man with schizophrenia is receiving treatment with olanzapine. He reports drooling and tightening of the facial muscles, particularly at night. Which of the following medications should be added to his treatment regimen to address these side effects?

A 60-year-old woman with longstanding schizophrenia has been taking antipsychotic medications for over 20 years. Recently, she developed involuntary, repetitive movements of her tongue and lips. Which of the following medications should be added to her treatment regimen to address these symptoms?

Patients with bipolar I disorder who have attempted suicide are offered lithium with the aim of preventing further suicide attempts. What type of preventative method is this?

A suicide helpline is established and advertised to the general public. What type of preventative method is this?

A 1-year-old child presents with a cleft palate and delayed milestones. The child has a history of in utero exposure to an antiepileptic medication. Which of the following medications is most likely responsible for this presentation?

A 10-year-old child presents with hyperactivity and distinct facial features, including small eye fissures, an underdeveloped philtrum, and a thin upper lip. Which of the following substances is most likely responsible for this presentation?

A newborn is jittery, has increased muscle tone, and is tachypnoeic two hours after delivery. The mother has a history of polysubstance abuse. Which of the following substances is most likely responsible for the newborn’s symptoms?

A woman comes to the clinic at the insistence of her new partner who is concerned that the woman has been rapidly fired from several jobs. During the appointment, the woman is easily distracted, constantly on her phone, says she doesn’t care about those “boring” jobs, and impulsively books an expensive flight for an international holiday. Which of the following ICD-11 personality disorder trait qualifiers is most appropriate for this case?

A reserved 45-year-old man lives with his mother and spends most of his time on the computer. He works from home and seldom leaves the house. He has never had an intimate relationship and has no friends. Which of the following ICD-11 personality disorder trait qualifiers is most appropriate for this case?

A 48-year-old man enjoys making denigrating comments about those around him. He believes that he is very smart and savvy, and “collects” young women on social media who seem to admire him. Though he portrays himself as caring, he takes pleasure in inflicting harm and can quickly become violent. Which of the following ICD-11 personality disorder trait qualifiers is most appropriate for this case?

A 46-year-old woman works long hours at the office every day, redoing the tasks of others because they do not meet her high standards. She stubbornly insists on following set schedules, even when unforeseen circumstances arise. Which of the following ICD-11 personality disorder trait qualifiers is most appropriate for this case?

A 38-year-old man is almost always anxious and pessimistic. He has a strong tendency to ruminate about his past mistakes, as well as potential future problems. He frequently gets upset in meetings and usually needs to leave the room to calm down. Which of the following ICD-11 personality disorder trait qualifiers is most appropriate for this case?

A 28-year-old woman engages in repetitive self-harm. She has had many boyfriends, but the relationships have been brief and have usually ended in screaming fights. In times of stress, she dissociates and experiences brief hallucinations. Which of the following ICD-11 personality disorder trait qualifiers is most appropriate for this case?

Which of the following definitions best describes the term “actus reus” in forensic psychiatry?

Which of the following definitions best describes the term “mens rea” in forensic psychiatry?

Which of the following definitions best describes the term “culpable homicide” in forensic psychiatry?

Which of the following definitions best describes the term “involuntary” in forensic psychiatry?

Which of the following definitions best describes the term “indictable offence” in forensic psychiatry?

Which of the following statistical concepts best describes the probability of making an incorrect rejection of a null hypothesis when it is true?

Which of the following statistical concepts best describes the probability of correctly detecting a true effect or difference in a study?

Which of the following statistical concepts best describes the level of statistical significance used to determine whether to reject the null hypothesis?

Which of the following statistical concepts best describes the probability of failing to detect a true effect or difference when it exists?

Which of the following statistical concepts best describes a measure of the likelihood that the results of a study occurred by chance?

You are conducting an economic study comparing the cost-effectiveness of medication-based treatment to non-medication-based treatment (residential care in a therapeutic open community) for chronic PTSD. Which of the following statistical concepts best describes the additional cost incurred for the medication-based treatment over the non-medication-based treatment?

A junior doctor is temporarily reassigned to the therapeutic open community unit that is providing non-medication-based treatment. As this unit is at a geographically distant location, the hospital is paying for the commuting expenses of the doctor. Which cost concept best represents the financial impact of this process?

Patients receiving therapeutic open community care are required to be absent from work due to the need for residential stay, resulting in a loss of productivity and wages. What type of cost is associated with the days lost to sickness?

During the trial, patients who receive medications that result in excessive sleep report being stigmatised by their family members for being inactive. Some of them find this distressing and believe that this contributes to difficulties in making living arrangements. What type of cost is associated with this phenomenon?

In a research study comparing rTMS and ECT for the treatment of major depressive disorder (MDD), the response rates in each treatment arm are provided to calculate the treatment effect. Response rate in rTMS group: 60%; response rate in ECT group: 75%. What is the difference in risk of achieving treatment response between the two treatment groups, expressed as an absolute percentage?

In a research study comparing rTMS and ECT for the treatment of major depressive disorder (MDD), the response rates in each treatment arm are provided to calculate the treatment effect. Response rate in rTMS group: 60%; response rate in ECT group: 75%. What is the number of patients needed to be treated with ECT over rTMS to achieve one additional treatment response?

In a research study comparing rTMS and ECT for the treatment of major depressive disorder (MDD), the response rates in each treatment arm are provided to calculate the treatment effect. Response rate in rTMS group: 60%; response rate in ECT group: 75%. What is the measure of the likelihood of achieving treatment response with ECT compared to rTMS, based on response rates?

In a dataset consisting of the following values: 25, 26, 36, 42, 31, 25, 36, 53, what is the standard deviation (SD)?

In a meta-analysis investigating the effectiveness of a particular intervention across multiple studies, a forest plot is generated to visualize the results. The heterogeneity between studies is an important consideration. What statistical measure is commonly used to quantify heterogeneity in a forest plot?

In a forest plot displaying results from a meta-analysis investigating the association between a specific exposure and a disease outcome, what does an odds ratio (OR) greater than 1 indicate?

In a clinical trial investigating the survival outcomes of two treatment groups, a Kaplan-Meier curve is generated to visualize the survival probabilities over time. What does the intersection of two survival curves on a Kaplan-Meier plot typically indicate?

In a study investigating the impact of treatment on survival outcomes in patients with cancer, researchers performed Cox proportional hazards analysis. What does a hazard ratio (HR) of 0.75 indicate in this context?

In a systematic literature review focused on the environmental impact of plastic pollution, a researcher wants to include grey literature sources. Which database is most appropriate for accessing grey literature in this context?

A researcher is conducting a systematic review on the effectiveness of mindfulness-based interventions for reducing anxiety symptoms. Which of the following Boolean operators should the researcher use to ensure relevant search results?

In a study investigating the association between smartphone usage and sleep quality, participants are recruited from a university campus. The recruitment method involves posting flyers in dormitories and classrooms. Which of the following statements best describes the potential selection bias in this study?

In a study investigating the relationship between coffee consumption and the risk of heart disease, researchers find a strong association between high coffee intake and increased risk of heart disease. However, upon further analysis, they discover that individuals who consume large amounts of coffee also tend to smoke cigarettes regularly. Which of the following statements best describes the role of smoking in this scenario?

In a hospital-based case-control study investigating the association between diabetes mellitus (DM) and coronary artery disease (CAD), researchers recruit participants from two groups: patients diagnosed with DM and patients diagnosed with CAD. Which of the following statements best describes the phenomenon of Berkson bias in this study?

In a clinical trial comparing the effectiveness of two treatments for hypertension, Treatment A and Treatment B, the following outcomes are observed:

• Treatment A: 100 out of 500 patients experience a reduction in blood pressure.
• Treatment B: 150 out of 500 patients experience a reduction in blood pressure.

Which of the following statements correctly describes the calculation of the Absolute Risk Reduction (ARR) for Treatment B compared to Treatment A?

In a study comparing the effectiveness of two treatments for depression, Treatment A and Treatment B, the following results were obtained:
Treatment A:
– Number of patients who experienced remission: 50
– Number of patients who did not experience remission: 150

Treatment B:
– Number of patients who experienced remission: 70
– Number of patients who did not experience remission: 130

Calculate the Odds Ratio (OR) for Treatment B compared to Treatment A?

In a randomized controlled trial investigating the efficacy of a new drug for hypertension, a CONSORT diagram is utilized to depict the flow of participants throughout the study. What does the CONSORT diagram primarily illustrate?

In the context of a systematic review assessing the efficacy of various interventions across multiple studies, which statistical concept is crucial for summarizing the strength and direction of the effects observed, thereby facilitating a standardized comparison irrespective of the units of measurement used in the individual studies?

In healthcare quality improvement, what does the audit cycle primarily involve?

In evidence-based medicine, what does the hierarchy of evidence primarily describe with regards to research study designs and their contribution to the strength of evidence?

In the context of measurement and data analysis, what is the primary distinction between precision and accuracy?

A research team is investigating the link between a new pharmaceutical drug and the reduction of chronic pain. In their study, they compare a treatment group taking the new drug with a placebo group. However, during data collection, it is noted that participants in the treatment group receive additional physiotherapy services not received by those in the placebo group. Which type of systematic error is most likely to occur due to this discrepancy?