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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 by early fatalities or silent cases. It results from missed cases being omitted from calculations. 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 the exposure but has no causative role. A well known example is carrying matches and lung cancer. People who have lung cancer are more likely to smoke and therefore more likely to carry matches, but carrying matches does not cause lung cancer. Confounding can be addressed in the design and analysis stage of a study. The main method 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) A form of bias that occurs when measurement of information differs among study groups examples include recall bias, reporting bias, diagnostic bias, and Hawthorne effect, errors in measurement

Information bias

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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. Only a problem in non-blinded trials. Observers may subconsciously measure or report data in a way that favours the expected study outcome

Expectation bias

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's problems 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 and counter-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 been projected 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 traumafocused psychological therapy. Drug treatments (paroxetine or mirtazapine for general use, 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 in almost anyone. The event must be persistently remembered or relived, as evidenced by flashbacks, 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 watchful waiting should be considered (follow up given within 1 month) All people with PTSD should be offered a course trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). Drug treatments for PTSD should not be used as a routine first-line treatment for adults in preference to a trauma-focused psychological therapy. Drug treatments (paroxetine or mirtazapine for general use, 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.

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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 Sertraline, paroxetine

Antidepressants Fluoxetine, amitriptyline, imipramine, (avoid paroxetine) Antipsychotics Olanzapine, haloperidol, clozapine, chlorpromazine Avoid if possible

Olanzapine, sulpride

Mood stabilisers Sedatives

Avoid if possible and use antipsychotics instead. Valproate is recommended if essential For anxiety - Lorazepam For insomnia - Zolpidem

Promethazine

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 can be conceptualised as serotonin toxicity. It is characterized by the triad of neuromuscular abnormalities (myoclonus, and clonus), altered mental state, and autonomic dysfunction. The clinical picture ranges from mild agitation and tremor to extreme muscle rigidity with hyperthermia that demands immediate intervention. Analysis of a series of cases found 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 is typically acute and rapidly progressive, following shortly after one or two doses of the offending medication. The most frequent cause of severe reaction is the co-administration of an MAOI with a SSRI. 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 only require benzodiazepines and fluids but more severe cases can require an intensive care environment. Neuroleptic malignant syndrome (NMS) NMS is not fully understood. There is some agreement however that it probably results from the result of dopamine blockade at the hypothalamus which messes up the thermoregulatory system and hence results in hyperthermia (a core feature). It is also suggested that the use of antipsychotics (neuroleptics) causes calcium uptake into muscles resulting in muscle rigidity (another core feature, lead pipe rigidity) which results in rhabdomyolysis and so elevated levels of creatinine phosphokinase (CPK). It is almost exclusively caused by antipsychotics (but is also associated with antidepressants and lithium). Rapid and large dose increases often trigger it, along with rapid dose reductions, and abrupt withdrawal of anticholinergics. It typically develops within 2 weeks of initial treatment but may occur at any time the drug is being taken. It can also be precipitated by agitation and/or dehydration. Treatment is not always necessary. The first step is removal of the antipsychotic and the treatment of fever in addition to the use of a benzodiazepine. Other options which may be necessary 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 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) The following table shows the current Maudsley guidelines on prescribing in pregnancy and breastfeeding.
Drug class Suggested in pregnancy Suggested in breastfeeding Sertraline, paroxetine

Antidepressants Fluoxetine, amitriptyline, imipramine, (avoid paroxetine) Antipsychotics Mood stabilisers Sedatives

Olanzapine, haloperidol, clozapine, Olanzapine, sulpride chlorpromazine Avoid if possible Promethazine Avoid if possible and use antipsychotics instead. Valproate is recommended if essential 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.

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

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 therapies called 'Treatment Choice in Psychological Therapies and Counselling'. It recognised the fact that very few pure forms of therapy existed and instead produced some general evidence based recommendations. Here are the edited highlights. It's worth reading them as you'll find they are the basis of a 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 longer therapies 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 important factors in choice of therapy and should not determine access to therapies Interest in self-exploration and capacity to tolerate frustration in relationships may 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 the natural phases of grief as seen in the table below. He did not specify a time period for each stage and added that people can go backwards and forwards from one stage to another. Normal grief
Phase Features I II III IV Shock and protest - including disbelief Preoccupation - involves yearning and anger Typical time course Few days Few weeks

Disorganisation - includes despair and acceptance of loss Several months 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 Delayed Absence of expected grief symptoms at any stage 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 year following 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 around the 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 is not affected by outliers. To calculate the median, the data set is arranged into numerical order 1 2 4 9 23 and the middle value selected. The mean value is calculated by adding all the values together and dividing by 5 and is equal to 7.8. Stats Measures of central tendency Descriptive statistics are used to describe the basic features of the data in a study. They are typically distinguished from inferential statistics which help to form conclusions beyond 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 Mean The mode is the most frequent value 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 or typical value of a data set depending on the measurement scale.
Measurement scale Categorical Nominal Ordinal Measure of central tendency Mode Mode Median or mode

Interval (Normal distribution) Mean (preferable), median, or mode Interval (Skewed data) Ratio (Normal distribution) Ratio (Skewed data) Median Mean (preferable), median, or mode Median

12) Which of the following is most likely to cause amenorrhoea? A. Quetiapine B. Clozapine C. Olanzapine D. Aripiprazole E. Amisulpride Exam question August 2008 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 occasionally antidepressants). Dopamine inhibits prolactin and so dopamine antagonists increase prolactin 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 in almost anyone. The event must be persistently remembered or relived, as evidenced by flashbacks, 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 watchful waiting should be considered (follow up given within 1 month) All people with PTSD should be offered a course trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). Drug treatments for PTSD should not be used as a routine first-line treatment for adults in preference to a trauma-focused psychological therapy. Drug treatments (paroxetine or mirtazapine for general use, 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.

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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 Exam question August 2008 AUDIT is used in primary care settings as it accurately detects both alcohol dependence and 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 a simple method of screening for excessive drinking. The test consists of 10 questions and attempts 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 indicate alcohol 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 that was 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 1 single spirits If the answer to the first question is 'never' then the patient is not misusing alcohol If the response to the first question is 'Weekly' or 'Daily or almost daily' then the patient 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 problem drinking. The CAGE is a well known but recent research has questioned its value as a screening test two 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 longest amount 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 the following table serves as a rough guide. As a general rule most substances remain positive in the urine for 1-3 days with the exception of heavy users of cannabis who can remain positive for up to 14-28 days.
Drug of abuse Length of time detectable in urine Cannabis Phencyclidine Methadone Morphine Benzodiazepine Heroin Cocaine Amphetamine LSD Codeine Alcohol 14-28 days 8 days 3 days 3 days 3 days 3 days 1-3 days 1-3 days 1-3 days 2 days 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 to have a learning disability (IQ <70). This figure includes 828,000 adults (aged 18 or more). Of these adults, we estimated that 177,000 were known users of learning disability services in England (equivalent to 0.47% of the adult population) People with Learning Disabilities in England. Centre for Disability Reasearch Report 2008 commissioned by Mencap and the Department of Health. The following table illustrates the categories of learning difficulties

IQ 5070 3549

Category Mild learning disability Moderate learning disability

Description Approximately 85% of cases; most can lead normal lives except may need assistance in handling difficult situations Approximately 10% cases; use simple language when talking but understand speech better. Patient can generally attend to the basic tasks of life after training but more complex activities such as using money usually require support within a special residential environment Approximately 3-4% cases: many able to look after themselves with careful supervision

2034

Severe learning disability Profound learning disability

<20

Approximately 1-2% cases: development level of one year old baby across a range of parameters and so require intensive help and supervision in all activities

The preferred term for people with an IQ below 70 is 'people with learning disability'. Bernal J. Psychiatric illness and learning disability: a dual diagnosis. Advances in Psychiatric Treatment (1995), vol.1, pp. 138-14