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Zoran

Unanswered ISQs II

17 posts in this topic

01 Visual hallucinations occur commonly in elderly depressed patients.

02 Blushing is seen in Kretchmer's Sensitiver Beziehungswahn.

03 In cortical blindness, one can still see within the blind spot.

04 Behaviour of others is normally considered dispositional.

05 Increased autonomic activity is present in  ASPD

06 Impulsive offending is seen in borderline PD.

07 Extensive case management as compared to standard case management reduces future hospital admissions.

08 In early onset dementia, progressive agnosia indicates Alzheimer's rather than vascular dementia.

09 Cyclic AMP secreted in the urine in mania.

10 Where work produced by a group is less than the sum of the individuals, decreased rate of work by the individuals is partly to blame.

11 Characteristics of an effective leader include allocation of work.

12 Modern social anthropology is concerned with ontogenic studies.

13 Thioridazine may cause ejaculatory failure.

14 Obsessive thoughts occur in more than 5% of people with Asperger's syndrome.

15 A small initial gain in weight in anorexia nervosa is associated with significant cognitive improvement.

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04. Behaviour of others is normally considered dispositional.    TRUE

This question is probably about the ' Fundamental Attribution Error' (GROSS, Psychology, pg.345):    ::)

The fundamental attribution error (FAE) refers to the general tendency to overestimate the importance of personal/ dispostional factors relative to situational/ environmental factors as causes of behaviour. (Ross, 1977). This will tend to make the others' behaviour seem more predictable which, in turn, enhances our sense of control over the environment.

:)

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15 A small initial gain in weight in anorexia nervosa is associated with significant cognitive improvement. FALSE

No reference for this , sorry, just an educated guess after having worked 6month with adolescents with eating disorders. :-X

Any other thoughts?

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13 Thioridazine may cause ejaculatory failure. TRUE

BNF:

Side effects of Thioridazine: ....., sexual dysfunction, particularly retrograde ejaculation, may occur.

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11 Characteristics of an effective leader include allocation of work. TRUE

The reference is Atkinson and Hilgard, cant remember the page numbers

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9) Li inhibits cAMP production:

Antimanic—Has not been established {57} {58} . The mood-stabilizing effect has been postulated to relate to a reduction of catecholamine neurotransmitter concentration, possibly mediated by lithium ion (Li + ) effect on Na + K + adenosine triphosphatase (Na + K + ATPase) to produce improved transneuronal membrane transport of sodium ion. An alternate postulate is that lithium may decrease cyclic adenosine monophosphate (cyclic AMP) concentrations

so I am guessing false

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7)!!!!!!!!!!!!! i'm verging on false.. what do you think?

The usefulness of intensive case management

The case studies suggested that intensive case management by enabling proactive casework involving action that was sensitive to individual circumstances and that anticipated crises. This helped prevent some significant psychiatric emergencies arising. This approach, which we termed sensitive anticipatory action, appeared to have the most significant impact on the frequency and duration of in-patient admission. Sensitive anticipatory action comprises intensive casework (often with non-symptomatic patients) aimed at promoting engagement; undertaking patient-centred medication review; assessing and responding to social care needs; and developing crisis care plans. Ironically, this was the sort of casework that the standard case management team displaced as a ‘time management’ strategy to practise assertive outreach with non-compliant patients.

The British Journal of Psychiatry (2003) 183: 437-445

© 2003 The Royal College of Psychiatrists

Assessing the value of assertive outreach

Qualitative study of process and outcome generation in the UK700 trial

TIM WEAVER, MSc

HOWEVER-

Cost-effectiveness of intensive v. standard case management for severe psychotic illness

UK700 case management trial

SARAH BYFORD, MSc

Centre for Health Economics, York

As previously reported, there was no difference between intensive and standard groups in terms of the primary outcome measure, days in hospital for psychiatric problems over 24 months (means 73.5 and 73.1 days, difference 0.4 days, 95% CI -17.4-18.1) (UK700 Group: Burns et al, 1999). Nor were there any significant differences in the secondary outcome measures between the intensive and standard groups: mean CPRS scores 18.5 and 18.1 (difference 0.4, 95% CI -1.8-2.7); mean quality of life scores 4.58 and 4.55 (difference 0.04, 95% CI -0.09-0.16); mean number of unmet needs 1.84 and 2.13 (difference -0.29, 95% CI -0.68-0.11); mean DAS total score 1.10 and 1.13 (difference -0.03, 95% CI -0.16-0.10); and mean patient's satisfaction score 16.7 and 17.1 (difference -0.3, 95% CI -1.2 to 0.5).

CLINICAL IMPLICATIONS

No beneficial effects of intensive case management on costs, clinical outcome or cost-effectiveness were observed.

The effect of intensive case management on costs was found to be no different in African-Caribbeans than other ethnic groups, or in the patients with severe disability than moderate disability patients.

The policy of advocating intensive case management for patients with severe psychosis is not supported by the results of this study and needs to be re-examined.

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7)!!!!!!!!!!!!! i'm verging on false.. what do you think?

Who, me? I'm wondering whether that refers to 'Enhanced CPA' as opposed to 'Standard CPA'? Is that what they're getting at? I'll settle for any authoritative answer at this stage really.

I'm sure there's someone out there who actually knows the correct answer. :)

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Hmm I'd go with false as well. Am assuming they are referring to the UK700 trial rather than CPA.

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Modern social anthropology is concerned with ontogenic studies

Am guessing false just going with the defination of Ontogeny-

'a purely biological unfolding of events involved in an organism changing gradually from a simple to a more complex level'

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15. Initial weight gain in AN is associated with cognitive improvemnt. TRUE. Some of the cognitive distorsions seen in AN are due to the effect of starvetion on the brain. The classic study by Key et al (1957; Minnesota Starvation Study) convincinsingly demonstrated this. [Ref: Thambirajah 2005 Psychological basis of psychiatry Churchill Livingstone pp132-33]

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Re: No.15

Thambirajah, you are probably right but the question says ' SIGNIFICANT COGNITIVE IMPROVEMENT'.

I am somewhat reluctant to go fot TRUE and will mark it FALSE.

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Bulimia is associated with increased mortality ?

False

The mortality rates for patients with bulimia nervosa within 2 to 5 years after diagnosis continue to remain at 5%.34 Between 50% and 60% of individuals will demonstrate recovery over this same period of time, with a relapse rate between 30% and 50%.34 In an extensive review of several follow-up studies by Woodside,34

P.749

2 years after treatment, 20% to 25% of individuals were well, 10% to 15% had minor recurrent difficulties, 15% had major recurrent difficulties, 15% were chronically ill, and 20% to 25% had fully relapsed. In one large study, 6 years after successful treatment, 60% of patients demonstrated a good, 29% an intermediate, and 10% a poor outcome, and 1% had died.30 The most prominent factor associated with failure to remain well was concomitant alcohol or drug use.34

Morbidity and mortality from anorexia nervosa remain significant. Earlier mortality rates in the 5% to 10% range have now been demonstrated to represent an early mortality of 5% and a late mortality that may be as high as 13% to 20%.34 Suicide remains the No. 1 cause of death, followed by cardiac arrhythmias, infections, gastrointestinal complications, and emaciation.38 In a longitudinal study, rates of death were 10 times and rates of suicide 58 times those expected after 11 years.44 Morbidity rates are estimated to be 25%, with morbidity reflecting the multiple organ system dysfunctions associated with starvation.45 The most common of these include osteoporosis, renal insufficiency, and infections.38

Text book of Gastroenterology.

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11. T4 levels are raised in anorexia nervosa ?

False

anorexia nervosa develop a euthyroid sick syndrome, in which decreased levels of thyroid-stimulating hormone (TSH), total thyroxine (T 4 ), and total triiodothyronine (T 3 ) may be seen, free T 4 and free T 3 are usually unchanged, and reverse T 3 (rT 3 ) is elevated. Generally, these endocrine abnormalities represent energy-conserving consequences of starvation that improve spontaneously with refeeding. They do not require immediate treatment but are to be followed with a repeat determination in approximately 3 weeks to determine if improvement occurs with refeeding.

Kaplan & Sadock's Comprehensive Textbook of Psychiatry

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1. The effect of cortisol is more than that of DHEA in adolescent depression?

2.Anorexia can be prevented by education in schools, activities and peer focus group discussions ?

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