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Kamran Shaikh

We need some discussion for paper 3

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Dear All,

I have been posting the questions for paper 3, but I see very little discussion. There is  all the question bank on www.mrcpsychrevisionwiki.org for the paper 3. I suggest that we should start solving those questions now. Now we'll have the guidance of our colleagues who passed the part 2 theory of Autmun 2007, especially in terms of critical review.  

So let us build up the discussion.

Many thanks.

k.a.s.

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Dear All,

I have been posting the questions for paper 3, but I see very little discussion. There is all the question bank on www.mrcpsychrevisionwiki.org for the paper 3. I suggest that we should start solving those questions now. Now we'll have the guidance of our colleagues who passed the part 2 theory of Autmun 2007, especially in terms of critical review.

So let us build up the discussion.

Many thanks.

k.a.s.

Are there actually any questions on the forum. I found it completely empty. or may be I am not looking in the proper place. Will try again. :)

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EMI 1

Theme: Sleep disorders

Options:

A. Circadian rhythm sleep disorder

B. Shift work sleep disorder

C. Narcolepsy

D. Obstructive sleep apnoea

E. Limb movement disorder

F. Somnambulism

G. Delayed sleep phase syndrome

Select one option in all questions below:

1. A 25 year old female falls asleep in the daytime and loses her balance with cataplexy

C. Narcolepsy

2. A 40 year old obese man complains of cough during the night.

D. Obstructive Sleep apnoea

[highlight]3. A 30 year old man has been depressed and is prescribed by his GP flupenthixol tablets. He later comes back to the GP complaining of sleep disturbance and fatigue in the daytime.

G. Delayed sleep phase syndrome [/highlight]

why is it delayed sleep phase syndrome.? I dont thin k it has any association with Flupenthixol. Isnt just [highlight]Circadian rhythm sleep disorder[/highlight] more appropriate?

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Some doubts can anyone help clarify with references please?

1. Cognitive Dissonance is amplified in motivational enhancement therapy.

this is T acc to manchester notes.

2. Cannabis has adverse effects on Immune system.

F acc to Manchester notes but the following link says T

http://www.mind.org.uk/Information/Factsheets/Treatments+and+drugs/The+psychological+effects+of+cannabis.htm

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Answer to 1 is true.

As for the cannabis question, it used to be thought that it impaired the immune system (Nahas, G.G. et al, 'Inhibition of Cellular Mediated Immunity in Marijuana Smokers,' Science 183:419-20 (1974)).

I think this has since been disproven (unless in massive doses in rats). See Wallace, J.M. et al, 'Peripheral Blood Lymphocyte Subpopulations and Mitogen Responsiveness in Tobacco and Marijuana Smokers,' Journal of Psychoactive Drugs 20:9-14 (1988) - suggests that the opposite is true.

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First one is true.. I would say because cognitive dissonance leads to change... so the MET will try and magnify it so that we change our behaviour in order to reach a state of cognitive consonance... in this case by stopping the drinks...

2nd one...

I would go for true.. because recent studies show that cannabis affects the immune system... even in humans... (although the question does not say humans)

But I am not sure if it adversely affects.. because a lot of the action on the inflammatory system is made use of in treating (or trying to treat) chronic inflammatory diseases...

El-Gohary, M.; Eid, M. A. Effect of cannabinoid ingestion (in the form of bhang) on the immune system of high school and university students. Hum. Exp. Toxicol.2004, 23, 149-156.

Pacifici, R.; Zuccaro, P.; Pichini, S.; Roset, P. N.; Poudevida, S.; Farre, M.; Segura, J.; De la Torre, R. Modulation of the immune system in cannabis users. J. Am. Med. Assoc. 2003, 289, 1929-

1931.

I googled this one and came up with a lot of sites with 'Myths about cannabis' which says that cannabis does not do anything like that... I would be wary of that and the fact that they quote really old studies (1980s and 1990s) with short term use...

[highlight]It is generally considered that the immunomodulatory effects of cannabis and cannabinoids is observed only after long-term exposure and while using high doses, while the newer clinical results suggest that cannabinoids shift the balance of pro-inflammatory cytokines and anti-inflammatory cytokines towards the T-helper cell type 2  profiles (Th2 phenotype), and suppress cell-mediated immunity whereas humoral immunity may be enhanced.[/highlight]

The Cannabinergic System as a Target for Anti-inflammatory Therapies. By: Dai Lu; Vemuri, V. Kiran; Duclos Jr., Richard I.; Makriyannis, Alexandros. Current Topics in Medicinal Chemistry, Jul2006, Vol. 6 Issue 13, p1401-1426, 26p

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EMI 1

Theme: Sleep disorders

Options:

A. Circadian rhythm sleep disorder

B. Shift work sleep disorder

C. Narcolepsy

D. Obstructive sleep apnoea

E. Limb movement disorder

F. Somnambulism

G. Delayed sleep phase syndrome

Select one option in all questions below:

[highlight]3. A 30 year old man has been depressed and is prescribed by his GP flupenthixol tablets. He later comes back to the GP complaining of sleep disturbance and fatigue in the daytime.

G. Delayed sleep phase syndrome [/highlight]

why is it delayed sleep phase syndrome.? I dont thin k it has any association with Flupenthixol. Isnt just [highlight]Circadian rhythm sleep disorder[/highlight] more appropriate?

I dont think there is enough data to call it a circadian rhythm disorder...

I would go for [highlight]periodic limb movements disorder... [/highlight]because neuroleptics (in this case, flupentixol) are known to precipitate this..

http://www.emedicine.com/neuro/topic523.htm

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EMI 1

Theme: Sleep disorders

Options:

A. Circadian rhythm sleep disorder

B. Shift work sleep disorder

C. Narcolepsy

D. Obstructive sleep apnoea

E. Limb movement disorder

F. Somnambulism

G. Delayed sleep phase syndrome

Select one option in all questions below:

[highlight]3. A 30 year old man has been depressed and is prescribed by his GP flupenthixol tablets. He later comes back to the GP complaining of sleep disturbance and fatigue in the daytime.

G. Delayed sleep phase syndrome [/highlight]

why is it delayed sleep phase syndrome.? I dont thin k it has any association with Flupenthixol. Isnt just [highlight]Circadian rhythm sleep disorder[/highlight] more appropriate?

I dont think there is enough data to call it a circadian rhythm disorder...

I would go for [highlight]periodic limb movements disorder... [/highlight]because neuroleptics (in this case, flupentixol) are known to precipitate this..

http://www.emedicine.com/neuro/topic523.htm

Thanks Dorian, but I am surprised to find u still here in paper 3 discussion.

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:lol: :lol:

Decided to stick around as much as I can... I will get severe withdrawals if I dont go thru the exams section...

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a 34 yr old man with no previous psych history is brought to hospital by the police after found being wandering outside his house naked and shouting at his neighbours. His neighb. have complained to the police over the past fortnight about loud music from the flat. He has purchased an expensive hi fi, he tells u nothing wrong with him and that u can check with his usual doctors at the HIV clinic.

what r ur main diff. diagnoses?

what will be the short term management in this case? choose up to 3 from the following

1. getting further hist. from neighbours

2. getting his old med. record

3. urine drug screen

4. liaising with HIV team

5. contact his family

6. detaining him under MHA

7. doing a physical examination

8. ensure his confidentiality

A 14 yr boy developed school refusal for the first time and has become fearful that he might be kidnapped on the way to school.

List 4 key issues u might ask from his mother?

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citalopram

carbamazepine

fluox

mirta

sert

sod valpr

nefaz

risp

venla

halo

1. can lower its own levels by inducing cyt p450, 3a3, 4 enz

2.S/E is driven predominantly by H1 receptor antagonism

3. 5HT2 antagonism as well as 5HT reuptake inhib there by enhansing slow wave sleep

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a 34 yr old man with no previous psych history is brought to hospital by the police after found being wandering outside his house naked and shouting at his neighbours. His neighb. have complained to the police over the past fortnight about loud music from the flat. He has purchased an expensive hi fi, he tells u nothing wrong with him and that u can check with his usual doctors at the HIV clinic.

what r ur main diff. diagnoses?

what will be the short term management in this case? choose up to 3 from the following

1. getting further hist. from neighbours

2. getting his old med. record

3. urine drug screen

4. liaising with HIV team

5. contact his family

6. detaining him under MHA

7. doing a physical examination

8. ensure his confidentiality

A 14 yr boy developed school refusal for the first time and has become fearful that he might be kidnapped on the way to school.

List 4 key issues u might ask from his mother?

Answers 3, 4, 7

Antiretroviral drugs do cause manic/psychotic symptoms......

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citalopram

carbamazepine

fluox

mirta

sert

sod valpr

nefaz

risp

venla

halo

1. can lower its own levels by inducing cyt p450, 3a3, 4 enz

2.S/E is driven predominantly by H1 receptor antagonism

3. 5HT2 antagonism as well as 5HT reuptake inhib there by enhansing slow wave sleep

3. Nefazodine / Trazodone

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Some doubts from Manchester notes for which I could not find proper references. Can anyone clarify

1. The first degree relative of a patient with BPAD have a 2 fold increased risk of developling unipolar depression compared to generl population. ? T

2.Excessive caffeine intake amy result inDST non suppression. ?T

3.Lithium treatment reduces risk of relapse during followup from 60% to 40% ?T

4.After ECT the EEG continues to show regular and irregular slow waves for up to 3 weeks. ? T

5.Sham ECT has no effect in the treatment of depression. ?T

6.The majority of bipolar patients have full remission in cognitive impairment between episodes ? F

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Some doubts from Manchester notes for which I could not find proper references. Can anyone clarify

1. The first degree relative of a patient with BPAD have a 2 fold increased risk of developling unipolar depression compared to generl population. ? T

2.Excessive caffeine intake amy result inDST non suppression. ?T

3.Lithium treatment reduces risk of relapse during followup from 60% to 40%  ?T

4.After ECT the EEG continues to show regular and irregular slow waves for up to 3 weeks. ? T

5.Sham ECT has no effect in the treatment of depression. ?T

6.The majority of bipolar patients have full remission in cognitive impairment between episodes ? F

 

1. Adoption studies provide an alternative approach to separating genetic and environmental factors in familial transmission. Only a limited number of such studies have been reported, and their results have been mixed. One large study found a threefold increase in the rate of bipolar disorder and a twofold increase in unipolar disorder in the biological relatives of bipolar probands. Similarly, in a Danish sample, a threefold increase in the rate of unipolar disorder and a sixfold increase in the rate of completed suicide in the biological relatives of affectively ill probands were reported. Other studies, however, have been less convincing and have found no difference in the rates of mood disorders.

Pg 532 Kaplan and Sadock Synopsis of psychiatry.

2. Acute caffeine administration increases cortisol and converts the dexamethasone suppression test (DST) to nonsuppression in normal humans. It is true...

3. Of persons who have a single manic episode, 90 percent are likely to have another. As the disorder progresses, the time between episodes often decreases. After about five episodes, however, the interepisode interval often stabilizes at 6 to 9 months. Of persons with bipolar disorder, 5 to 15 percent have four or more episodes per year and can be classified as rapid cyclers. In randomized trials, the relapse rate in patients treated with lithium is about 37% compared with 79% with placebo.

The numbers are varying... but I guess it would be roughly true... a reduction by 20 - 30%.

4. It is True and is possibly related to improvement I guess... but rarely longer than 2 months ( Sackheim et al)

5. Its difficult to say.. because placebo effect is going to be there... but compared to real ECT, sham ECT has no effect.

6. This is false... because there is now sufficient data to say so.

I guess that would be true...

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Some doubts from Manchester notes for which I could not find proper references. Can anyone clarify

6.The majority of bipolar patients have full remission in cognitive impairment between episodes ? F

[highlight]6. This is false... because there is now sufficient data to say so.

I guess that would be true...

[/highlight]

So Dorian, Is it true or false ie do they have ful remission or not?

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Some doubts from Manchester notes for which I could not find proper references. Can anyone clarify

6.The majority of bipolar patients have full remission in cognitive impairment between episodes ? F

 

[highlight]6. This is false... because there is now sufficient data to say so.

I guess that would be true...

[/highlight]

So Dorian, Is it true or false ie do they have ful remission or not?

Sorry... What I meant was, there is persistent cognitive deficits even in remission of clinical symptoms... so I guess the answer is right... the statement is False...

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Some more doubts :)

1. The homozygous co twin of a patient with Bipolar has 5 % chance of developing schizophrenia ? F

2. In about half the cases of Capgras Syndrome, an organic aetiology can be ascertained. ? F ( I have read some where it is 37%, don’t know where)

3. Physical Dependence can develop after long term PCP use. ? F http://www.minddisorders.com/Ob-Ps/Phencyclidine-and-related-disorders.html

4. Expressed emotions predict the outcome of most psychiatric disorders. ? F ( I think EE has a role in precipitating relapse but can it predict outcome ???)

5. Schizophrenics are more likely to develop cancers than gen population ?F ( are they more likely because more smokers??? Don’t know

6. Poverty doubles the risk of developing depression in single women. ? F

7. In Bipolar disorder if a person travels from West to East, the chance of a relapse of mania is worse than if hey travel from East to West

8. The difference in results of Beck Depression Rating Scale and Hamilton Depression Rating Scale is due to the tests being administered differently. ? T ( They are different one self and one observer rated)

9. Memory problems improve towards the end of a course of ECT ? T ( Memory problems due to Depression may improve??? but will cognitive imapirment due to ECT improve???)

http://apt.rcpsych.org/cgi/reprint/12/3/228.pdf?ck=nck

10. In SAD melatonin secretion increases in winter ? T ( according to Manchester)

11. In a sample of civil servants in a highly pressurised work environment, females are likely to take more days off sick than men. ? F ( women able to cope with stress better)

12. Anorexia Nervosa can be prevented by education in schools and peer group discussions. ? T

13. In the treatment of AN with severe weight loss, initial wt gain is associated with cognitive improverment

14. Most neurotic children become neurotic adults. ? T( trait neuroticism is enduring but most????)

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Hi Kamran,

You have suggested to see some website but when I clicked on that link a window opens up and asks for user-id and password.

Please tell me how to proceed, as i dont have user id and password.

Many thanks.

Pallash

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