The MRCPsych Study Manual

Ben Green

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357485
• Edition: 3
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This manual is for busy clinicians and managers. It can help to improve the quality of care by explaining how to apply guidelines in a wide variety of clinical settings. Case studies written by the protagonists themselves describe the experiences of using guidelines in treating a wide range of conditions in primary and secondary care. The final sections collate the lessons learnt from these examples and propose practical solutions that can be applied in everyday clinical care by doctors nurses professionals allied to medicine and healthcare managers.

MRCPsych Part I: MCQ Written Paper

Individual Statements

• 1 Rett syndrome occurs in both boys and girls.
• 2 According to ICD-10 violence confined to family members is not one of the signs of conduct disorder.
• 3 Transitional objects are associated with the work of Bowlby.
• 4 Being female is associated with slower speech development.
• 5 Conduct disorder is present in less than 3% of boys aged under 10.

1 True.

Although it predominantly affects girls, occurring in 1 in every 10 000 to 15 000 female births, it does occur rarely in boys. The fault has recently been pinpointed to the MeCP2 gene on the X chromosome. Recurrence in the same family is very rare – Rett syndrome is sporadic in most cases.

Reference:

• Amir RE et al. (2000) Influence of mutation type and X chromosome inacti-vation on Rett syndrome phenotypes. Annals of Neurology. 47(5): 670–9.

2 False.

One of the conduct disorders described in ICD-10 is F91.0 Conduct Disorder Confined to the Family Context in which violence against family members (but not others) and deliberate fire setting, among other signs, are grounds for the diagnosis.

3 False.

Transitional objects are associated with the work of Winnicott.

4 False.

Being female is associated with earlier and better speech development.

5 False.

Conduct disorder was found in 4% of boys studied by Rutter et al. in the classic Isle of Wight Study. Other studies have found rates even higher to about 16%.

Reference:

• Rutter M, Tizard J, Yule W, Graham P and Whitmore K (1976) Research report: Isle of Wight Studies, 1964–1974. Psychological Medicine. 6(2): 313–32.

• 6 Increasing rates of childhood psychiatric disorders can in part be explained by changes in social acceptability.
• 7 Quetiapine causes gynaecomastia.
• 8 SSRIs prescribed in pregnancy are associated with reduced birth weight.
• 9 Drugs that can cause depression include tetrabanazine.
• 10 Drugs that can induce psychosis include mefloquine.

6 True.

7 False.

Gynaecomastia is associated with hyperprolactinaemia secondary to some antipsychotics as prolactin is under the inhibitory control of dopamine. Quetiapine however does not usually raise prolactin levels. Neither does clozapine or aripiprazole.

Reference:

• Taylor D, Paton C and Kerwin R (2005) Maudsley 2005–2006 Prescribing Guidelines. Taylor and Francis, London.

8 True.

SSRIs (selective serotonin reuptake inhibitors) prescribed in pregnancy are associated with reduced birth weight and also reduced gestational age (although depression itself is associated with reduced gestational age). SSRIs are not generally believed to be teratogenic.

Reference:

• Taylor D, Paton C and Kerwin R (2005) Maudsley 2005–2006 Prescribing Guidelines. Taylor and Francis, London.

9 Trae.

10 Trae.

Mefloquine can indeed cause psychosis, but this seems uncommon. The incidence rate of psychosis during current mefloquine exposure has been calculated as 1.0/1000 person-years.

References:

• Meier CR, Wilcock K and Jick SS (2004) The risk of severe depression, psychosis or panic attacks with prophylactic antimalarials. Drug Safety. 27(3): 203–13.
• Stuiver PC, Ligthelm RJ and Goud TJ (1989) Acute psychosis after mefloquine. [Letter.] The Lancet. 2(8657): 282.

• 11 Post-traumatic stress disorder (PTSD) must arise within four months of the traumatic event for an ICD-10 diagnosis.
• 12 De Clerambault’s syndrome usually involves a delusion of infidelity.
• 13 Echo de la pensées is the experience of hearing one’s thoughts simultaneously spoken out loud.
• 14 Charles Bonnet syndrome involves complex visual hallucinations.
• 15 Parapraxis is a difficulty with dressing associated with parietal lobe damage.

11 False.

ICD-10 guidelines acknowledge that there may be a latency period between the trauma and the onset of PTSD, but say that this rarely exceeds six months. Nevertheless the diagnosis may still be possible if the onset is after six months if the clinical manifestations are feasible.

Reference:

• World Health Organization (1992) ICD-10 Clinical Descriptions and Diagnostic Guidelines. WHO, Geneva.

12 False.

De Clerambault (1872–1934) was a French psychiatrist. He is known for the syndrome in which patients believe themselves to be the object of attention or love of a famous or unattainable person such as a king or film star. The delusion of infidelity or morbid jealousy is associated with the Othello syndrome.

13 False.

Gedankenlautwerden is the experience of hearing one’s thoughts simultaneously spoken out loud. Echo de la pensées is the experience of hearing one’s thoughts spoken out loud after a slight delay, not simultaneously.

14 True.

Charles Bonnet syndrome involves complex visual hallucinations. It is sometimes seen in the elderly and in patients with central or peripheral impairment/loss of vision.

15 False.

Parapraxis is a term coined for a Freudian slip of the tongue. Dressing dyspraxia is a difficulty with dressing associated with parietal lobe damage.

• 16 ‘Knifeblade’ atrophy on brain scan is a recognised feature of Wilson’s disease (hepatolenticular degeneration).
• 17 Bereavement increases the risks of subsequent depressive disorder and also death.
• 18 Tardive dyskinesia can be measured using the Abnormal Involuntary Movements Scale.
• 19 Pareidolia is classified as a symptom of psychosis.
• 20 Psychological defence mechanisms are usually associated with the work of Reich.

16 False.

Wilson’s disease results from an abnormally low serum caeruloplasmin level, and consequently high serum copper levels so that there is a resulting deposition of copper in the CNS (central nervous system) and elsewhere. Diagnosis is by measuring caeruloplasmin levels and testing urine collections for the excess urinary excretion of copper. Wilson’s disease has an autosomal recessive inheritance. ‘Knifeblade’ atrophy is characteristically seen in Pick’s disease.

Referen...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Preface to the third edition
• Preface to the second edition
• Preface to the first edition
• List of Contributor
• The MRCPsych Study Programme
• MRCPsych Part I: MCQ Written Paper
• Group Exercise: Risk Assessment
• MRCPsych Part I: OSCE
• MRCPsych Part II: Basic Sciences Written Paper
• MRCPsych Part II: Clinical Topics Written Paper
• MRCPsych Part II: Essay
• MRCPsych Part II: Critical Review Paper
• MRCPsych Part II: Clinical Examinations
• Group Exercise: Formulation
• MRCPsych Part II: Patient Management Problems
• Index