general adult module handbook 4 semester · general adult module handbook 4th ... which of the...

General Adult Module Handbook

4th

Semester

Royal College of Psychiatrists Membership Course

Module Lead – Dr Brijesh Desai, Consultant Psychiatrist Course Director – Dr Latha Hackett, Consultant in Child & Adolescent Psychiatry

NW School of Psychiatry

North Western Postgraduate Department of Psychiatry

North Western School of Psychiatry Course 2014/15

A Psychiatry Medical Education Collaborative between Mental Health Trusts and Health Education North West

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Table of Contents

Brief guidelines for case conference presentation .............................................................................. 4

Brief guidelines for journal club presentation ...................................................................................... 6

Syllabus Links ...................................................................................................................................... 7

Links to Critical Appraisal Checklists ................................................................................................... 7

Session 1: Psychosis - 4 ................................................................................................................... 8

Learning Objectives ............................................................................................................................. 8

Expert Led Session ............................................................................................................................. 8

Case Presentation ............................................................................................................................... 8

Journal Club Presentation (Select 1 paper) ........................................................................................ 8

‘555’ Topics (Select 1 topic; 5 slides with no more than 5 bullet points) ............................................. 8

MCQs ................................................................................................................................................... 8

Additional Resources / Reading Materials .......................................................................................... 9

Session 2: Depression - 4 ............................................................................................................... 10

Learning Objectives ........................................................................................................................... 10

Expert Led Session ........................................................................................................................... 10

Case Presentation ............................................................................................................................. 10

Journal Club Presentation (Select 1 paper) ...................................................................................... 10

‘555’ Topics (Select 1 topic; 5 slides with no more than 5 bullet points) ........................................... 10

MCQs ................................................................................................................................................. 10

Additional Resources / Reading Materials ........................................................................................ 11

Session 3: Bipolar Disorder - 4 ..................................................................................................... 12






MCQs ................................................................................................................................................. 12


Session 4: General Hospital Psychiatry ........................................................................................ 14






MCQs ................................................................................................................................................. 14


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Session 5: Organic Psychiatry ....................................................................................................... 16






MCQs ................................................................................................................................................. 16


Session 6: Obsessive Compulsive Disorder ................................................................................ 18






MCQs ................................................................................................................................................. 18


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Brief guidelines for case conference presentation

The objectives of case conference are:

1) To provide a forum to discuss complex/interesting cases in a learning atmosphere.

2) To develop your ability to present cases in a concise and logical manner.

3) To develop your presentation skills.

Guidelines for presenters:

1. Please use PowerPoint for the presentation (or if you are using other tools make sure that they are

compatible with your local IT facilities).

2. You have to present a case that is relevant to the theme of the day on which you are presenting.

3. Please meet with your educational/clinical supervisor at least 4-6 weeks prior to the presentation to

identify an appropriate case to present. If there is no suitable case in the team that you work in, you

may have to approach other teams/consultants to identify a case.

4. Cases can be chosen for their atypical presentation, diagnosis, complexity or for exploring

management options.

5. It would be helpful if you can identify specific clinical questions that would you would like to be

discussed/answered at the end of the presentation.

6. We would recommend the following structure for the presentation:

Introduction (include reasons for choosing the case)

Circumstances leading to admission (if appropriate)

History of presenting complaint

Past Psychiatric history

Medical History/ current medication

Personal/family History

Alcohol/Illicit drugs history

Forensic history

Premorbid personality

Social circumstances

Mental state examination

Investigations

Progress since admission (if appropriate)

A slide with questions that you would you like to be discussed

Discussion on differential diagnosis including reasons for and against them.

Management / treatment

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7. The structure of the presentation can vary as long it is logical and concise. Please build into the

presentation some natural points to stop and discuss the case.

8. Important: Please ask a senior member of your team who knows the case to attend on the day you

are presenting.

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Brief guidelines for journal club presentation

The objectives of journal club presentation are:

1) To learn to perform a structured critical appraisal of a study.

2) To learn to make appropriate use of evidence in making decisions about the care of your

patients.

3) To prepare for the MRCPsych exams.

4) To develop your presentation skills.

Guidelines for presenters:

1. Please use PowerPoint for the presentation (or if you are using other tools make sure that they are

compatible with your local IT facilities).

2. Please select one of the 3 papers listed for the week from the School of Psychiatry handbook to

present.

3. Email the paper to your local co-ordinator at least a week before the presentation so that it can be

circulated in time.

4. As the presenter you are expected to both present the paper and critically review it.

5. We would recommend the following structure for the presentation: Background to study, methods,

analysis, results, conclusions, critical appraisal of the study and implications for clinical practice

6. The most important part of the presentation is the critical appraisal. This should include aspects

such as:

Purpose of the study

Type of study

Subject selection and any bias

Power calculation (could the study ever answer the question posed)

Appropriateness of statistical tests used

Use of relevant outcomes

Implications of findings

Applications of findings/conclusions in your area

Directions for further research

7. Use standardized critical appraisal tools.

8. Please discuss the paper and the presentation with your educational/clinical supervisor prior to the

presentation.

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Syllabus Links

Syllabus for MRCPsych (Dec 2013) - General Adult syllabus in in Section 7, pages 12, 13.

Syllabus for MRCPsych critical review

MRCPsych Paper A -The Scientific and theoretical basis of Psychiatry

MRCPsych Paper B - Critical review and the clinical topics in Psychiatry

MRCPsych CASC

Links to Critical Appraisal Checklists

Study Checklists

Randomized Controlled Trial

1. CONSORT Checklist

2. SIGN Checklist

3. CASP Checklist

Case-control Study 1. SIGN Checklist

2. CASP Checklist

Cohort Study 1. SIGN Checklist

2. CASP Checklist

Meta-analysis & Systematic Review

1. PRISMA statement

2. SIGN Checklist

3. CASP Checklist

Qualitative study 1. CASP Checklist

Economic study 1. SIGN Checklist

2. CASP Checklist

Diagnostic study 1. SIGN Checklist

2. CASP Checklist

http://www.rcpsych.ac.uk/pdf/Syllabic%20Curriculum%20MRCPsych%20December%202013.pdf

http://www.rcpsych.ac.uk/pdf/Paper%203%20Critical%20Review%20Syllabus%20(May%202011)-web.pdf

http://www.rcpsych.ac.uk/traininpsychiatry/examinations/about/mrcpsychpapera.aspx

http://www.rcpsych.ac.uk/traininpsychiatry/examinations/about/mrcpsychpaperb.aspx

http://www.rcpsych.ac.uk/traininpsychiatry/examinations/about/mrcpsychcasc.aspx

http://www.consort-statement.org/

http://www.sign.ac.uk/methodology/checklists.html

http://media.wix.com/ugd/dded87_c7984187fdc74d25a3fba6c707383b15.pdf


http://media.wix.com/ugd/dded87_19dd1d558a9977c0e0b30cedf86a9da7.pdf


http://media.wix.com/ugd/dded87_36c5c76519f7bf14731ed1985e8e9798.pdf

http://www.prisma-statement.org/2.1.2%20-%20PRISMA%202009%20Checklist.pdf


http://media.wix.com/ugd/dded87_37491d0241aa448a8f3d4ae17c869472.pdf

http://media.wix.com/ugd/dded87_951541699e9edc71ce66c9bac4734c69.pdf


http://media.wix.com/ugd/dded87_ff37ab65474ac19e19ec31d5f2e4887d.pdf


http://media.wix.com/ugd/dded87_ff37ab65474ac19e19ec31d5f2e4887d.pdf

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Session 1: Psychosis - 4

Journal theme: Genetic studies in Psychosis

Learning Objectives

To develop an understanding of psychosis (aetiology, epidemiology, natural history,

neurobiology, genetics, diagnostic criteria, classification, psychopathology, clinical

presentation, assessment, risks) and its management (pharmacological, psychological,

social).

To develop an understanding of genetic studies and develop skills for critically appraising

them

Expert Led Session

Topic: Schizophrenia- course and prognosis

Case Presentation

A case of Schizophrenia (any subtype) /Schizoaffective disorder / Delusional disorder / Acute

and transient psychotic disorder / First-episode psychosis

Journal Club Presentation (Select 1 paper)

Nicodemus K, Marenco S, Batten A, Vakkalanka R, Egan M, Straub E, Weinberger D (2008)

Serious obstetric complications interact with hypoxia-regulated/vascular-expression genes to

influence schizophrenia risk. Molecular Psychiatry 13, 873-877.

Di Forti M, et al. (2012) Confirmation that the AKT1 (rs 2494732) genotype influences the risk

of psychosis in cannabis users. http://dx.doi.org/10.1016/j.biopsych.2012.06.020.

Cardno A, Rijsdijk F, Murray R, McGuffin P (2002) A twin study of genetic relationships

between psychotic symptoms. Am J Psychiatry 159:539-545.

‘555’ Topics (Select 1 topic; 5 slides with no more than 5 bullet points)

Relative side effect comparison of antipsychotics

Major Schizophrenia candidate genes

Clozapine monitoring

MCQs

1. The chemical structure of Olanzapine is:

A. Benzizoxazole

B. Dibenzothiazepine

C. Thienobenzodiazepine

D. Butyrophenone

E. Benzobutyramide

http://www.nature.com/mp/journal/v13/n9/full/4002153a.html

http://www.nature.com/mp/journal/v13/n9/full/4002153a.html

http://dx.doi.org/10.1016/j.biopsych.2012.06.020

http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.159.4.539


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2. Which of the following genes are thought to be involved in the aetiology of Schizophrenia

according to the current evidence?

A. COMT

B. DISC-1

C. DTNBP-1

D. GABRB-2

E. All of the above

3. Which of the following is not a predictor of course and outcome in Schizophrenia?

A. Sociodemographic status

B. Features of initial clinical state and treatment response

C. First rank symptoms at baseline

D. Family history of psychiatric disorders

E. Premorbid personality and functioning

4. Which of the following scales is the most appropriate for assessment of extra-pyramidal side

effects of antipsychotics?

A. Barnes’ scale

B. Brief Psychiatric Rating Scale

C. Simpson-Angus Scale

D. Positive and Negative Symptom Scale

E. Unified Parkinson’s Disease Rating Scale

5. Who established antipsychotic effects of Chlorpromazine?

A. John Cane and colleagues

B. Jean Delay and Pierre Deniker

C. Eugene Bleuler

D. John Cade

E. Arvid Carlsson

Additional Resources / Reading Materials

Please refer first semester MRCPsych General Adult handbook

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Session 2: Depression - 4

Journal theme: ROC analysis studies in Depression

Learning Objectives

To develop an understanding of depression (aetiology, epidemiology, natural history,



social).

To develop an understanding and skills for critically appraising Receiver Operating

Characteristic Curve studies.

Expert Led Session

Topic: Depression- course and prognosis

Case Presentation

A case of major depressive disorder / severe depression with psychotic symptoms /

dysthymia / recurrent depressive disorder


Leentjens A, Verhey F, Luijckx G-J, Troost J (2001) The validity of the Beck Depression

Inventory as a screening and diagnostic instrument for depression in patients with Parkinson’s

disease. Movement Disorders 15(6), 1221-1224.

Cameron I, Cardy A, Crawford J, Toit S, Hay S, Mitchell K, Sharma S, Shivaprasad, S,

Winning S, Reid I (2011) Measuring depression severity in general practice: discriminatory

performance of the PHQ-9, HADS-D and BDI-II. Br J Gen Pract, DOI:

10.3399/bjgp11X583209.

Kim Y, et al (2007) Low plasma BDNF is associated with suicidal behaviour in depressed

patients. Progress in Neuro-Psychopharmacology & Biological Psychiatry 31, 78–85.


Risk factors associated with early onset and late onset depression

Biological markers of recurrent depression

Treatment of recurrent depression

MCQs

1. In recurrent depression, long term antidepressants should not be withdrawn until what duration

since complete remission:

A. 3 months

B. 6 months

C. 1 year

D. 2 years

E. 3 years

http://onlinelibrary.wiley.com/doi/10.1002/1531-8257(200011)15:6%3C1221::AID-MDS1024%3E3.0.CO;2-H/abstract;jsessionid=B0A729CAF6FDF17C200847627B6220BC.f03t03



http://bjgp.org/content/bjgp/61/588/e419.full.pdf

http://bjgp.org/content/bjgp/61/588/e419.full.pdf

http://www.researchgate.net/profile/Yong-Ku_Kim/publication/6883664_Low_plasma_BDNF_is_associated_with_suicidal_behavior_in_major_depression/links/54367bed0cf2dc341db344a6.pdf

http://www.researchgate.net/profile/Yong-Ku_Kim/publication/6883664_Low_plasma_BDNF_is_associated_with_suicidal_behavior_in_major_depression/links/54367bed0cf2dc341db344a6.pdf

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2. Late onset depression is often:

A. Chronic

B. Acute in onset

C. Associated with neuroticism

D. Associated with psychosis

E. Associated with personality disorder

3. The ‘Kindling Effect’ was first described by:

A. Goddard

B. Kraepelin

C. Beck

D. Hamilton

E. Kessler

4. Which of these is a predictor of good prognosis in major depressive disorder:

A. Comorbid alcohol dependency

B. Old age

C. Acute onset

D. Increased length of episode

E. Reduce interval between episodes

5. The average duration of an untreated episode of depression:

A. 3 years

B. 1 year

C. 6 months

D. 3 months

E. 1 month


Please refer first semester MRCPsych General Adult handbook.

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Session 3: Bipolar Disorder - 4

Journal theme: Meta-analysis / systematic review on bipolar disorder

Learning Objectives

To develop an understanding of bipolar disorder (aetiology, epidemiology, natural history,



social).

To develop an understanding of meta-analysis and systematic review and develop skills for

critically appraising them.

Expert Led Session

Topic: Bipolar disorder- course and prognosis

Case Presentation

A case of type I bipolar disorder / type II bipolar disorder / cyclothymia / bipolar disorder with

psychotic symptoms / rapid cycling bipolar disorder/ unipolar mania.


Geddes J, Burgess S, Hawton K, Jamison K, Goodwin G (2004) Long-term Lithium therapy

for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am

J Psychiatry, 161:217-222.

Geddes J, Calabrese J, Goodwin G (2009) Lamotrigine for treatment of bipolar depression:

independent meta-analysis and meta-regression of individual patient data from five

randomized trials. BJPsych 194, 4-9.

Scherk H, Pajonk F, Leucht S (2007) Second-generation antipsychotic agents in the

treatment of acute mania. A systematic review and meta-analysis of randomized controlled

trials. JAMA Psychiatry, 64(4), 442-455.


Distinguishing between mood symptoms of bipolar disorder (type I and II), emotionally

unstable personality disorder and cyclothymia

Psychological therapies in bipolar disorder – summary of evidence

Role of depot antipsychotics in bipolar disorder

MCQs

1. Using the broadest definition, prevalence of bipolar spectrum disorders in the general population

has been estimated as high as:

A. 0.8%

B. 1.2%

C. 3.9%



http://bjp.rcpsych.org/content/bjprcpsych/194/1/4.full.pdf



http://archpsyc.jamanetwork.com/article.aspx?articleid=209997



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D. 8.3%

E. 10.4%

2. Age at onset of bipolar disorder:

A. Has little prognostic relevance

B. Is not a heritable trait

C. Has been observed to be higher in more recent studies

D. Is higher in women than men

E. Has implications for clinical course

3. Individuals with bipolar disorder:

A. Rarely receive a diagnosis of unipolar depression

B. Have longer episodes of mania than depression

C. Commonly have psychiatric co-morbidities

D. Have fewer depressive episodes than those with unipolar depression

E. Show poorer prognosis if they have predominantly manic episodes

4. When compared with bipolar I disorder, bipolar II disorder:

A. Is associated with better inter-episode functioning

B. Is similar and frequently develops into bipolar I disorder

C. Is associated with fewer affective episodes overall

D. Has a less chronic course

E. Has a significantly higher age at onset

5. Regarding the treatment of bipolar disorder:

A. Delays in initiating treatment are rare

B. The vast majority of patients respond to lithium or an anticonvulsant treatment when in a manic

phase

C. Quetiapine leads to remission in over 50% of patients in the depressive phase

D. There are a number of well-tolerated treatments that are effective in all phases of the illness

E. The majority of patients are maintained on monotherapies


Please refer first semester MRCPsych General adult handbook

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Session 4: General Hospital Psychiatry

Journal theme: Case report/ case series

Learning Objectives

To develop an understanding of psychiatric presentations in general hospital / liaison

psychiatry.

To develop an understanding of Case reports/case series studies and develop skills for

critically appraising them.

Expert Led Session

Topic: Overview of psychiatric presentations in general hospital / liaison psychiatry p

Case Presentation

A case of psychiatric presentation in general hospital / liaison psychiatry


Tang A, O’Sullivan A, Diamond T, Gerard A, Campbell P (2013) Psychiatric symptoms as a

clinical presentation of Cushing’s syndrome. Annals of General Psychiatry 12:23.

Peloizza L, Bonacini F, Ferrari A (2010) Psychiatric disorder as clinical presentation of

primary Sjogren’s syndrome: two case reports. Annals of General Psychiatry 9:12.

Marouf F, Giallourakis C, Bear L, Hanau M, Holbert B (2013) Case 33-2013: a 40-year-old

woman with abdominal pain, weight loss and anxiety about cancer. NEJM, 369:1639-1647.


Psychosis in medical conditions

Depression in medical conditions

Principles of assessment in liaison psychiatry

MCQs

1. Lesions in the following structure have been associated with pathological crying:

A. Temporal pole

B. Pineal gland

C. Caudate nucleus

D. Pons

E. Tegmentum

2. The following theoretical model is commonly applied to somatoform pain disorders:

A. Central demyelination theory

B. Central sensitisation theory

C. Operant sensitisation theory

D. Central operant theory

E. Operant receptive field theory

http://www.annals-general-psychiatry.com/content/pdf/1744-859X-12-23.pdf




http://www.nejm.org/doi/pdf/10.1056/NEJMcpc1215968

http://www.nejm.org/doi/pdf/10.1056/NEJMcpc1215968

Page | 15

3. Diagnostic criteria for Chronic fatigue syndrome requires a duration of symptoms for at least

A. 4 weeks

B. 3 months

C. 4 months

D. 6 months

E. 12 months

4. Diagnostic criteria for Fibromyalgia requires a duration of symptoms for at least

A. 4 weeks

B. 3 months

C. 4 months

D. 6 months

E. 12 months

5. The following medication is routinely used for treating Fibromyalgia:

A. Carbamazepine

B. Vigabatrin

C. Pregabalin

D. Mirtazepine

E. Mianserin


Gelder M, Andreason N, Lopez-Ibor J, Geddes J (Eds) 2012. New Oxford textbook of

psychiatry. Oxford University Press.

Lloyd G and Guthrie E (Eds) 2012 Handbook of Liaison Psychiatry. Cambridge Medicine.

Guthrie E and Creed F (Eds) 1996. Seminars in Liaison Psychiatry. College Seminar Series.

Gaskell. London.

Page | 16

Session 5: Organic Psychiatry

Journal theme: Neuroimaging studies

Learning Objectives

To develop an understanding of organic psychiatric disorders.

To develop an understanding of brain imaging studies and develop skills for critically

appraising them.

Expert Led Session

Topic: Overview of organic psychiatric disorders in GA psychiatry.

Case Presentation

Any case with a theme of organic psychiatric disorder or where there are specific organic

findings (e.g in brain scans) or where such disorders are a part of differential diagnoses.


Lindenbery-Meyer A, Poline J, Kohn P, Holt J, Egan M, Weinberger M, Berman K (2001).

Evidence of abnormal cortical functional connectivity during working memory in

Schizophrenia. Am J Psychiatry, 158:1809-1817.

Hamilton J, Etkin A, Furman D, Lemus M, Johnson R, Gotlib I (2012) Functional

neuroimaging of major depressive disorder: a meta-analysis and new integration of baseline

activation and neural response data. Am J Psychiatry 169:693-703.

De Wit S, Alonso P, Schweren L, et al. (2014) Multicentre voxel-based morphometry mega-

analysis of structural brain scans in obsessive-compulsive disorder. Am J Psychiatry 171:340-

349.


Pathophysiological theories of chronic somatoform pain disorders.

Pathophysiological finding in chronic fatigue syndrome

Voxel-based morphometry – a brief overview of the method and its application

MCQs

1. Patients with Phaeochromocytoma may resemble patients experiencing:

A. Depression

B. Mania

C. Psychosis

D. Panic disorder

E. OCD

http://www.researchgate.net/profile/Andreas_Meyer-Lindenberg/publication/11661919_Evidence_for_abnormal_cortical_functional_connectivity_during_working_memory_in_schizophrenia/links/0fcfd50ae0f4e99138000000.pdf

http://www.researchgate.net/profile/Andreas_Meyer-Lindenberg/publication/11661919_Evidence_for_abnormal_cortical_functional_connectivity_during_working_memory_in_schizophrenia/links/0fcfd50ae0f4e99138000000.pdf

http://www.researchgate.net/profile/Ian_Gotlib/publication/224846655_Functional_neuroimaging_of_major_depressive_disorder_a_meta-analysis_and_new_integration_of_base_line_activation_and_neural_response_data/links/00b7d517923bee9462000000.pdf



Page | 17

2. Which of the following commonly features in early Borrelia infection?

A. Erythema nodosum

B. Flu type symptoms

C. Tinnitus

D. Polyuria

E. abdominal pain, especially at night

3. Which of the following is NOT a risk factor for hypothyroidism?

A. Age <40 years

B. Post-partum

C. Neck surgery

D. Radiation exposure

E. Amiodarone

4. Patients with untreated Borrelia infection progressing to neurological symptoms:

A. 5%

B. 10%

C. 15%

D. 18%

E. 20%

5. HSV encephalitis commonly affects the:

A. Frontal lobes

B. Temporal lobes

C. Parietal lobes

D. Brainstem

E. Corpus callosum


David A, Fleminger S, Kopelman M, Lovestone S, Mellers J (2012) Lishman’s organic

psychiatry- a textbook of neuropsychiatry (Ed 4th). Wiley-Blackwell. West Sussex.

Page | 18

Session 6: Obsessive Compulsive Disorder

Journal theme: RCT studies in OCD

Learning Objectives

To develop an understanding of OCD (aetiology, epidemiology, natural history, neurobiology,

genetics, diagnostic criteria, classification, psychopathology, clinical presentation,

assessment, risks) and its management (pharmacological, psychological, social).

To develop an understanding of Randomized controlled trail and develop skills for critically

appraising them.

Expert Led Session

Topic: OCD- an overview

Case Presentation

A case of OCD or a case in which it is a differential diagnosis.


Foa E, et al. (2005) Randomized, placebo-controlled trial of exposure and ritual prevention,

Clomipramine and their combination in the treatment of obsessive-compulsive disorder. Am J

Psychiatry 162: 151-161

Carey P, Vythilingum B, Seedat S, Muller J, Ameringen M, Stein D (2005) Quetiapine

augmentation of SRIs in treatment refractory obsessive-compulsive disorder: a double-blind,

randomized, placebo-controlled study. BMC Psychiatry 5:5. doi:10.1186/1471-244X-5-5.

Kamijima K, Murasaki M, Asai M, Higuchi T, Nakajima T, Taga C, Matsunaga H (2004)

Paroxetine in the treatment of obsessive-compulsive disorder: randomized, double-blind,

placebo-controlled study in Japanese patients. Psychiatry Clin Neurosci 58(4): 427-433


Neurobiology of OCD

Summary of NICE guidelines on OCD

Evidence for psychological therapies in OCD- summary

MCQs

1. The lifetime risk of OCD is:

A. 2.1%

B. 1 %

C. 0.5 %

D. 5 %

2. Which of the following it TRUE about OCD?

A. There is evidence of increased volume of basal ganglia structures

http://www.jabramowitz.com/uploads/1/0/4/8/10489300/btcmi_main_paper.pdf

http://www.jabramowitz.com/uploads/1/0/4/8/10489300/btcmi_main_paper.pdf

http://www.biomedcentral.com/content/pdf/1471-244X-5-5.pdf



http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2004.01278.x/epdf

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2004.01278.x/epdf

Page | 19

B. Meta-analyses of brain imaging studies shows consistent findings

C. Studies have found an increase in volume of orbitofrontal cortex

D. Anterior cingulate area volume always remains normal

3. NICE recommends:

A. CBT including exposure and response prevention in OCD with mild functional impairment

B. Choice of monotherapy with an SSRI or intensive CBT alone for OCD with moderate functional

impairment

C. Use of combination therapy after inadequate response at 12 weeks

D. All of the above

4. NICE recommends consideration of in-patient treatment in OCD when there is:

A. Risk of suicide

B. Severe self-neglect

C. Reversal of normal night/day patterns making attendance for daytime therapy impossible

D. A, B and C

E. Only A and B

5. All of the following statements about the CBT model for OCD is true EXCEPT:

A. According to the model, intrusive thoughts are universal, with a content indistinguishable from that

of clinical obsessions

B. Avoidance is not a part of the definition of OCD

C. Excessive attentional bias on monitoring intrusive thoughts is specific to OCD

D. Rumination covers both the obsession and any accompanying mental compulsion

E. Thought-action fusion is also known as magical thinking


Gelder M, Andreason N, Lopez-Ibor J, Geddes J (Eds) 2012. New Oxford textbook of

psychiatry. Oxford University Press

general adult module handbook 4 semester · general adult module handbook 4th ... which of the...

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