Psych Quiz

7 Jul

100-question challenge

Inside the clinical mind

A graduate-level tour of psychiatry, clinical psychology and paraphilias. Tap an option to lock it in — the answer and explanation open in place, and your running score sits in the corner.

100specialist-informed questions

56rated hard

1 tapto submit each answer

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No scripts, no trackers, no external files — it runs entirely offline. Questions and options are shuffled in this build.

Question 1 of 100Clinical psychology: measurement-based careMedium

What is the main purpose of routine outcome monitoring with feedback during psychotherapy?

ATo flag progress, stagnation or deterioration for timely treatment reviewBTo compare therapists without adjustment for differences in case complexityCTo replace formulation with automatic treatment-switching rulesDTo determine diagnosis solely from changes in standardised symptom scores

Correct.

Not quite.

Correct answer: To flag progress, stagnation or deterioration for timely treatment review

Repeated measures can reveal when a patient is not improving as expected and support collaborative review. Scores complement rather than replace clinical judgement, formulation and discussion.

Question 2 of 100Psychiatry: psychopharmacologyHard

A person taking a non-selective monoamine oxidase inhibitor develops pounding headache and severe hypertension after eating a mature cheese. What is the underlying interaction?

ACheese-derived histamine directly stimulates vascular alpha receptorsBTyramine blocks catecholamine reuptake after competing for hepatic metabolismCTyramine escapes monoamine-oxidase metabolism and releases stored catecholaminesDDietary sodium reduces renal excretion of the antidepressant

Correct.

Not quite.

Correct answer: Tyramine escapes monoamine-oxidase metabolism and releases stored catecholamines

Non-selective MAO inhibition can allow dietary tyramine to reach the circulation and provoke noradrenergic release, producing a hypertensive crisis. This is the basis of classic tyramine dietary restrictions.

Question 3 of 100Paraphilias: classificationHard

A person is distressed about a consensual atypical sexual interest solely because their community condemns it. Under the DSM-5 framework described by the APA, what is the key diagnostic point?

AAny clinically significant distress is sufficient regardless of its sourceBConcealing the interest from others establishes functional impairmentCDistress arising solely from social condemnation is not sufficient by itselfDNot acting on the interest rules out disorder even when intrinsic distress is severe

Correct.

Not quite.

Correct answer: Distress arising solely from social condemnation is not sufficient by itself

The APA explicitly distinguishes personal distress intrinsic to the interest from distress resulting merely from society's disapproval. Consensual atypical behaviour is not automatically pathological.

Question 4 of 100Psychiatry: phenomenologyHard

Which experience is a classic example of a delusion of control or passivity?

AExperiencing one's arm as moved by an external forceBInterpreting nearby strangers' laughter as a reference to oneselfCRepeating a checking ritual to prevent a feared catastropheDHearing a voice giving a running commentary on one's actions

Correct.

Not quite.

Correct answer: Experiencing one's arm as moved by an external force

Passivity phenomena involve the conviction that one's actions, impulses or bodily experiences are controlled by an outside agency. Suspicious beliefs, hallucinations and compulsions belong to different phenomenological categories.

Question 5 of 100Psychiatry: eating disordersHard

Which biochemical pattern is most typical after recurrent self-induced vomiting in bulimia nervosa?

AHypocalcaemic respiratory acidosis with raised chlorideBHypokalaemic, hypochloraemic metabolic alkalosisCHyperkalaemic, hyperchloraemic metabolic acidosisDHypernatraemic respiratory alkalosis with normal potassium

Correct.

Not quite.

Correct answer: Hypokalaemic, hypochloraemic metabolic alkalosis

Loss of gastric hydrochloric acid promotes metabolic alkalosis and chloride depletion; renal compensation and volume depletion contribute to potassium loss. The pattern is clinically important because hypokalaemia can provoke arrhythmias.

Question 6 of 100Paraphilias: history of classificationHard

What happened to 'ego-dystonic homosexuality' in the 1987 DSM-III-R revision?

AIt was moved into a residual paraphilic-disorders categoryBIt was renamed persistent sexual-orientation conflictCIt was removed as a diagnosisDIt was retained but restricted to people seeking orientation change

Correct.

Not quite.

Correct answer: It was removed as a diagnosis

After homosexuality had been removed as a disorder category in the 1970s, the residual diagnosis of ego-dystonic homosexuality remained for a time. DSM-III-R removed it in 1987, reflecting recognition that sexual orientation itself is not a mental disorder.

Question 7 of 100Clinical psychology: exposureHard

According to the inhibitory-learning account of exposure therapy, successful exposure primarily establishes:

AComplete erasure of the original conditioned fear association through repeated non-reinforcementBCertainty that the feared outcome is objectively impossibleCA relaxed physiological state that generalises automatically across contextsDA competing inhibitory expectancy that the feared event need not occur

Correct.

Not quite.

Correct answer: A competing inhibitory expectancy that the feared event need not occur

Extinction learning is new learning, not unlearning. The original fear association can return through renewal, reinstatement or spontaneous recovery, so exposure aims to make inhibitory learning strong and retrievable across contexts.

Question 8 of 100Clinical psychology: ACTHard

In acceptance and commitment therapy, cognitive defusion is intended to:

AEvaluate evidence and replace distorted thoughts with more accurate onesBNotice thoughts as mental events, not literal facts or commandsCSuppress unwanted thoughts through sustained attentional controlDRepeat feared thoughts until their emotional impact gradually habituates

Correct.

Not quite.

Correct answer: Notice thoughts as mental events, not literal facts or commands

Defusion changes the relationship to thoughts rather than disputing every thought's content. A person learns to notice verbal events as thoughts while choosing behaviour in line with values.

Question 9 of 100Clinical psychology: psychotherapy processMedium

In Bordin's influential model, the working alliance has which three components?

ASymptom reduction, adherence to treatment and timely discharge planningBAccurate empathy, formal diagnosis and confidence in the therapist's expertiseCInterpretation of transference, development of insight and emotional catharsisDShared treatment goals, agreed therapeutic tasks and a relational bond

Correct.

Not quite.

Correct answer: Shared treatment goals, agreed therapeutic tasks and a relational bond

The working alliance is a collaboration around goals and therapeutic tasks supported by a relational bond. The model was deliberately broad enough to apply across therapy orientations.

Question 10 of 100Paraphilias: assessmentHard

What does penile plethysmography most directly measure in a forensic or specialist assessment?

AActuarial recidivism risk derived from static historical factorsBChanges in penile circumference or volume during standardised stimuliCVisual reaction time as an indirect measure of attentional preferenceDSelf-reported attraction across age and gender categories

Correct.

Not quite.

Correct answer: Changes in penile circumference or volume during standardised stimuli

Phallometry records physiological genital response patterns. It can contribute to a wider assessment but has technical, ethical and interpretive limitations and is not a standalone diagnosis or lie detector.

Question 11 of 100Psychiatry: mood disordersMedium

A patient in a severe depressive episode is convinced they have bankrupted their family despite clear evidence of financial security. The delusion is best described as:

APersecutoryBMood-incongruentCNihilisticDMood-congruent

Correct.

Not quite.

Correct answer: Mood-congruent

Delusions of guilt, ruin, worthlessness or deserved punishment are congruent with depressive mood. Mood congruence concerns thematic fit with the mood state, not whether the belief is plausible.

Question 12 of 100Psychiatry: depressionMedium

Behavioural activation for depression most directly targets which maintaining process?

AAvoidance and inactivity that reduce access to rewarding experiencesBBiased appraisals that generate recurrent negative automatic thoughtsCOvergeneral recall of autobiographical memories from the person's pastDUnresolved interpersonal disputes and difficult role transitions

Correct.

Not quite.

Correct answer: Avoidance and inactivity that reduce access to rewarding experiences

Behavioural activation links mood to patterns of avoidance and reduced reinforcement. Treatment systematically increases engagement in meaningful, planned activities rather than waiting for motivation to return first.

Question 13 of 100Clinical psychology: psychotherapy researchHard

Why may a psychotherapy appear more effective against a waiting-list control than against a credible active control?

AWaiting lists do not match attention, expectancy or therapeutic contactBActive control conditions cannot be allocated using concealed randomisationCWaiting-list designs prevent spontaneous recovery and regression to the meanDWaiting-list participants usually have greater baseline severity after randomisation

Correct.

Not quite.

Correct answer: Waiting lists do not match attention, expectancy or therapeutic contact

Control conditions shape effect estimates. A credible active control better matches nonspecific treatment ingredients, so the between-group difference more closely isolates the intervention's specific contribution.

Question 14 of 100Clinical psychology: CBTHard

Why can 'safety behaviours' maintain social anxiety even when they appear to help a person cope?

AThey convert anxious predictions into fixed psychotic beliefs over timeBThey directly amplify autonomic arousal throughout every social encounterCThey reduce self-focused attention before corrective learning can occurDThey prevent learning what happens without the protective behaviour

Correct.

Not quite.

Correct answer: They prevent learning what happens without the protective behaviour

Safety behaviours can make a tolerable encounter seem dependent on concealment, rehearsal, avoidance or reassurance. This blocks disconfirmation of the threat belief and may also worsen self-monitoring.

Question 15 of 100Psychiatry: psychopharmacologyMedium

A patient started on an antipsychotic reports unbearable inner restlessness and repeatedly paces, saying they cannot keep still. What is the most likely adverse effect?

ATardive dyskinesiaBAkathisiaCAcute dystoniaDDrug-induced parkinsonism

Correct.

Not quite.

Correct answer: Akathisia

Akathisia is a subjective sense of inner restlessness accompanied by observable motor activity such as pacing. It can be intensely distressing and is sometimes mistaken for anxiety or agitation.

Question 16 of 100Clinical psychology: research methodsMedium

Patients are selected for treatment because they scored extremely high on a distress scale. On retesting, their average score falls even if the intervention has no effect. What statistical phenomenon is this?

ARegression toward the meanBSelection-induced collider biasCAttenuation from restricted rangeDSimpson's reversal paradox

Correct.

Not quite.

Correct answer: Regression toward the mean

Extreme scores contain both stable signal and chance fluctuation. When people are selected at an extreme, random components are less likely to be equally extreme on retest, producing apparent improvement without causation.

Question 17 of 100Psychiatry: somatic disordersHard

In somatic symptom disorder, which statement is most accurate?

AThe physical symptoms need not be medically unexplainedBA proven medical illness rules out the diagnosisCThe symptoms must be consciously fabricatedDThe diagnosis requires a delusional conviction of infestation

Correct.

Not quite.

Correct answer: The physical symptoms need not be medically unexplained

Modern diagnostic formulations focus on disproportionate thoughts, anxiety or behaviour related to symptoms, not on proving that symptoms lack a medical explanation. Genuine medical disease and somatic symptom disorder can coexist.

Question 18 of 100Clinical psychology: psychotherapy researchMedium

In a psychotherapy trial, what does treatment-fidelity assessment primarily examine?

AWhether the outcome difference was large enough to matter clinicallyBWhether the diagnostic interview achieved adequate predictive accuracyCWhether treatment was delivered as intended and distinct from controlsDWhether participants regarded the assigned treatment as credible

Correct.

Not quite.

Correct answer: Whether treatment was delivered as intended and distinct from controls

Fidelity includes therapist adherence, competence and differentiation between conditions. Without it, a null result might reflect poor implementation, while a positive result may be hard to attribute to the specified model.

Question 19 of 100Paraphilias: diagnosisMedium

Exhibitionistic disorder is primarily defined by recurrent arousal from:

AExposing the genitals to an unsuspecting personBWearing clothing culturally associated with another genderCReceiving pain in a consensual sexual contextDWatching consensually produced sexual material

Correct.

Not quite.

Correct answer: Exposing the genitals to an unsuspecting person

The defining pattern involves exposing the genitals to an unsuspecting person. The diagnostic threshold additionally requires acting on urges with a non-consenting person or clinically significant distress or impairment, depending on the system and criterion set.

Question 20 of 100Clinical psychology: psychometricsMedium

Which statement best distinguishes reliability from validity?

AA measure may be valid even if repeated scores are wholly inconsistentBA measure can be highly consistent yet systematically measure the wrong constructCValidity is simply the internal consistency of items within a scaleDReliability establishes that the measured diagnostic category exists in nature

Correct.

Not quite.

Correct answer: A measure can be highly consistent yet systematically measure the wrong construct

Reliability concerns consistency or precision; validity concerns whether interpretations and uses of scores are justified. Reliability is necessary for many forms of validity but cannot establish them by itself.

Question 21 of 100Paraphilias: classificationMedium

Which statement best reflects the DSM-5-TR distinction between a paraphilia and a paraphilic disorder?

AA disorder exists whenever the interest is prohibited by local criminal lawBEvery statistically unusual sexual interest is classified as a mental disorderCAtypical interest alone is insufficient; distress, impairment or harm is requiredDRequesting professional help is itself sufficient to establish a disorder

Correct.

Not quite.

Correct answer: Atypical interest alone is insufficient; distress, impairment or harm is required

DSM separates atypical sexual interests from paraphilic disorders. Disorder generally requires clinically significant personal distress or impairment, or an interest or behaviour involving harm, non-consent or persons unable to consent.

Question 22 of 100Psychiatry: substance-related disordersHard

A malnourished person with heavy alcohol use is confused and at risk of Wernicke encephalopathy. What is the key principle when giving carbohydrate?

ADelay thiamine until several days of feeding have established metabolic toleranceBWithhold carbohydrate until laboratory tests confirm clinically significant thiamine deficiencyCGive thiamine before or with carbohydrate, but never delay emergency glucoseDGive glucose first and add thiamine only if the confusion fails to improve

Correct.

Not quite.

Correct answer: Give thiamine before or with carbohydrate, but never delay emergency glucose

Thiamine is required for carbohydrate metabolism, and deficiency can precipitate or worsen Wernicke encephalopathy. Thiamine should be given promptly before or alongside carbohydrate, but life-threatening hypoglycaemia must still be treated immediately.

Question 23 of 100Clinical psychology: evidence synthesisHard

In a meta-analysis, what can an asymmetric funnel plot legitimately suggest?

AProof that the pooled effect is sufficiently large to matter clinicallyBDefinitive evidence that investigators suppressed all unfavourable findingsCConfirmation that every included study has a low risk of methodological biasDPossible small-study effects, with publication bias among several explanations

Correct.

Not quite.

Correct answer: Possible small-study effects, with publication bias among several explanations

Funnel-plot asymmetry can reflect publication bias, selective reporting, heterogeneity, methodological differences or chance. It is a diagnostic clue, not a verdict.

Question 24 of 100Psychiatry: phenomenologyMedium

An older inpatient becomes disoriented overnight, cannot sustain attention, and alternates between lucidity and marked confusion over hours. Which feature most strongly distinguishes delirium from a primary psychotic disorder?

AFormed visual hallucinations occurring after darkBReversal or fragmentation of the sleep–wake cycleCFluctuating impairment of attention and awarenessDPersecutory ideas emerging during a confused state

Correct.

Not quite.

Correct answer: Fluctuating impairment of attention and awareness

Delirium is defined chiefly by an acute disturbance of attention and awareness with a fluctuating course. Psychosis may include delusions or hallucinations, but it does not by itself produce the characteristic waxing and waning attentional deficit.

Question 25 of 100Psychiatry: neuropsychiatryHard

Which feature should make a clinician particularly cautious about prescribing antipsychotics to a person with dementia with Lewy bodies?

ASevere neuroleptic sensitivity can cause marked motor and systemic deteriorationBDopamine blockade improves hallucinations without materially affecting parkinsonian symptomsCAll antipsychotics accumulate because Lewy body disease impairs hepatic metabolismDAntipsychotics selectively worsen cognition while leaving motor function relatively unaffected

Correct.

Not quite.

Correct answer: Severe neuroleptic sensitivity can cause marked motor and systemic deterioration

People with dementia with Lewy bodies can have marked sensitivity to antipsychotics, including severe worsening of parkinsonism, confusion or systemic reactions. If antipsychotics are used, the risk-benefit judgement is especially demanding.

Question 26 of 100Paraphilias: risk assessmentHard

What is the primary purpose of the Static-99R?

AImmediate risk of violence during the next twenty-four hoursBChangeable treatment targets associated with imminent offending riskCSexual-interest patterns inferred from physiological responses to stimuliDRelative sexual-recidivism risk estimated from static historical factors

Correct.

Not quite.

Correct answer: Relative sexual-recidivism risk estimated from static historical factors

Static-99R is an actuarial recidivism-risk instrument for particular adult male populations with a history of sexual offending. It does not diagnose sexual interests, determine guilt or provide a complete dynamic risk formulation.

Question 27 of 100Psychiatry: psychotic disordersHard

Which longitudinal finding is specifically required for schizoaffective disorder in DSM-5-TR, but not for bipolar disorder with psychotic features?

AA major depressive episode persisting for at least two consecutive weeksBMarked social or occupational decline during the course of the illnessCTwo weeks of hallucinations or delusions without a major mood episodeDPsychotic symptoms occurring exclusively during a clearly syndromal mood episode

Correct.

Not quite.

Correct answer: Two weeks of hallucinations or delusions without a major mood episode

DSM-5-TR schizoaffective disorder requires a period of psychosis in the absence of a major mood episode, while mood episodes occupy most of the illness. In bipolar disorder with psychotic features, psychosis is confined to mood episodes.

Question 28 of 100Psychiatry: psychopharmacologyHard

Which antipsychotic is especially associated with clinically significant prolactin elevation?

AQuetiapineBRisperidoneCClozapineDAripiprazole

Correct.

Not quite.

Correct answer: Risperidone

Risperidone and its metabolite paliperidone commonly raise prolactin through dopamine D2 blockade in the tuberoinfundibular pathway. Aripiprazole's partial agonism often makes it prolactin-sparing.

Question 29 of 100Paraphilias: diagnosis and consentMedium

Which situation most clearly supports a diagnosis of sexual sadism disorder rather than merely a consensual sadistic interest?

ARecurrent sexual arousal from suffering enacted with a non-consenting personBEnjoyment of dominance or aggression within a competitive sporting contextCRepeated aggressive fantasies that contain no specifically sexual arousalDConsensual sadomasochistic role-play without significant distress or impairment

Correct.

Not quite.

Correct answer: Recurrent sexual arousal from suffering enacted with a non-consenting person

DSM criteria distinguish consensual interests from disorder, while non-consensual enactment directly meets the harm-related threshold. ICD-11 separately names coercive sexual sadism disorder.

Question 30 of 100Paraphilias: ICD-11Hard

How does ICD-11 generally handle fetishistic and transvestic interests compared with older classifications?

ABoth remain named disorders whenever the interests are recurrent and intenseBBoth are classified as secondary manifestations of an underlying psychotic disorderCBoth are classified as compulsive sexual behaviour regardless of consent or impairmentDNeither is named; residual diagnosis requires non-stigma distress or serious risk

Correct.

Not quite.

Correct answer: Neither is named; residual diagnosis requires non-stigma distress or serious risk

ICD-11 narrowed the paraphilic-disorder section toward patterns involving non-consenting persons. Solitary or consensual patterns can be classified only when they produce marked, non-stigma-based distress or significant injury or death risk.

Question 31 of 100Clinical psychology: psychotherapy researchHard

The 'Dodo bird verdict' in psychotherapy research is the debated claim that:

APsychotherapy produces no greater benefit than an untreated waiting listBOnly behavioural treatments produce durable change across disordersCTherapist competence contributes nothing once a manual is followedDDifferent bona fide psychotherapies tend to yield broadly similar outcomes

Correct.

Not quite.

Correct answer: Different bona fide psychotherapies tend to yield broadly similar outcomes

The Dodo bird debate concerns whether bona fide therapies are approximately equivalent because common factors dominate, or whether specific methods produce meaningful differential effects for particular disorders and outcomes.

Question 32 of 100Clinical psychology: psychodynamic conceptsMedium

In psychotherapy, transference most conventionally refers to:

AThe patient's conscious appraisal of the therapist's expertise and credibilityBThe therapist's personal reactions to the patient and the treatmentCThe patient's prior relational expectations being replayed with the therapistDThe patient's use of therapeutic skills in relationships outside treatment

Correct.

Not quite.

Correct answer: The patient's prior relational expectations being replayed with the therapist

Transference concerns how prior relational templates shape the patient's experience of the therapist. It is not confined to psychoanalysis and can be noticed in many forms of therapy.

Question 33 of 100Psychiatry: personality disordersHard

What is the defining structural change in the ICD-11 approach to personality disorder?

AA single personality-disorder diagnosis graded by severity, with trait qualifiersBRetention of ten categorical personality types, each graded only by symptom countCReplacement of personality-disorder diagnosis by trait scores with no severity judgementDA hybrid system requiring one categorical type plus two mandatory trait domains

Correct.

Not quite.

Correct answer: A single personality-disorder diagnosis graded by severity, with trait qualifiers

ICD-11 replaced the former set of discrete personality-disorder categories with a dimensional system based chiefly on severity, supplemented by trait-domain qualifiers and a borderline-pattern qualifier.

Question 34 of 100Clinical psychology: psychotherapy processHard

A strong therapeutic alliance correlates with good outcome. Which alternative explanation most directly illustrates reverse causation?

APatient motivation may independently improve both alliance and treatment outcomeBTherapists who form alliances well may also deliver techniques more competentlyCEarly symptom improvement leads both parties to rate the alliance more highlyDAlliance and outcome ratings may share the same respondent and response biases

Correct.

Not quite.

Correct answer: Early symptom improvement leads both parties to rate the alliance more highly

Alliance may facilitate change, but reverse causation and shared factors are plausible: improvement can strengthen hope and collaboration, and patient characteristics may influence both alliance and outcome. Longitudinal and adjusted analyses are needed.

Question 35 of 100Paraphilias: classification systemsHard

Which named category appears in ICD-11 but not among the eight named DSM-5 paraphilic disorders?

ACoercive sexual sadism disorder involving non-consenting personsBSexual masochism disorder involving consensual pain or humiliationCExhibitionistic disorder involving exposure to unsuspecting personsDVoyeuristic disorder involving observation of unsuspecting persons

Correct.

Not quite.

Correct answer: Coercive sexual sadism disorder involving non-consenting persons

ICD-11 includes coercive sexual sadism disorder, focusing on arousal from the suffering of non-consenting persons. DSM-5 instead names sexual sadism disorder and uses its own criteria and specifiers.

Question 36 of 100Psychiatry: neuropsychiatryHard

Which cognitive profile is most characteristic of Korsakoff syndrome?

AFluctuating attention with visual hallucinationsBIsolated loss of procedural memoryCProgressive aphasia with preserved new learningDSevere anterograde amnesia with confabulation

Correct.

Not quite.

Correct answer: Severe anterograde amnesia with confabulation

Korsakoff syndrome, usually related to thiamine deficiency, prominently impairs new learning and may produce confabulation. Procedural memory can be relatively preserved.

Question 37 of 100Psychiatry: mood disordersHard

Under DSM-5-TR conventions, which feature by itself makes an elevated-mood episode mania rather than hypomania?

AReduced need for sleepBPsychosis during the episodeCUncharacteristic talkativenessDIncreased goal-directed activity

Correct.

Not quite.

Correct answer: Psychosis during the episode

Psychotic features make the episode manic, irrespective of duration. The other features occur in both mania and hypomania; the distinction also depends on severity, marked impairment, hospitalisation and duration.

Question 38 of 100Paraphilias: classificationHard

Which statement about hebephilia is most accurate in DSM-5-TR classification?

AIt is not a separately named DSM-5-TR paraphilic disorderBIt automatically qualifies as other specified paraphilic disorderCIt is the DSM term for attraction to people in late adolescenceDIt is a named subtype of pedophilic disorder involving pubescent minors

Correct.

Not quite.

Correct answer: It is not a separately named DSM-5-TR paraphilic disorder

Hebephilia refers in research and debate to sexual interest in pubescent or early-adolescent individuals, but it is not a separately named DSM-5-TR diagnosis. Attempts to infer a diagnosis from the term alone are therefore misleading.

Question 39 of 100Psychiatry: psychopharmacologyHard

Which adverse effect of clozapine is common, potentially fatal, and liable to be underestimated if clinicians focus only on blood counts?

AMyocarditis presenting with chest pain, tachycardia or breathlessnessBAgranulocytosis detected through mandatory neutrophil monitoringCDose-related seizures, particularly at high plasma concentrationsDSevere gastrointestinal hypomotility causing ileus or bowel obstruction

Correct.

Not quite.

Correct answer: Severe gastrointestinal hypomotility causing ileus or bowel obstruction

Clozapine can cause profound constipation, ileus and gastrointestinal hypomotility, which can be fatal. Agranulocytosis is better known, but bowel monitoring and prompt treatment of constipation are also essential.

Question 40 of 100Psychiatry: functional disordersHard

Which finding is most useful as positive evidence for functional limb weakness rather than merely evidence that tests are normal?

AStructural imaging is normal despite persistent reported weaknessBHip extension improves automatically during forceful contralateral hip flexionCWeakness follows a consistent myotomal pattern on repeated examinationDReflexes are reduced in the same distribution as the reported weakness

Correct.

Not quite.

Correct answer: Hip extension improves automatically during forceful contralateral hip flexion

Hoover's sign demonstrates internal inconsistency: apparent weakness during direct testing improves during an automatic synergistic movement. Functional neurological disorder should be diagnosed using positive signs, not simply by exclusion.

Question 41 of 100Clinical psychology: psychotherapy researchHard

What is the purpose of a dismantling study of a multicomponent psychotherapy?

ATo estimate how therapist allegiance differs across treatment orientationsBTo compare the same treatment at different session frequencies or intensitiesCTo compare the full treatment with a version missing one componentDTo test whether outcome is mediated by change in a proposed mechanism

Correct.

Not quite.

Correct answer: To compare the full treatment with a version missing one component

Dismantling designs compare a full treatment with a version lacking one component. They can clarify active ingredients, although interactions between components and statistical power complicate interpretation.

Question 42 of 100Clinical psychology: outcome measurementHard

What question does a Reliable Change Index address for an individual patient?

AWhether change exceeds the amount expected from measurement error aloneBWhether the average group difference reaches statistical significanceCWhether the patient has crossed a formal diagnostic thresholdDWhether the treating clinician adhered closely to the therapy manual

Correct.

Not quite.

Correct answer: Whether change exceeds the amount expected from measurement error alone

The RCI standardises an individual's pre-post change using the measure's reliability and variability. It concerns change beyond measurement noise, which is distinct from recovery or movement into a non-clinical range.

Question 43 of 100Paraphilias: diagnosisMedium

Frotteuristic disorder centres on recurrent sexual arousal involving:

ATouching or rubbing against a non-consenting personBBeing humiliated by a consenting partnerCObserving an unsuspecting person who is naked or sexually activeDExposing one's genitals to an unsuspecting person

Correct.

Not quite.

Correct answer: Touching or rubbing against a non-consenting person

Frotteuristic disorder involves touching or rubbing against a non-consenting person. Voyeuristic and exhibitionistic disorders involve different non-consensual acts; consensual humiliation may fall outside disorder unless other criteria are met.

Question 44 of 100Psychiatry: psychopharmacologyHard

What pharmacological description best distinguishes aripiprazole from most older antipsychotics?

AIrreversible antagonism at dopamine D2 receptorsBSelective antagonism at dopamine D1 receptorsCInhibition of presynaptic dopamine synthesisDPartial agonism at dopamine D2 receptors

Correct.

Not quite.

Correct answer: Partial agonism at dopamine D2 receptors

Aripiprazole acts as a partial agonist at D2 receptors, alongside serotonergic actions. Most first-generation antipsychotics are primarily D2 antagonists.

Question 45 of 100Psychiatry: physical treatmentsMedium

In which situation is electroconvulsive therapy particularly valued because a rapid response may be lifesaving?

AChronic schizophrenia dominated by persistent negative symptomsBPanic disorder with frequent attacks but no depressive syndromeCSevere depression improving slowly but with stable nutrition and hydrationDSevere psychotic depression with refusal of food and fluids

Correct.

Not quite.

Correct answer: Severe psychotic depression with refusal of food and fluids

ECT is considered for severe, potentially life-threatening depression and for catatonia or severe mania in selected cases, especially when rapid improvement is required or other treatments have failed.

Question 46 of 100Psychiatry: psychotic disordersHard

Which statement best captures the current clinical meaning of 'treatment-resistant schizophrenia'?

AA psychotic relapse following withdrawal of an otherwise effective antipsychoticBContinuing symptoms during irregular adherence to several antipsychotic drugsCPersistent symptoms despite two adequate antipsychotic trialsDPersistent negative symptoms after one brief trial at a low dose

Correct.

Not quite.

Correct answer: Persistent symptoms despite two adequate antipsychotic trials

Treatment resistance generally means inadequate response despite two antipsychotic trials of sufficient dose, duration and adherence. Establishing adequacy matters before clozapine is considered.

Question 47 of 100Clinical psychology: outcome measurementMedium

A trial finds a statistically significant two-point improvement on a 60-point symptom scale. What additional question is captured by a minimal clinically important difference?

AWhether treatment explains a large proportion of outcome-score varianceBWhether the observed group difference is unlikely under a null hypothesisCWhether the magnitude of change matters to patients or clinical decisionsDWhether an individual's change exceeds expected measurement error

Correct.

Not quite.

Correct answer: Whether the magnitude of change matters to patients or clinical decisions

Statistical significance concerns compatibility with a null model and is influenced by sample size. A clinically important difference asks whether the magnitude matters in lived or treatment terms.

Question 48 of 100Psychiatry: psychopharmacologyHard

Why can starting a regular NSAID such as ibuprofen raise concern in a patient stabilised on lithium?

AIt induces hepatic enzymes that increase the metabolic clearance of lithiumBIt raises gastric pH and thereby increases gastrointestinal lithium absorptionCIt displaces lithium from circulating plasma protein-binding sitesDIt reduces renal lithium clearance through altered renal perfusion

Correct.

Not quite.

Correct answer: It reduces renal lithium clearance through altered renal perfusion

Lithium is cleared by the kidneys. NSAIDs can reduce renal lithium clearance, causing serum levels to rise; the interaction is clinically important and may require avoidance or closer monitoring.

Question 49 of 100Paraphilias: treatmentHard

What is a major intended effect of gonadotropin-releasing hormone agonists when used in severe paraphilic disorders?

AReducing intrusive thoughts through a primarily serotonergic mechanismBBlocking peripheral erections while leaving central sexual drive unchangedCSuppressing gonadal testosterone and substantially reducing sexual driveDExtinguishing conditioned arousal through memory reconsolidation

Correct.

Not quite.

Correct answer: Suppressing gonadal testosterone and substantially reducing sexual drive

GnRH agonists suppress gonadal testosterone and can markedly reduce sexual drive and fantasy intensity. They require consent, careful indication and monitoring for substantial adverse effects; they do not simply delete a preference or replace psychosocial risk management.

Question 50 of 100Paraphilias: treatmentHard

Why might an SSRI be considered in some people with a paraphilic disorder?

AIt is selected when immediate and profound androgen suppression is requiredBIt may reduce preoccupation and treat comorbid depression or obsessive symptomsCIt changes arousal preference through aversive pharmacological conditioningDIt is indicated only when elevated testosterone has been clinically demonstrated

Correct.

Not quite.

Correct answer: It may reduce preoccupation and treat comorbid depression or obsessive symptoms

SSRIs may help when repetitive urges have an obsessive-compulsive quality, when mood or anxiety disorders coexist, and through libido-reducing sexual effects. Evidence and treatment goals vary, so medication is part of an individual formulation rather than a universal cure.

Question 51 of 100Psychiatry: obsessive-compulsive disordersMedium

In exposure and response prevention for obsessive-compulsive disorder, 'response prevention' primarily means:

ARefraining from rituals or neutralising after confronting the triggerBPostponing exposure until anticipatory anxiety has fully subsidedCReappraising the probability of danger immediately after each triggerDUsing distraction to suppress the intrusive thought during exposure

Correct.

Not quite.

Correct answer: Refraining from rituals or neutralising after confronting the trigger

ERP deliberately evokes obsessional fear while preventing compulsions or neutralising responses. This allows new learning that anxiety and uncertainty can be tolerated without ritualising.

Question 52 of 100Clinical psychology: psychodynamic conceptsHard

What distinguishes projective identification from simple projection in many psychodynamic accounts?

AAttributing a disowned feeling to another person without any interpersonal enactmentBAn enactment pressuring the recipient toward the projected emotional stateCIdentifying with another person's admired qualities to regulate self-esteemDConsciously provoking another person in order to control their behaviour

Correct.

Not quite.

Correct answer: An enactment pressuring the recipient toward the projected emotional state

Projection is attribution of disowned material to another. Projective identification additionally describes an interpersonal enactment in which the other person may be induced to feel or behave in ways congruent with the projection.

Question 53 of 100Clinical psychology: OCD treatmentMedium

In exposure and response prevention for contamination-focused OCD, which procedure most directly tests the maintaining belief?

ATouching a feared surface and then not washing or seeking reassuranceBCompleting the usual washing ritual but shortening it by several minutesCReplacing thoughts about germs with deliberately reassuring mental imagesDDiscussing contamination beliefs while avoiding direct contact with feared cues

Correct.

Not quite.

Correct answer: Touching a feared surface and then not washing or seeking reassurance

ERP combines exposure to the feared cue with prevention of rituals and subtle neutralising. This permits learning about uncertainty, distress tolerance and the actual consequences of not compulsively washing.

Question 54 of 100Psychiatry: emergenciesHard

Which examination finding most strongly favours serotonin syndrome over neuroleptic malignant syndrome?

AInducible or spontaneous clonus with hyperreflexiaBA unilateral resting tremor with cogwheel rigidityCProfound muscle weakness with reduced tendon reflexesDGeneralised lead-pipe rigidity with slowed voluntary movement

Correct.

Not quite.

Correct answer: Inducible or spontaneous clonus with hyperreflexia

Serotonin toxicity is characterised by neuromuscular excitation, especially clonus and hyperreflexia, often with rapid onset. Neuroleptic malignant syndrome more typically causes generalised lead-pipe rigidity and evolves more slowly.

Question 55 of 100Clinical psychology: assessmentMedium

A diagnostic instrument identifies 90 of 100 people who truly have a disorder. Which property is being described?

ASensitivityBSpecificityCInter-rater reliabilityDPositive predictive value

Correct.

Not quite.

Correct answer: Sensitivity

Sensitivity is the proportion of true cases correctly identified. Specificity is the proportion of non-cases correctly rejected; predictive values additionally depend on prevalence.

Question 56 of 100Paraphilias: diagnosisMedium

Voyeuristic disorder is most specifically associated with arousal from:

ATouching or rubbing against a stranger in a crowded public settingBReading another person's intimate correspondence without their permissionCObserving an unsuspecting person who is naked, disrobing or sexually activeDExposing one's genitals to an unsuspecting person for sexual arousal

Correct.

Not quite.

Correct answer: Observing an unsuspecting person who is naked, disrobing or sexually active

Voyeuristic disorder concerns observing an unsuspecting person in intimate circumstances. Ordinary curiosity, consensual viewing and non-sexual privacy violations do not by themselves meet this definition.

Question 57 of 100Clinical psychology: research methodsHard

In a single-case ABAB design, what is the main inferential value of withdrawing and then reintroducing treatment?

AWithdrawal prevents treatment carry-over effects from occurring by definitionBThe repeated phases provide a direct estimate of population prevalenceCThe design reliably blinds participants to the current treatment phaseDRepeated behaviour changes across treatment phases strengthen a causal inference

Correct.

Not quite.

Correct answer: Repeated behaviour changes across treatment phases strengthen a causal inference

If behaviour changes with introduction, reverses with withdrawal and changes again with reintroduction, alternative explanations become less plausible. The design is unsuitable when effects are irreversible or withdrawal is unsafe.

Question 58 of 100Psychiatry: mood disordersMedium

Which lifetime history is incompatible with a diagnosis of bipolar II disorder under DSM-style definitions?

AA manic episodeBPeriods of euthymiaCA major depressive episodeDA hypomanic episode

Correct.

Not quite.

Correct answer: A manic episode

Bipolar II disorder requires hypomanic and major depressive episodes and no history of mania. Once a manic episode has occurred, bipolar I is the relevant bipolar diagnosis, even if depression is prominent.

Question 59 of 100Paraphilias: classificationHard

Which set consists entirely of the eight named paraphilic disorders in DSM-5?

AVoyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, hebephilic, fetishistic and transvestic disordersBVoyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, compulsive sexual behaviour and transvestic disordersCVoyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, fetishistic and transvestic disordersDVoyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, fetishistic and gender dysphoria

Correct.

Not quite.

Correct answer: Voyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, fetishistic and transvestic disorders

The DSM-5 chapter names eight disorders. Other specified and unspecified paraphilic disorders can be used when appropriate, but hebephilia and compulsive sexual behaviour are not among the eight named categories.

Question 60 of 100Psychiatry: phenomenologyHard

During an interview, a patient's speech moves rapidly from one topic to another, but the links remain understandable through puns, distractions and associations. Which term best fits?

AIncoherenceBPoverty of speechCThought blockingDFlight of ideas

Correct.

Not quite.

Correct answer: Flight of ideas

Flight of ideas is a rapid succession of ideas with discernible associative links, typically seen in mania. In incoherence the links become unintelligible; thought blocking is an abrupt interruption; poverty of speech is reduced output.

Question 61 of 100Clinical psychology: psychodynamic conceptsHard

Countertransference is best understood in contemporary clinical use as:

AThe collaborative bond that supports agreement on therapeutic goals and tasksBThe therapist's emotional and behavioural responses within the relationshipCThe patient's feelings toward the therapist shaped by earlier relationshipsDThe therapist's deliberate self-disclosure to strengthen rapport and trust

Correct.

Not quite.

Correct answer: The therapist's emotional and behavioural responses within the relationship

Countertransference includes the therapist's reactions, which may reflect personal history, the patient's interpersonal impact and the dyadic process. It can be informative but also risks distorting care if unexamined.

Question 62 of 100Clinical psychology: assessmentHard

What was Paul Meehl's central finding in comparing clinical and statistical prediction?

AAdding intuition to a formula consistently improved prediction over the formulaBClinicians surpassed formulas when both used the same standardised predictorsCSimple actuarial methods often matched or outperformed unaided clinical judgementDStatistical methods worked only after experts assigned case-specific weights

Correct.

Not quite.

Correct answer: Simple actuarial methods often matched or outperformed unaided clinical judgement

Meehl showed that reproducible statistical rules often equal or beat informal clinical prediction. Expert judgement remains important for data quality, formulation and exceptional circumstances, but confidence is not a substitute for validation.

Question 63 of 100Psychiatry: catatoniaHard

A mute, immobile patient resists examination, maintains imposed postures and has no clear neurological explanation. Which bedside intervention is often used both as a diagnostic probe and an initial treatment for suspected catatonia?

AAn antipsychotic trial to reduce mutism, rigidity and posturingBA naloxone trial to reverse a possible opioid-related stuporCA lorazepam challenge to test for rapid clinical improvementDA levodopa trial to assess responsiveness to dopaminergic treatment

Correct.

Not quite.

Correct answer: A lorazepam challenge to test for rapid clinical improvement

A prompt improvement after lorazepam supports catatonia and benzodiazepines are first-line treatment in many cases. Lack of response does not exclude catatonia, and severe or persistent cases may require ECT.

Question 64 of 100Paraphilias: diagnosisMedium

In diagnostic terminology, pedophilic interest is principally directed toward:

AChildren who have not yet begun pubertyBAny person below the local age of consentCAdults who appear younger than their ageDPeople in late adolescence

Correct.

Not quite.

Correct answer: Children who have not yet begun puberty

Pedophilic disorder concerns a persistent, intense sexual interest in prepubescent children. Legal age-of-consent categories and pubertal-development categories are not identical.

Question 65 of 100Psychiatry: mood disordersMedium

Which clinical change most strongly suggests antidepressant-induced mania rather than ordinary early improvement in depression?

AReturn of appetite, concentration and ordinary interest after several weeksBReduced morning anxiety with no change in judgement or sleep needCNew grandiosity, markedly reduced need for sleep and risky goal-directed activityDTransient nausea and activation during the first few medication doses

Correct.

Not quite.

Correct answer: New grandiosity, markedly reduced need for sleep and risky goal-directed activity

Mania involves a qualitatively abnormal mood and activation syndrome, including decreased need for sleep, grandiosity and disinhibited or risky behaviour. Simple recovery of energy or appetite lacks this syndromal pattern.

Question 66 of 100Clinical psychology: psychometricsHard

Why is Cohen's kappa often preferred to simple percentage agreement when assessing two raters?

AIt guarantees that agreement reflects valid clinical classificationsBIt corrects observed agreement for chance-expected agreementCIt removes the influence of category prevalence from the estimateDIt converts categorical ratings into an equivalent continuous score

Correct.

Not quite.

Correct answer: It corrects observed agreement for chance-expected agreement

Kappa compares observed categorical agreement with chance-expected agreement. It can itself be affected by prevalence and rater bias, so it should not be interpreted mechanically.

Question 67 of 100Psychiatry: catatoniaHard

In catatonia, what does 'waxy flexibility' describe?

AOpposing examination movements without a stated or apparent motiveBSlight, even resistance followed by retention of the imposed postureCMaintaining an imposed posture after the examiner releases the supported limbDAutomatically imitating another person's gestures and movements

Correct.

Not quite.

Correct answer: Slight, even resistance followed by retention of the imposed posture

Waxy flexibility is a catatonic motor sign in which a limb offers mild, uniform resistance to repositioning and then remains where placed. Imitation of movement is echopraxia; emotion-triggered loss of tone is cataplexy.

Question 68 of 100Psychiatry: eating disordersMedium

In treating anorexia nervosa, why is weight restoration regarded as a central rather than merely cosmetic goal?

AIt provides an objective outcome that can replace psychological assessmentBMalnutrition itself sustains cognitive, emotional and physical dysfunctionCIt predicts recovery regardless of persisting eating-disorder psychopathologyDIt permits psychotherapy to wait until distorted beliefs resolve spontaneously

Correct.

Not quite.

Correct answer: Malnutrition itself sustains cognitive, emotional and physical dysfunction

NICE emphasises reaching a healthy weight because malnutrition impairs cognition, mood, physical health and engagement with therapy. Weight restoration is necessary but not sufficient for full recovery.

Question 69 of 100Clinical psychology: behavioural therapyHard

Which intervention best exemplifies behavioural activation rather than simple activity scheduling?

AFilling the week with activities without analysing avoidance or reinforcementBUsing relaxation whenever sadness, fatigue or guilt begins to riseCChoosing activities through functional analysis of avoidance and reinforcementDTesting the evidence for automatic thoughts before changing behaviour

Correct.

Not quite.

Correct answer: Choosing activities through functional analysis of avoidance and reinforcement

Behavioural activation uses monitoring and functional analysis to reduce avoidance and increase contact with meaningful or reinforcing activity. A crowded diary alone can reproduce failure, exhaustion or avoidance.

Question 70 of 100Clinical psychology: anxiety treatmentMedium

Which exercise is an example of interoceptive exposure in panic treatment?

ASpinning deliberately to provoke dizziness, then remaining with the sensationsBSeeking repeated reassurance that bodily sensations are medically harmlessCWriting a detailed account of a traumatic event in sessionDEntering a crowded shop and remaining until anxiety changes

Correct.

Not quite.

Correct answer: Spinning deliberately to provoke dizziness, then remaining with the sensations

Interoceptive exposure deliberately evokes feared bodily sensations such as dizziness, breathlessness or palpitations. In-vivo exposure targets external situations; reassurance can function as a safety behaviour.

Question 71 of 100Psychiatry: psychopharmacologyMedium

According to standard treatment guidance, which antipsychotic has a distinctive role after adequate trials of other antipsychotics have failed in schizophrenia?

AQuetiapineBClozapineCAripiprazoleDHaloperidol

Correct.

Not quite.

Correct answer: Clozapine

Clozapine is the key evidence-based treatment for treatment-resistant schizophrenia. Its use is limited by potentially serious adverse effects and the need for structured monitoring.

Question 72 of 100Psychiatry: psychopharmacologyMedium

Why is valproate subject to unusually strict reproductive-safety controls in the UK?

APrenatal exposure substantially raises congenital and neurodevelopmental risksBIt strongly induces enzymes and reliably defeats hormonal contraceptionCIt markedly increases the maternal risk of venous thrombosisDIt commonly causes permanent infertility after prolonged treatment

Correct.

Not quite.

Correct answer: Prenatal exposure substantially raises congenital and neurodevelopmental risks

Valproate exposure in pregnancy is associated with major congenital and neurodevelopmental risks. UK controls therefore restrict initiation and require specialist review and risk-management measures.

Question 73 of 100Psychiatry: diagnostic reasoningHard

Which feature most clearly distinguishes malingering from factitious disorder?

AMarked inconsistencies between reported symptoms and observed functioningBRepeated presentation to different services under changing clinical historiesCA clear external incentive, such as money or avoiding prosecutionDDeliberate production of symptoms that are presented as genuine illness

Correct.

Not quite.

Correct answer: A clear external incentive, such as money or avoiding prosecution

Both malingering and factitious disorder can involve intentional symptom production. Malingering is motivated by external gain, whereas factitious disorder is driven by adopting the patient role without an obvious external reward.

Question 74 of 100Clinical psychology: ACTMedium

What does 'psychological flexibility' mean in the ACT model?

ARevise core beliefs until they become consistently positiveBAct with awareness and values while allowing internal experienceCRegulate emotion until distress is absent before taking actionDUse adaptive distraction to avoid difficult internal experiences

Correct.

Not quite.

Correct answer: Act with awareness and values while allowing internal experience

Psychological flexibility involves openness to internal experience, present-moment awareness and committed action in valued directions. It does not require feeling good or removing unwanted thoughts.

Question 75 of 100Paraphilias: clinical formulationHard

Which formulation is most clinically defensible when assessing a person with an atypical sexual interest?

AUse the diagnostic label as the main proxy for offending risk and consentBAssess interest, diagnosis, behaviour, consent, impairment and risk separatelyCFocus on past behaviour because subjective distress adds little to formulationDCombine interest, behaviour and risk into one global clinical judgement

Correct.

Not quite.

Correct answer: Assess interest, diagnosis, behaviour, consent, impairment and risk separately

Clinical diagnosis, illegal or harmful behaviour and recidivism risk are related but non-identical questions. A defensible assessment keeps them separate, uses collateral information where appropriate and states the limits of inference.

Question 76 of 100Psychiatry: psychotic disordersMedium

Which finding is conventionally classified as a negative symptom of schizophrenia?

AAuditory hallucinationsBThought insertionCPersecutory delusionsDAvolition

Correct.

Not quite.

Correct answer: Avolition

Avolition is reduced initiation and persistence of goal-directed activity. Hallucinations, delusions and passivity experiences are positive symptoms because they add abnormal experiences or beliefs.

Question 77 of 100Clinical psychology: assessmentHard

A screening test has high sensitivity and specificity, but the disorder is extremely rare in the tested population. What problem may still arise?

AMany positive results may still be false because prevalence is lowBThe test's specificity necessarily falls as the disorder becomes less prevalentCLow prevalence prevents reliable estimation of agreement between repeated testsDMost negative results may still be missed cases because sensitivity is imperfect

Correct.

Not quite.

Correct answer: Many positive results may still be false because prevalence is low

Positive predictive value depends strongly on prevalence. Even a good test can generate more false than true positives when applied indiscriminately to a very low-base-rate condition.

Question 78 of 100Psychiatry: neuropsychiatryMedium

Which early presentation is more suggestive of behavioural-variant frontotemporal dementia than typical Alzheimer's disease?

AEarly episodic-memory loss with relatively preserved social conductBFluctuating cognition with recurrent formed visual hallucinationsCEarly disinhibition, loss of empathy and socially inappropriate behaviourDAsymmetric apraxia with cortical sensory loss and limb rigidity

Correct.

Not quite.

Correct answer: Early disinhibition, loss of empathy and socially inappropriate behaviour

Behavioural-variant frontotemporal dementia often begins with personality and social-conduct change, apathy, disinhibition or loss of empathy. Typical Alzheimer's disease more often begins with episodic-memory difficulty.

Question 79 of 100Psychiatry: phenomenologyMedium

A patient is convinced that their spouse has been replaced by an identical-looking impostor. Which named delusional misidentification syndrome is this?

ACapgras syndromeBDe Clérambault syndromeCCotard syndromeDFregoli syndrome

Correct.

Not quite.

Correct answer: Capgras syndrome

Capgras syndrome is the belief that a familiar person has been replaced by a double. Fregoli syndrome is the belief that different people are actually one disguised persecutor; Cotard syndrome centres on nihilistic beliefs; De Clérambault syndrome is erotomania.

Question 80 of 100Clinical psychology: MBTHard

Mentalization-based treatment for borderline personality disorder is especially concerned with improving the ability to:

AReplace uncertain interpretations with deliberately positive explanationsBSuppress emotional responses before they enter conscious awarenessCUnderstand behaviour through mental states under attachment stressDApply explicit social rules consistently across different relationships

Correct.

Not quite.

Correct answer: Understand behaviour through mental states under attachment stress

Mentalizing means understanding behaviour in relation to thoughts, feelings, intentions and beliefs. The capacity can collapse under high arousal or attachment threat, leading to rigid and inaccurate interpretations.

Question 81 of 100Psychiatry: psychopharmacologyHard

A patient taking lithium develops persistent thirst and large volumes of dilute urine. Which mechanism is most characteristic?

AIncreased aldosterone action causing renal potassium lossBExcess antidiuretic-hormone secretion causing water retentionCOsmotic diuresis caused by persistent hyperglycaemiaDReduced collecting-duct responsiveness to antidiuretic hormone

Correct.

Not quite.

Correct answer: Reduced collecting-duct responsiveness to antidiuretic hormone

Lithium can cause nephrogenic diabetes insipidus by reducing the kidney's response to antidiuretic hormone. The result is impaired urine concentration, polyuria and polydipsia.

Question 82 of 100Psychiatry: anxiety disordersMedium

Which temporal description best matches a panic attack?

APersistent generalised apprehension present on most days across several consecutive monthsBA trauma memory re-experienced with sustained arousal for several hoursCAn abrupt surge of intense fear or discomfort peaking within minutesDA recurrent intrusive thought followed by a neutralising ritual

Correct.

Not quite.

Correct answer: An abrupt surge of intense fear or discomfort peaking within minutes

Panic attacks are discrete surges that intensify rapidly, with cognitive and physical symptoms. Panic disorder additionally requires recurrent unexpected attacks plus persistent concern or maladaptive behavioural change.

Question 83 of 100Psychiatry: psychopharmacologyMedium

Which movement disorder is most associated with cumulative dopamine-receptor blockade and may persist after the drug is stopped?

AAkathisiaBNeuroleptic malignant syndromeCAcute dystoniaDTardive dyskinesia

Correct.

Not quite.

Correct answer: Tardive dyskinesia

Tardive dyskinesia usually emerges after longer exposure and commonly produces involuntary oro-buccal-lingual or choreiform movements. Unlike many acute extrapyramidal effects, it may be persistent.

Question 84 of 100Clinical psychology: DBTMedium

Which set contains the four standard skills modules in comprehensive dialectical behaviour therapy?

AExposure, response prevention, behavioural activation and sleep restrictionBFree association, interpretation, working through and terminationCAttention, memory, language and executive functioningDMindfulness, distress tolerance, emotion regulation and interpersonal effectiveness

Correct.

Not quite.

Correct answer: Mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness

DBT skills training is organised around mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Comprehensive DBT also includes individual therapy, consultation structures and between-session coaching.

Question 85 of 100Clinical psychology: research methodsHard

Why is intention-to-treat analysis generally preferred as the main analysis in a randomised trial?

AIt excludes participants who did not follow the protocolBIt preserves the prognostic balance created by random allocationCIt estimates the effect only among perfect adherersDIt guarantees that missing data cause no bias

Correct.

Not quite.

Correct answer: It preserves the prognostic balance created by random allocation

Intention-to-treat retains participants in their allocated groups, protecting the comparison from post-randomisation selection. Missing outcome data still require careful handling and can threaten validity.

Question 86 of 100Clinical psychology: assessmentMedium

What is a major advantage of ecological momentary assessment over a single retrospective questionnaire?

AIt separates within-person and between-person effects without modelling assumptionsBIt samples experience close to occurrence, reducing global recall biasCIt estimates stable personality traits more directly than repeated observationsDIt standardises contexts so each participant experiences identical exposures

Correct.

Not quite.

Correct answer: It samples experience close to occurrence, reducing global recall bias

EMA repeatedly samples states and contexts in daily life, improving temporal resolution and reducing reliance on global memory. It can still suffer from burden, missingness, reactivity and measurement error.

Question 87 of 100Clinical psychology: CBTMedium

In Beck's cognitive model of depression, the 'cognitive triad' consists of negative views about:

AThe id, the ego and the superegoBThoughts, emotions and bodily sensationsCParents, partners and authority figuresDThe self, the world and the future

Correct.

Not quite.

Correct answer: The self, the world and the future

The cognitive triad describes linked negative beliefs about oneself, one's experiences or world, and the future. It is a formulation concept rather than a claim that every depressed person expresses all three explicitly.

Question 88 of 100Psychiatry: obsessive-compulsive disordersHard

Which statement about insight in obsessive-compulsive disorder is most accurate?

AAbsent insight means the primary diagnosis must be a psychotic disorderBInsight ranges from good or fair to absent or frankly delusionalCDiagnosis requires recognition that the obsessional belief is unreasonableDCompulsions occur only when the associated belief is held with certainty

Correct.

Not quite.

Correct answer: Insight ranges from good or fair to absent or frankly delusional

OCD can be specified with good or fair insight, poor insight, or absent insight/delusional beliefs. The content and function of obsessions and compulsions remain diagnostically important even when insight is limited.

Question 89 of 100Psychiatry: traumaMedium

Which treatment is a first-line psychological intervention for many adults with post-traumatic stress disorder?

ASingle-session psychological debriefing soon after the eventBStress-management training used as the sole interventionCTrauma-focused cognitive behavioural therapyDNon-directive supportive counselling without trauma processing

Correct.

Not quite.

Correct answer: Trauma-focused cognitive behavioural therapy

NICE recommends trauma-focused psychological treatments such as trauma-focused CBT and EMDR for PTSD. Routine psychologically focused debriefing after trauma is not recommended as prevention.

Question 90 of 100Paraphilias: diagnosis and behaviourMedium

Why is 'pedophilic disorder' not synonymous with 'child sexual abuse'?

AThe categories completely overlap whenever the child is prepubescentBDiagnosis requires a conviction, whereas abuse may be identified clinicallyCOffending behaviour is sufficient for diagnosis regardless of motive or patternDOne denotes an enduring arousal pattern; the other denotes harmful behaviour

Correct.

Not quite.

Correct answer: One denotes an enduring arousal pattern; the other denotes harmful behaviour

Interest, diagnosis and behaviour must be distinguished. Some people with pedophilic interests do not offend, and some offences against children are driven by factors other than a persistent pedophilic preference.

Question 91 of 100Clinical psychology: psychometricsMedium

A mood scale gives very similar scores when administered twice during a period in which the patient's condition is stable. This most directly supports:

ATest-retest reliabilityBContent validityCIncremental validityDTreatment fidelity

Correct.

Not quite.

Correct answer: Test-retest reliability

Test-retest reliability concerns temporal stability when the underlying construct is not expected to change. It is inappropriate to demand high stability from a measure of a rapidly changing state.

Question 92 of 100Clinical psychology: psychometricsHard

Why is a high Cronbach's alpha not proof that a questionnaire measures a single construct?

AAlpha directly estimates dimensionality after correcting for test lengthBAlpha primarily measures temporal stability across repeated administrationsCRedundant items can inflate alpha without establishing unidimensionalityDAlpha above a conventional threshold proves a single common latent trait

Correct.

Not quite.

Correct answer: Redundant items can inflate alpha without establishing unidimensionality

Alpha reflects average inter-item covariance and test length under assumptions. A multidimensional or repetitive scale can have a high alpha; factor analysis and substantive theory are needed to evaluate dimensionality.

Question 93 of 100Clinical psychology: DBTMedium

The term 'dialectical' in dialectical behaviour therapy most centrally refers to the synthesis of:

ALinking validation with detailed behavioural chain analysisBBalancing emotion-regulation skills with crisis-survival strategiesCBalancing acceptance with active behavioural changeDCombining individual therapy with structured group skills training

Correct.

Not quite.

Correct answer: Balancing acceptance with active behavioural change

DBT explicitly balances validating the person's current experience with active strategies for behavioural change. Treating either pole as sufficient undermines the model.

Question 94 of 100Paraphilias: differential diagnosisHard

Why should transvestic disorder not be conflated with gender dysphoria?

ATransvestic disorder is defined by cross-dressing frequency regardless of arousalBThey are distinguished primarily by the person's sexual orientation and identityCOne concerns arousal linked to cross-dressing; the other concerns gender incongruenceDGender dysphoria is a specifier applied within transvestic disorder

Correct.

Not quite.

Correct answer: One concerns arousal linked to cross-dressing; the other concerns gender incongruence

The constructs concern different phenomena. Cross-dressing, transgender identity and gender dysphoria are not interchangeable, and none is automatically evidence of a paraphilic disorder.

Question 95 of 100Psychiatry: emergenciesMedium

Which pattern is most characteristic of neuroleptic malignant syndrome?

AAtaxia, nystagmus and slurred speech after sedative useBHyperthermia, autonomic instability and severe rigidity after dopamine blockadeCClonus, diarrhoea and marked hyperreflexia after an SSRI interactionDMiosis, respiratory depression and reduced bowel sounds

Correct.

Not quite.

Correct answer: Hyperthermia, autonomic instability and severe rigidity after dopamine blockade

Neuroleptic malignant syndrome is associated with dopamine blockade or abrupt withdrawal of dopaminergic drugs and presents with fever, rigidity, altered mental state and autonomic instability. The alternatives describe other toxidromes.

Question 96 of 100Paraphilias: classificationMedium

A person engages in consensual masochistic sexual activity, reports no distress or impairment, and takes negotiated safety precautions. Which conclusion best follows from DSM-5 principles?

ARecurrent masochistic arousal establishes disorder even without impairmentBThe consensual behaviour alone does not establish sexual masochism disorderCDiagnosis requires objective medical danger even if distress is absentDConsent removes any need to assess the risks of the specific practice

Correct.

Not quite.

Correct answer: The consensual behaviour alone does not establish sexual masochism disorder

DSM-5 deliberately distinguishes consensual atypical interests from disorders. Sexual masochism disorder requires the relevant arousal pattern plus clinically significant distress or impairment; particular high-risk practices require separate risk assessment.

Question 97 of 100Psychiatry: mood disordersHard

A patient with major depression has profound anhedonia, early-morning waking, psychomotor retardation and mood that does not brighten with positive events. Which specifier is most compatible?

ASeasonal patternBAtypical featuresCWith panic attacksDMelancholic features

Correct.

Not quite.

Correct answer: Melancholic features

Melancholic depression is associated with pervasive loss of pleasure or non-reactive mood plus features such as early waking, psychomotor change, excessive guilt and appetite loss. Atypical features include mood reactivity and often hypersomnia or increased appetite.

Question 98 of 100Psychiatry: ethics and lawMedium

Under the Mental Capacity Act framework in England and Wales, which statement about decision-making capacity is most accurate?

AA seriously unwise decision is sufficient evidence that capacity is absentBCapacity is determined globally from diagnosis, cognitive testing and functional historyCCapacity concerns the particular decision at the time it must be madeDA prior finding of incapacity continues to govern later versions of that decision

Correct.

Not quite.

Correct answer: Capacity concerns the particular decision at the time it must be made

Capacity is decision-specific and time-specific. A psychiatric diagnosis or an apparently unwise decision does not by itself establish incapacity; the assessment concerns understanding, retaining, using or weighing information and communicating a choice.

Question 99 of 100Psychiatry: phenomenologyMedium

A severely depressed patient says, with fixed conviction, that their organs have disappeared and that they are already dead. Which syndrome is most closely described?

AGanser syndromeBCapgras syndromeCOthello syndromeDCotard syndrome

Correct.

Not quite.

Correct answer: Cotard syndrome

Cotard syndrome involves nihilistic delusions, often concerning non-existence, bodily decay or death. It is classically associated with severe mood disorder but may occur in other neurological or psychiatric conditions.

Question 100 of 100Psychiatry: phenomenologyHard

In psychopathology, 'thought insertion' refers to which experience?

AThoughts are being placed in one's mind from outsideBOne's actions are being controlled by an external forceCThoughts are being removed by an external agentDOther people can hear one's thoughts as they occur

Correct.

Not quite.

Correct answer: Thoughts are being placed in one's mind from outside

Thought insertion is a disturbance in the sense of ownership of thought: the person experiences certain thoughts as not their own and as inserted by an outside source. Thought broadcasting, thought blocking and clang associations are distinct phenomena.

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