MRCPsych Clinical Procedures and Protocols 5

Question 1

A patient receiving ECT develops a prolonged seizure lasting over 3 minutes. What is the first-line pharmacological intervention?

Accepted Answer

IV lorazepam

Answer

IV lorazepam (or diazepam) is the first-line treatment for a prolonged ECT-induced seizure, as benzodiazepines rapidly terminate seizure activity.

Question 2

A Section 117 aftercare plan is being developed for a patient being discharged. Under the Mental Health Act 1983, which patients are entitled to Section 117 aftercare?

Accepted Answer

Patients detained under Section 3, 37, 45A, 47, or 48

Answer

Section 117 aftercare applies specifically to patients who have been detained under sections 3, 37, 45A, 47, or 48 of the Mental Health Act.

Question 3

Which rating scale is most appropriate for monitoring the severity of alcohol withdrawal in an inpatient setting?

Accepted Answer

CIWA-Ar

Answer

The Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar), is the standard tool for monitoring and guiding treatment of alcohol withdrawal symptoms.

Question 4

A patient with a known penicillin allergy is started on a course of psychotropic medication, but the pharmacist flags a potential serious interaction. Which antidepressant has the highest risk of QTc prolongation and should be used with caution in patients on other QT-prolonging drugs?

Accepted Answer

Citalopram

Answer

Citalopram (and escitalopram) have dose-dependent QTc prolongation risk and are contraindicated with other QT-prolonging agents; maximum daily doses are restricted by the MHRA.

Question 5

When conducting a risk assessment for violence, which of the following is an example of a dynamic (changeable) risk factor?

Accepted Answer

Current substance misuse

Answer

Dynamic risk factors are modifiable and include current substance misuse, medication non-adherence, and current mental state, as opposed to static factors like past history or demographics.

(MRCPsych) Member of the Royal College of Psychiatrists Practice Test

(MRCPsych) Member of the Royal College of Psychiatrists Practice Test

MRCPsych Clinical Procedures and Protocols 5