MRCPsych Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: When assessing suicidal ideation, which feature of a plan most significantly elevates immediate risk?
- Vague, non-specific thoughts of death
- A detailed plan with access to the intended means (Correct answer)
- Passive ideation without intent to act
- Ideation present only during acute stress
Correct answer: A detailed plan with access to the intended means
A specific, detailed plan combined with access to lethal means is one of the strongest indicators of imminent suicidal risk.
Question 2: In the mental state examination, 'loosening of associations' is best described as:
- Sudden interruption of a train of thought
- Loss of logical connection between successive thoughts (Correct answer)
- The belief that thoughts are being broadcast to others
- Repetition of words or phrases spoken by the examiner
Correct answer: Loss of logical connection between successive thoughts
Loosening of associations (derailment) refers to a disruption in the logical relationship between ideas, characteristic of psychotic disorders.
Question 3: A 45-year-old presents believing news anchors are sending coded personal messages through the television. This phenomenon is termed:
- Thought insertion
- Ideas of reference (Correct answer)
- Passivity experience
- Persecutory delusion
Correct answer: Ideas of reference
Ideas of reference involve the false belief that external events, media, or people have special personal significance directed at the patient.
Question 4: Which instrument is specifically validated for assessing severity of obsessive-compulsive symptoms in clinical practice?
- Hamilton Anxiety Rating Scale (HAM-A)
- Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (Correct answer)
- Positive and Negative Syndrome Scale (PANSS)
- Beck Depression Inventory (BDI)
Correct answer: Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
The Y-BOCS is the gold standard clinician-administered scale for measuring the severity of obsessions and compulsions.
Question 5: During a cognitive assessment, a patient can repeat a 7-digit string forward but only 4 digits backward. This finding most likely reflects:
- Intact working memory with impaired long-term recall
- Reduced working memory capacity and executive processing (Correct answer)
- Global cognitive impairment consistent with dementia
- Malingering due to asymmetric performance
Correct answer: Reduced working memory capacity and executive processing
Digit span backward requires active manipulation of information in working memory, so reduced backward span suggests impaired working memory and frontal executive function.
Question 6: The structured clinical interview approach in psychiatric assessment is most valuable because it:
- Eliminates the need for collateral information
- Improves diagnostic reliability across clinicians (Correct answer)
- Reduces assessment time compared to unstructured interviews
- Removes the influence of clinical judgment entirely
Correct answer: Improves diagnostic reliability across clinicians
Structured clinical interviews (e.g., SCID) standardize diagnostic questions, significantly improving inter-rater reliability for psychiatric diagnoses.
Question 7: When assessing a patient's capacity to consent to treatment, which element is NOT part of the four-component legal standard?
- Understanding the information provided
- Appreciating how information applies to their situation
- Agreeing with the clinician's recommended treatment (Correct answer)
- Communicating a consistent choice
Correct answer: Agreeing with the clinician's recommended treatment
Capacity requires understanding, appreciation, reasoning, and communication of a choice — agreement with the clinician's recommendation is not a criterion.
MRCPsych Patient Assessment and Evaluation 2
When assessing suicidal ideation, which feature of a plan most significantly elevates immediate risk?