In which of the following settings are anatomical dolls used to aid interview?
D. Anatomical dolls are used in forensic investigation of children who are alleged victims of sexual abuse. Various procedures such as drawings, puppets, observation for sexualized behaviour, etc., have been used to obtain a child’s report of sexual abuse. But research has not confirmed that responses supposedly indicative of abuse (e.g. drawing genitalia in human figure drawings, demonstrating intercourse, or oral sex between anatomical dolls, etc.) consistently occur with high frequency among abused children. Hence the use of such methods is controversial.
Reference:
A patient with chronic schizophrenia has improved core signs and symptoms. His remaining symptoms are of such low intensity that they no longer interfere significantly with his behaviour. The burden of current symptoms is such that if assessed now using standard criteria, he would not be diagnosed as having schizophrenia, although his social and vocational functioning has not altered much over the course of treatment.
Which of the following correctly describes this state?
B. The Remission in Schizophrenia Working Group defined remission ‘as a state in which patients have experienced improvements in core signs and symptoms to the extent that any remaining symptoms are of such low intensity that they no longer interfere significantly with behaviour and are below the threshold typically utilized in justifying an initial diagnosis of schizophrenia’. Thus ‘remission’ is not the same as ‘recovery’, which is the ability to function in the community, socially and vocationally, as well as being relatively free of psychopathology. Accordingly, remission is a necessary but not sufficient step towards recovery. Note that such a scientific definition of recovery views recovery as a state of outcome; this is very different from the concept of recovery promulgated by consumer groups.
While measuring non-adherence to psychotropic medications, which of the following groups provides a subjective overestimate of the true adherence rates?
D. In clinical practice, medication adherence is either assumed de facto or assessed from patients’ self-reports. Both these measures of adherence have limited validity. Medication levels in body fluids are susceptible to manipulation. The use of electronic monitoring and a third party such as a pharmacist/clinical assistant to assess adherence may be more useful. Using the measurement of adherence as a dichotomous variable, a study comparing adherence estimates by patients, clinicians, and research assistants using electronic monitors was carried out. Compared with electronic monitoring, prescribers dramatically overestimated adherence levels. Electronic monitoring detected greater non-adherence rates (57%) than either prescribers (7%) or patients (5%), although independent third-party ratings were closer to electronic ratings (54%).
According to the European schizophrenia cohort study, homelessness experienced by patients with schizophrenia is highest in:
C. Homelessness has a recognized association with severe mental illness. ‘Rooflessness’ refers to those living on the streets; it is difficult to include them in research surveys. Hence most researchers use a looser definition of having no fixed address and include people living in hostels and emergency accommodation. A broader term of ‘housing instability’ refers to the tenuousness of housing tenure. In the USA, community studies show that about a fi fth of those with schizophrenia had no fixed address – a rate that was 2.4 times higher than for major depression. The European Schizophrenia Cohort (Bebbington et al., 2005) found that 32.8% of the British sample had experienced homelessness in their lifetime compared with 8.4% in Germany and 12.9% in France. The rate in London was even higher (43%).
References:
Which of the following is the major principle behind the original development of assertive community treatment?
A. Assertive community treatment (ACT) was initially developed from the‘training in community living’ programme at the Mendota Mental Health Institute in Madison,Wisconsin, by Marx, Stein, and Test. According to them community rehabilitation existent in the 1970s served only to maintain patients in ‘a tenuous community adjustment on the brink of rehospitalization’, instead of helping patients to meet all their needs. The key principle was to provide treatment in community settings, because skills learnt in the community can be better applied in the community. In the UK it has been shown that community mental health teams are able to support people with serious mental illnesses as effectively as ACT teams, but ACT may be better at engaging clients and may lead to greater satisfaction with services (UK-700 and REACT studies; see Burns et al. for more information). A systematic review of the evidence on the ACT model has suggested that the degree of reliance on hospitalization may be the key factor in heterogeneity of outcomes seen in ACT services: the higher the reliance on hospitalization in a community, the more effective the ACT-based services are for that community. Other options in the question are false. The cost of skills training is not a major factor behind the advocacy of the ACT model.
Click to expand