21 November

Question 1

Is cognitive behavioural therapy effective in treating vascular depression?

Answer 1

It may help to manage the manifestations, but does not treat the underlying cause.

Question 2

What should you always consider regarding vascular depression?

Answer 2

It is not a recognised diagnosis in the DSM-5

Question 3

What is a psychosocial disability?

Answer 3

A psychosocial disability arises when someone with a mental health condition interacts with a social environment that presents barriers to their equality with others.

Question 4

What is schizophreniform disorder?

Answer 4

Schizophreniform disorder, like schizophrenia, is a psychotic disorder that affects how you act, think, relate to others, express emotions and perceive reality

Question 5

What is a somatic hallucination?

Answer 5

A perception of being touched in the absence of a sensory stimulus

Question 6

What is the role of Vitamin D levels in mental health disorders?

Answer 6

Vitamin D is considered to be a crucial factor that influences symptoms of depression, negative emotions, and quality of life, but to date, no systematic review has been conducted with regard to its effect on other domains of mental health.

Question 7

Do auditory hallucinations always result in a diagnosis of psychosis?

Answer 7

No

Question 8

Do psychotic symptoms always result in a diagnosis of psychosis?

Answer 8

No

Question 9

When is a diagnosis of psychosis indicated?

Answer 9

When psychotic symptoms are primary (as a result of schizophrenia)

Question 10

What is mania?

Answer 10

Extremely elevated and excitable mood usually associated with bipolar disorder.

Question 11

Where must RAH staff present to ED?

Answer 11

Calvary Hospital

Question 12

What does erroneous mean?

Answer 12

Wrong; incorrect.

Question 13

What is disopyramide?

Answer 13

An antiarrhythmic

Question 14

What is the mechanism of action of disopyramide?

Answer 14

Prolongs refractory period of myocardial tissue (atria, ventricles, ventricular conduction system, bypass tracts) and reduces automaticity in Purkinje fibres. It has significant anticholinergic activity, which may increase atrioventricular nodal conduction, and it also has a negative inotropic effect.

Question 15

What is the indication of disopyramide?

Answer 15

Life-threatening ventricular tachyarrhythmias refractory to other treatment

Question 16

What are 6 precautions of diSOPYRAMIDe?

Answer 16

1. Electrolyte disturbances (eg hypokalaemia, hyperkalaemia, hypomagnesaemia): increase risk of arrhythmias; correct before starting treatment if possible.
2. Risk factors for angle-closure glaucoma: acute angle-closure crisis may rarely be precipitated.
3. BPH, bladder outlet obstruction: diSOPYRAMIDe may precipitate urinary retention.
4. Myasthenia gravis: diSOPYRAMIDe may increase muscle weakness.
5. Dementia, cognitive impairment: diSOPYRAMIDe may worsen cognitive function.
6. Diabetes: hypoglycaemia may occur with diSOPYRAMIDe

Question 17

What are 2 contraindications with diSOPYRAMIDe?

Answer 17

1. Digoxin toxicity
2. Treatment with flecainide

Question 18

What is altruism?

Answer 18

Disinterested and selfless concern for the well-being of others.

Question 19

What is amisulpride?

Answer 19

An antipsychotic

Question 20

What is an indicator that a clozapine level is not a true steady-state level?

Answer 20

Unusual and/or fluctuating clozapine/norclozapine levels

Question 21

What drug charts do TCP use?

Answer 21

NRMC Charts

Question 22

What is the mechanism of action of carbamazepine?

Answer 22

Prevents repetitive neuronal discharges by blocking voltage-dependent and use-dependent sodium channels.

Question 23

What are 3 indications of carbamazepine?

Answer 23

1. Epilepsy, including simple and complex focal (partial) seizures, and generalised tonic-clonic seizures
2. Trigeminal and glossopharyngeal neuralgias
3. Bipolar disorder

Question 24

What are 2 indications of aripiprazole?

Answer 24

1. Schizophrenia
2. Bipolar disorder as monotherapy (can be used with lithium or valproate in acute mania)

Question 25

What must you always remember about TDM?

Answer 25

The primary reason to adjust the dose must be to treat the individual rather than to optimise the number on the TDM report.

Question 26

What is the standard oral dose of aripiprazole for schizophrenia?

Answer 26

Adult, oral 10–15 mg once daily. Clinical trials used up to 30 mg daily. Do not increase dose for at least 2 weeks after starting (this time is needed to achieve steady state).

Question 27

What is the standard oral dose of aripiprazole in patients who are CYP2D6 poor metabolisers?

Answer 27

Halve the initial dose

Question 28

What is the standard oral dose of aripiprazole in patients who are also taking strong inhibitors of CYP3A4 or CYP2D6?

Answer 28

The manufacturer suggests a dose reduction when starting one of these drugs, see product information.

Question 29

What is the standard oral dose of aripiprazole for bipolar disorder?

Answer 29

Adult, oral 15–30 mg once daily. Clinical trials used up to 30 mg daily.

Question 30

When should treatment for primary hypercholesterolaemia be started?

Answer 30

Cholesterol levels fluctuate over time. A single measurement of cholesterol may not always reflect the ‘usual’ cholesterol level. For this reason, it is advisable to have at least two different measurements several weeks to several months apart before beginning any kind of treatment.