Adult Psychiatry

Question 1

Hyperprolactinaemia symptoms

Answer 1

1) Infrequent menstruation/amenorrhoea
2) Galactorrhoea, breast growth
3) Loss of libido, sexual dysfunction - any difficulties in intimacy? any reduction in desire for intimacy?

Long term risks:
1) Osteoporosis
2) Breast cancer

Question 2

Management of hyperprolactinaemia

Answer 2

If symptomatic 530 - 2120 mIU/I:
- Switch to non prolactin elevating drug e.g. olanzapine, aripiprazole
- OR add small dose of aripiprazole
- Monitor prolactin levels every 6 months

• could also consider reducing dose?
• rare cases - dopamine agonist e.g. bromocriptine, but could worsen psychosis

If >3180 mIU/I
- Referral to neurosurgeon

If high prolactin but asymptomatic:
- Monitor + joint decision to continue
- OR switch to another antipsychotic

Question 3

Clozapine Side Effects

Answer 3

Common:
- Sedation
- Lower BP
- Tachycardia
- Constipation
- Weight gain
- Hypersalivation
- Prolong QTC

Less common:
- Agranulocytosis
- Paralytic ileus (bowels not moving)
- Myocarditis, Cardiomyopathy

*Risk of seizures/fits
*Safetynetting advice - when patient’s do not feel well or has an infection, to seek medical advice promptly

Question 4

Clozapine management

Answer 4

1) Bloods - Weekly for first 18 weeks, fortnightly after
2) Regular laxatives
3) Monitor physical obs + ECG
4) Start with low dose to minimise side effects
5) Other medications to help with hypersalivation, EPSEs etc.
6) Good diet - fibre, low sugar and fat
7) Exercise

Question 5

How helpful is clozapine?

Answer 5

6 out of 10 have shown to benefit from clozapine

Question 6

ECT prognosis

Answer 6

8 out of 10 get better!
ECT is amongst the safest treatments given under general anaesthesia

Question 7

SSRI side effects

Answer 7

Common: Nausea and vomiting, tummy discomfort, dizzyness, headaches. loss of libido, difficulties in intimacy (erectile dysfunction, difficulty in achieving orgasm/masterbation), anxiety

*Takes 2-4 weeks - watch out for suicidal thoughts due to slightly more energy

Question 8

SSRI - definition

Answer 8

A type of antidepressant that regulates the chemical called serotonin in your brain, which plays a role in OCD and depression

Question 9

Conversion disorder management

Answer 9

Bio - antidepressant
Psych - CBT, family to NOT reinforce the things the patient can’t do
Social - OT, PT

Question 10

Treatment resistant schizophrenia

Answer 10

Trialed more than 2 antipsychotics of different classes

Question 11

Treatment resistant depression

Answer 11

Trialed 2 antidepressants