Charlie Rookes Psychiatry Flashcards
Citalopram
SSRI antidepressant
Vanlafaxine
SNRI antidepressant
Sulpiride
Antipsychotic (substituted benzamide)
Olanzapine
Antipsychotic (atypical)
Perehenazine
Antipsychotic (penothiazine)
Mirtazepine
Antidepressant (presynaptic alpha2-antagonist)
Lorazepam
Benzodiazepine
Clomethiazole
Hypnotic
Lofepramine
TCA
Amisulpride
Antipsychotic (atypical)
Procyclidine
Antimuscarinic
Zuclopenthixol
Antipsychotic (Thioxanthene)
Haloperidol
Antipsychotic (Butyrophenone)
Clozapine
Antipsychotic (atypical)
Amytal
Barbiturate
Fluoxetine
SSRI antidepressant
Amitriptyline
TCA
Aripiprazole
Antipsychotic (atypical)
Zopiclone
Hypnotic
Fluphenazine
Antipsychotic (Phenothiazine)
Lithium
Mood stabiliser
Sodium Valproate
Mood stabiliser
Moclobemide
Reversible MAOI Antidepressant
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Postural Hypotension
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Alpha adrenergic receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Galactorrhoea
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Amenorrhoea
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Dystonia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Drowsiness
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Histamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Urinary retention
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Gyanecomastia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Akathisia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Constipation
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Dry mouth
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Blurred vision
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Cholinergic receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Tardive dyskinesia
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Rigidity
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Which receptor, targeted by antipsychotic agents, is responsible for the following side effects?
- Tremor
Dopamine receptors
Alpha adrenergic receptors
Cholinergic Receptors
Histamine Receptors
Dopamine receptors
Does the following factor suggest poor or good prognosis in schizophrenia?
Sudden onset
Good
Does the following factor suggest poor or good prognosis in schizophrenia?
Older age at onset
Good
Does the following factor suggest poor or good prognosis in schizophrenia?
Prominent mood symptoms
Good
Does the following factor suggest poor or good prognosis in schizophrenia?
Long episode
poor
Does the following factor suggest poor or good prognosis in schizophrenia?
Negative symptoms
poor
Does the following factor suggest poor or good prognosis in schizophrenia?
Social isolation
Poor
Does the following factor suggest poor or good prognosis in schizophrenia?
Married
Good
Does the following factor suggest poor or good prognosis in schizophrenia?
Good work record
Good
Does the following factor suggest poor or good prognosis in schizophrenia?
Compliant with medication
Good
Emotional coldness is a characteristic feature of Schizoid peronality disorder?
True
False
True
Other features include:
- Anhedonia
- Indifference to praise or criticism
- Preference for solitary activities
- Excessive preoccupation with fantasy and introspection
- Insensitivity to social norms and conventions
- Limited capacity to express feelings
A series of suicidal threats of acts of DSH are well recognised phenomena in histrionic Personality Disorder
- True
- False
False - these characteristics are features of Borderline personality disorder.
Borderline PD features include:
- Affective instability
- Chronic feelings if emptiness
- Confusion about self-image, aims and internal preferences
- Repeated emotional crisis
Histrionic PD features include:
- Shallow, labile affect
- Theatrical, exaggerated expression of emotions
- Self-indulgent, lack of consideration for others
- Easily hurt feelings
- Continuously seeking appreciation, excitement and attention
A person suffering from paranoid personality disorder has callous unconcern for the feelings of others
True
False
False - commonly found in Dissocial/Antisocial personality disorder
Other features include:
- Gross and persistent irresponsibilty and disregard to social norms
- Incapacity to maintain enduring relationships
- Low tolerance to frustration
- Proneness to blame others
- Incapacity to experience guilt or to learn from punishment
Paranoid PD:
- Excessive sensitivity to setbacks and rebuffs
- Tendency to bear grudges persistently
- Suspiciousness
- Tenacious sense of personal rights out of keeping with actual situation
- Tendency to experience excessive self-importance
A 23-year-old man has recovered from his second episode of schizophrenia. Six months after discharge from inpatient care, he is symptom-free, and insists on stopping all his antipsychotic medication. He lives with his parents in what the clinical team have judged to be a high expressed emotion household. If he goes ahead and stops his medication, what is the probability that he will experience a relapse within nine months?
1% 5% 20% 50% 80%
80%
While giving his past psychiatric history, a 45-year-old man says that he was treated for depression in the past with medication. He cannot remember the name of the medication, but said that he recalls that when he started taking it, he experienced gastrointestinal discomfort. Also, he started taking it at night but had to switch to taking it in the morning because taking it at night disturbed his sleep even more than the depression itself had done. Which of the following medications is most likely to be the one he was taking?
Amitriptyline Mirtazapine Citalopram Zolpidem Olanzapine
Citalopram
A 24-year-old man presents with what appears to be an acute psychotic episode. Which of the clinical features below is most likely to discriminate between this being a schizophreniform psychosis or a manic episode?
The presence of auditory hallucinations
The presence of persecutory delusions
The presence of delusions that are incongruent with the patient’s mood
The presence of cognitive impairment
The presence of a disorder of the form of thought
The presence of delusions that are incongruent with the patient’s mood
A general practitioner refers a 20-year old woman for specialist assessment, stating that she has a phobia. Which of the following features is most likely to indicate a diagnosis of social phobia as opposed to agoraphobia
History of fear of the dark in childhood Fear of standing in supermarket queues Fear of travelling on the underground Fear of blushing in public Palpitations and sweating accompanying episodes of fear
Fear of blushing in public
A 15-year old girl is brought to her general practitioner by her mother, who suspects that her daughter has an eating disorder. Which of the following features makes it more likely that the daughters diagnosis is bulimia, as opposed to anorexia?
A body-mass index of 18
Visiting the gym daily for a vigorous workout
Making herself vomit after meals
Having very detailed knowledge of the calorific values of different foods
Being very self-conscious about her weight and appearance
A body-mass index of 18
A 22-year old man presents to his general practitioner with a history of gradually increasing concern about contamination. He worries for much of the day that he has become infected by bacteria, and reports that he has to wash his hands thoroughly whenever he touches objects that he thinks are dusty. He has a particular routine that he must follow when washing his hands and if this routine is interrupted, he must begin the routine again. What term best describes his hand-washing specifically?
Obsession Compulsion Delusion Overvalued idea Stereotypy
Compulsion
An 18-year old girl presents in the Accident and Emergency Department following an overdose of aspirin tablets. It appears that this was an impulsive gesture, in front of her boyfriend, during the course of an argument. She and her boyfriend had been drinking, but on examination, she did not appear intoxicated. Examination revealed no specific mental state abnormalities, and she denied wanting to kill herself. Statistically, what is the probability that she will present again with another episode of self-harm within the next 12 months?
50% 20% 5% 1% 0.1%
20%
A 22-year old man comes to the local general practice, asking to be signed on as a temporary patient. The circumstances of his presentation make the doctor suspect that the patient is abusing drugs. As he comes into the consulting room, the doctor notices that he seems to be sweating, has a runny nose and dilated pupils. Such symptoms are associated with withdrawal from one of the following drugs. Which one?
Cannabis Methamphetamine Heroin Diazepam Cocaine
Heroin
An 82-year old woman is brought by her daughter-in-law to the general practitioner. Mental state examination reveals that she shows considerable cognitive impairment. Which of the following features would suggest that this presentation is of Alzheimer-type dementia rather than multi-infarct (vascular) dementia?
A history of adult-onset diabetes
A history of step-wise decline in her cognitive state
A history of a gradual decline in her cognitive state
The fact that her daughter-in-law first noticed her cognitive impairment a few months previously, when she was already 82 years old
The absence of any family history of cerebrovascular disease
A history of a gradual decline in her cognitive state
You are a medical house officer, asked to assess a 76-year old man, recently admitted to the medical ward because he had become cachectic, presumably because he was neglecting himself. His mental state fluctuates markedly. At times, he appears lucid, while at other times he is very distressed and appears to be responding to auditory and visual hallucinations. During his lucid times, he can find his way without difficulty to the toilet and back to his bed. When he is distressed, he easily gets lost on his way to or from the toilet. What should be the main focus of his management?
Start treatment with olanzepine, titrating dose against the effect on his mental state
Start treatment with diazepam, titrating dose against the effect on his mental state
Transfer him immediately to an old age psychiatry unit, where staff are trained to make specialist mental state assessments
Move him to a bed which is closer to the toilet
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
A 32-year old man presents to his general practitioner with a 5-week history of worsening low mood, which he attributes to tensions within his marriage. On direct questioning, he admits that he finds it very difficult to concentrate on his work, and finds no interest in it. He routinely wakes 3 hours before he was accustomed to previously, and feels unrefreshed when he wakes. He now feels hopeless about the future, and says that life isnt worth living, although on questioning, he has made no plans to end his life. Direct questioning reveals no relevant past or family history. Physical examination reveals no abnormalities. What would be the most appropriate management plan?
Ask him to return to the surgery in a week’s time to review
Refer him to the practice counsellor
Prescribe temazepam to help with his sleep, and ask him to return for review in a week’s time
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week’s time
Refer him to the local community mental health team for an urgent assessment, in view of his thoughts about ending it all
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week’s time
A 45-year old man is brought to Accident and Emergency, having collapsed in a local pub. The ambulance crew state that others in the pub said the man had been drinking heavily, on his own, for some hours, and then had what appears to have been a fit. When you assess him once he has sobered up, he reports that his wife and children left him two weeks earlier, and that he lost his job six months ago because of his drinking. He admits that he has to have a large tot of whisky each morning before he gets out of bed. He has undergone a detoxification regime twice before, once with his general practitioner and once with a specialist alcoholism service. On both occasions, he started drinking again within three weeks of ending the regime. Initial investigations include a raised mean corpuscular volume. What is the most appropriate immediate management plan?
Counsel him about his excessive drinking and discharge him to be followed up by his general practitioner
Admit him for medical observation and then treat him symptomatically
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
Refer him to the local substance misuse service, asking for an urgent assessment
Refer him to the local inpatient psychiatric unit for admission
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
A 20-year old man has just been discharged from inpatient psychiatric care. He has a definitive diagnosis of schizophrenia. There were no conspicuous precipitating factors apart from stress from his work at university. In particular, he has never taken illicit drugs, and there is no family history of psychosis. He has a non-identical twin brother. What is the lifetime risk of his twin developing schizophrenia?
80% 50% 10% 5% 1%
10%
Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?
1% 5% 10% 25% 60%
25%
A 16-year old boy is referred to Child and Adolescent Mental Health Services. His parents describe a 4-month history of increasingly bizarre behaviour, disorganised speech, and incongruent affect. On direct questioning, the boy himself admits to hearing voices, and also expresses delusional beliefs. He is diagnosed as having a psychotic episode. What is the overall probability that he will recover fully from this episode and experience no further relapses of psychosis?
80% 50% 20% 10% 1%
20%
A 20-year old man has been referred by his general practitioner for specialist mental health assessment. He says that people are talking about him all the time, especially when he turns on the television. He believes that the flight path of aircraft have been specially changed so that they fly over his home, and interfere with his brain waves. He complains that he cannot sleep at night because people come into his flat and talk incessantly. He admits that everything that is happening to him is making him feel depressed. The psychiatrist makes a working diagnosis, and prescribes some medication. Which medication would be most appropriate in these circumstances?
Diazepam Temazepam Fluoxetine Chlorpromazine Olanzepine
Olanzepine
Published research evidence supports the effectiveness of a number of interventions in bulimia nervosa. Which of the following interventions has to date not been supported by robust research evidence?
Fluoxetine (high dose) Cognitive-behaviour therapy Interpersonal therapy Psychoanalytic psychotherapy Self-help materials based on the cognitive model
Psychoanalytic psychotherapy
An 18-year old woman presents in Accident and Emergency having taken an overdose of aspirin tablets. Which of the factors below indicate a particularly increased risk of a further overdose in the future?
That the patient is female rather than male
That the patient binge-drinks alcohol, and the overdose was taken while intoxicated
That she was seen in A&E following another overdose a few months previously
That she lives in a chaotic and dysfunctional household
That the patient is 18 years old
That she was seen in A&E following another overdose a few months previously
Under the Mental Health Act (1983), who can make an application to have a patient admitted to an inpatient psychiatric unit under Section 2 or 3?
The patient’s own general practitioner
The patient’s psychiatrist
The managers of the unit to which the patient is to be admitted
Any doctor who is fully registered with the GMC
An Approved Social Worker
An Approved Social Worker
You are a general practitioner, asked to see an 8-year old boy by his mother, because he has been bed-wetting. Examining the child, you notice several bruises, at different stages of resolution, on the boys arms, and a burn mark on his back, the size of which is consistent with being burned by a lighted cigarette. The mothers explanation for these injuries appears implausible, and you suspect that the boy is being abused. What do you do?
Report your concerns to the police
Report your concerns to the local Primary Care Trust
Report your concerns to Social Services
Organise an urgent child protection case conference
Contact your local Child and Adolescent Mental Health Service (CAMHS) to discuss what best to do
Report your concerns to Social Services
A 23-year old woman presents in the Accident and Emergency Department with what appears to acute appendicitis, and a decision is taken to recommend appendectomy. She is accompanied by her mother, who says that her daughter has a learning disability. Although the daughter now lives independently, she attended a special school because of her learning difficulties. The mother does not think that her daughter will understand the need for surgery. What would be the most appropriate course of action?
Do not proceed with surgery, but manage the patient conservatively until the diagnosis and required treatment are more certain
Ask the patient’s mother to sign the consent form on behalf of the patient
Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
Go ahead with the appendectomy without the patient’s informed consent, under Common Law, on the grounds that it is urgently necessary
Contact the Trust solicitors immediately, giving details of the case, and asking them to arrange an urgent hearing before a judge to get permission to carry out the appendectomy
Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
A care home for the elderly contacts you as the local general practitioner to see an 86-year old widow who was previously frail but otherwise quite well, but now presents with a 3-day history of confusion. Talking with staff, you learn that she sometimes cannot find her way to the dining room, or back to her own room, and sometimes appears to mis-recognise people she has known for a long time. However, at other times, she appears to be her normal self. The home is finding her behaviour increasingly difficult to cope with. What would be your most appropriate initial response to this situation?
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient’s presentation
Arrange for the practice nurse to visit regularly, to build up a more detailed picture of the presenting problems
Ask for a domiciliary visit by the local psychiatry for the elderly team
Arrange for her to be transferred to a nursing home, where staff are better able to manage her current behaviour
Send her to the local Accident and Emergency Department, so that she can be thoroughly examined and investigated, and admitted if necessary
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient’s presentation
A 38-year old man comes to see you, his general practitioner, because of persistent gastrointestinal pains. You think his symptoms are likely to be due to a gastric ulcer. You elicit a history of binge-drinking with friends in the local pub at weekends, but the patient insists that he drinks only two cans of lager each evening during the week. He denies having to drink first thing in the mornings, or experiencing craving to drink during weekdays. What would be your most appropriate response to the psychiatric component of this history?
Refer him to the local specialist substance misuse service for further assessment and counselling
Recommend that he starts attending the local branch of Alcoholics Anonymous
Tell him that because he is probably showing the first indications of physical damage due to alcohol, he must now abstain from alcohol
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
Tell him that because he is probably showing the first indications of physical damage due to alcohol, he must now abstain from alcohol, and prescribe a descending-dose regime of chlordiazepoxide
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
You are asked, as a house officer, to assess a man in his 50s who has recently been admitted to an acute medical ward from the Accident and Emergency Department. Nursing staff are concerned that he appears to be disoriented. On examination, you note that, amongst other signs, he has a horizontal nystagmus, and some difficulties in heel-toe walking. What is the most likely diagnosis?
Wernicke's encephalopathy Korsakoff's syndrome Post-ictal state following a temporal lobe epileptic seizure Cerebellar degeneration Vitamin B12 deficiency
Wernicke’s encephalopathy
A 26-year old woman on antidepressant prophylaxis following successful treatment of a first episode of depression six months previously, presents at a follow-up appointment at the local community mental health team with a two-week history of expansive mood and great confidence, feeling on top of the world, having boundless energy, and requiring hardly any sleep. What would be the most appropriate immediate intervention?
Leave her antidepressant medication unchanged and ask her to return again for review in two days’ time
Leave her antidepressant medication unchanged, and prescribe temazepam to help her sleep
Leave her antidepressant medication unchanged, and start her on a moderate dose of olanzepine daily
Leave her antidepressant medication unchanged, and start her on lithium carbonate
Discontinue her antidepressant medication, and start her on lithium carbonate
Discontinue her antidepressant medication, and start her on lithium carbonate
