Corrections

Question 1

Can ECT cause retrograde or anterograde amnesia?

Answer 1

Retrograde

Question 2

Mx of symptoms of mania in primary care?

Answer 2

Urgent referral to CMHT

Question 3

Mx of symptoms of hypomania in primary care?

Answer 3

Routine referral to CMHT

Question 4

Once levels are stable, how often shoud lithium levels be checked?

Answer 4

Every 3 months, 12h post dose

Question 5

Is flight of ideas a feature of mania or hypomania?

Answer 5

Mania

Question 6

1st line intervention for ‘less severe’ depression?

Answer 6

Guided self-help

Question 7

PHQ-9 score for less severe depression?

Answer 7

<16

Question 8

Mx of patients with OCD with severe functional impairment?

Answer 8

Referral to 2ary care mental health team for assessment

N.B. - clomipramine should only be considered as an alternative primary pharmacological intervention to SSRIs when the individual expresses a preference for clomipramine based on past positive experiences or if SSRIs are contraindicated

Question 9

What needs to be co-prescribed alongside SSRI + NSAIDs?

Answer 9

PPI (due to increased bleeding risk)

Question 10

1st line medication in mx of OCD?

Answer 10

SSRIs

Question 11

Mx of OCD:

a) mild functional impairment

b) moderate functional impairment

c) severe functional impairment

Answer 11

a) CBT (including ERP)

b) SSRI or more intensive CBT

c) refer to the secondary care mental health team for assessment, offer combined treatment whilst waiting (CBT + SSRI)

Question 12

When treating OCD copmapred to depression, how long does an SSRI take to work?

Answer 12

The SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response

Question 13

What is adjustment disorder?

Answer 13

A protracted response to a significant life event or life change characterised by significant emotional distress and disturbance that interferes with normal social functioning.

Symptoms:
- Depressive symptoms
- And/or anxiety symptoms
- Inability to cope

Question 14

When do symptoms of adjustment disorder occur after the stressor?

Answer 14

Occurs within 1 month of particular stressor

Shouldn’t persist longer than 6 months after
stressor is removed

Question 15

What is a likely side effect of memantine?

Answer 15

Constipation

Question 16

Contraindications of AChEIs?

Answer 16

1) QT prolongation

2) 2nd/3rd degree heart block in an unpaced patient

3) Sinus bradycadia <50 bpm

Question 17

What is an alternative to AChEIs in patients with dementia with a contraindication e.g. QT prolongation?

Answer 17

Cognitive stimulation therapy

Question 18

What is the most appropriate treatment for patients with SEVERE Alzheimer’s?

Answer 18

Memantine

Question 19

What is semantic dementia a type of ?

Answer 19

FTD

Question 20

Why are those with Down’s syndrome more likely to get early onset Alzheimer’s?

Answer 20

The exta copy of APP can lead to early onset beta amyloid plaques

Question 21

What other side effects is akathisia associated with?

Answer 21

Due to distressing nature:
- Aggression
- Low mood
- Suicidal ideations

Question 22

What is alogia?

Answer 22

Paucity of speech (a common negative symptom of schizophrenia)

Question 23

What can clozapine toxicity be precipitated by? Why?

Answer 23

Acute infection e.g. pneumonia

Clozapine is metabolised by P450 system –> downregulation of these enzymes during infection/inflammation can lead to increased clozapine level