Exam

Question 1

Core symptoms of depression (3)

Answer 1

Low mood, anhedonia, anergia

Question 2

Additional depression symptoms (7)

Answer 2

Biological- poor sleep, early wakening,appetite changes
Poor concentration and memory
Feelings of guilt, hopelessness about future
Suicidality/self harm
Obsessions e.g. death
Delusions (e.g. of sin, guilt)
Hallucinations (second person auditory is most common)

Question 3

What does a depression diagnosis consist of?

Answer 3

Two core symptoms plus others
4 = mild
6 = moderate
8 = severe
(also take into account the level of functional impairment)

Question 4

What is dysthmia?

Answer 4

Chronic sub-threshold depressive state of greater than two years duration

Question 5

Signs/symptoms of mania (6)

Answer 5

Elevated mood
Irritability
Disinhibition
Overactivity
Decreased need for sleep
Psychotic features e.g. delusions, hallucinations

Question 6

Definition of bipolar affective disorder

Answer 6

Two or more episodes of mania +/-depression

Question 7

How are mania and hypomania distinguished?

Answer 7

In hypomania there are no psychotic features

Question 8

What is cyclothymia?

Answer 8

Persistent mood instability

Question 9

Treatment of acute mania (3)

Answer 9

Atypical antipsychotics e.g. olanzapine FIRST CHOICE
Benzodiazepines
Sodium valproate

Question 10

Prophylaxis of mania (3)

Answer 10

Lithium 1st line
Anticonvulsants (sodium valproate, lamotrigine, carbamezapine)
Atypical antipsychotics

Question 11

Features of thought a) flow [5] b) content [3] in mania

Answer 11

a) flight of ideas, loosening of associations, pressured speech, neologisms, circumstantiality
b) delusions e.g. religious, grandiose, persecutory; obsessions; ideas of reference

Question 12

Treatment of

a) mild to moderate depression
b) moderate to severe depression

Answer 12

a) CBT; relaxation therapy; consider antidepressants if persisting, patient has a history of severe depression
b) antidepressants + high intensity psychological treatment (CBT or interpersonal therapy)

Question 13

When should an urgent psychiatric referral be made in depression?(3)

Answer 13

Active suicidal ideas or plans
Putting themselves or others at risk
Evidence of self neglect

Question 14

Antidepressant treatment

a) first-line
b) when there is no response/partial response at 2-4 weeks

Answer 14

a) SSRI such as citalopram

b) other SSRI; mirtazapine; tricyclic

Question 15

When should tricyclics be avoided?

Answer 15

When there is a risk of overdose

Question 16

How long should treatment continue for after remission, and how long should doses be reduced over

Answer 16

At least six months

Doses should be reduced over 4 weeks, although fluoxetine can be withdrawn faster

Question 17

When should SSRIs be prescribed with caution?

Answer 17

Epileptics- lowers the seizure threshold
Peptic ulcer disease
Young people

Question 18

Important drug interactions of SSRIs (5)

Answer 18

QT prolonging drugs
Monoamine oxidase inhibitors
Triptans
NSAIDS- if given with SSRI, co-prescribe PPI
Warfarin/heparin/aspirin- avoid SSRI, give mirtazapine

Question 19

Physical symptoms of anxiety (7)

Answer 19

Sweating, chills
Trembling, shaking
Throat lump
Palpitations
Chest pain/discomfort
Nausea/GI upset
Dry mouth

Question 20

Cognitive symptoms of anxiety (5)

Answer 20

Fear of losing control
Derrealisation
Depersonalisation
Hyper-vigilance
Meta-worry

Question 21

Definition of generalised anxiety disorder

Answer 21

anxiety that is:
not restricted to particular circumstances
persistent (most days for 6 months)
causing significant distress/functional impairment

Question 22

Common co-morbidities in anxiety (3)

Answer 22

Depression
Substance abuse
Other anxiety disorders e.g.PTSD

Question 23

What is social anxiety disorder characterised by

Answer 23

Persistent fear of situations where the patient is exposed to unfamilial people, or scrutiny by others

Question 24

Psychological measures for anxiety treatment (2)

Answer 24

CBT

Relaxation therapy

Question 25

Pharmacological measures for anxiety treatment (4)

Answer 25

Benzodiazepines
SSRIs (sertraline is 1st line)
Buspirone (5HT-1A agonist)
Beta blockers (somatic symptoms)

Question 26

Problems with benzodiazepines in anxiety management (3)

Answer 26

Paradoxical aggression
Anterograde amnesia
Tolerance/dependence

Question 27

What are

a) obsessions
b) compulsions

Answer 27

a) stereotyped, purposeless, egodystonic words/phrases that enter the patients mind
b) senseless repeated rituals

Question 28

Common
a) obsessions [3]
b) compulsions [3]
in OCD

Answer 28

a) contamination, order/symmetry, fear of harm e.g. locking doors
b) cleaning, hoarding, checking

Question 29

Rating scale used in obsessive compulsive disorder to assess functional impact

Answer 29

Yale-Brown Obsessive Compulsive scale

Question 30

First line treatment in mild-moderate functional impairment for OCD

Answer 30

Low intensity psychological intervention e.g. CBT, exposure and response prevention treatment

Question 31

Treatment for moderate-severe functional impairment in OCD

Answer 31

High intensity CBT+ERP

+- SSRI