extra

Question 1

A 23-year-old female is seen in A&E following self-inflicted lacerations to their body. Throughout treatment, they claim their partner is unloving and abusive towards them and that they just want it all to end. The family member accompanying them says they have been in and out of relationships since their late teens, and they go from idolising the partner to calling them abusive and controlling in a single conversation. They say the partners get scared off as the patient’s mood changes so quickly, and they have difficulty controlling their anger. She also mentions that one day the patient may feel they are on top of the world and be confident enough to dress in tight-fitting clothing, but the next day will be hidden away in baggy hoodies and refuses to come out of the house.

What personality disorder would most likely apply to this patient?

Answer 1

borderline

Question 2

A 33-year-old nursery worker diagnosed with emotionally unstable personality disorder (EUPD) begins dialectical behaviour therapy to help self-regulate her emotions.

Which of the following phenomena are most characteristic of emotionally unstable personality disorder?

Answer 2

Splitting

Splitting is a phenomenon sometimes seen in EUPD, whereby relationships alternate between idealisation and devaluation. As a result, patients may regard others as either wholly good, or wholly bad, often without reasonable grounds to hold such opinions.

Question 3

OCD gold standard tx

Answer 3

The gold standard treatment for OCD (obsessive-compulsive disorder) is a kind of CBT (cognitive behavioral therapy) called “exposure with response prevention,” or exposure therapy.

Question 4

post natal pychosis what should you do

Answer 4

Make an urgent referral to perinatal mental health team

This woman has postpartum psychosis, a disorder which usually presents suddenly in the first few weeks after birth. The woman can present with paranoia, delusions, hallucinations, confusion, mania or depression. It is considered an emergency due to the severity of its presentation and associated high risk. It requires urgent input from a perinatal specialist mental health team, who have provisions to respond to emergency situations

Postpartum psychosis is managed with antipsychotics and sometimes mood stabilisers. These need to be prescribed with the consideration of breastfeeding if the mother is doing so.

Question 5

echopraxia,

Answer 5

In echopraxia, a patient imitates another person’s movements

Question 6

when does delirium tremens develop

Answer 6

acute alcohol withdrawal - 72hours in

Question 7

Where in the digestive system is the majority of alcohol consumed absorbed?

Answer 7

the proximal small intestine

Question 8

thryoid problems caused by what bipolar tx

Answer 8

lithium

Question 9

Obsessive–compulsive personality disorder what do they prioritise

Answer 9

work

Question 10

What is Russell’s sign?

Answer 10

Repeated contact of the fingers with teeth during self-induced vomiting episodes can lead to characteristic abrasions, small lacerations, and calluses on the back of the hand overlying the knuckles; formally known as Russell’s Sign.

Question 11

3sx of werncikes encephalopathy

Answer 11

Wernicke’s encephalopathy is an acute neurological condition due to thiamine/vitamin B1 deficiency. It is characterised by the triad of
confusion
ataxia
ophthalmoplegia (weakness or paralysis of the eye muscles).
Only 10% of patients present with all three symptoms; therefore, a high index of suspicion is required for patients at risk of Wernicke’s encephalopathy. Thiamine deficiency leading to Wernicke’s encephalopathy has a variety of causes, eg. prolonged starvation, anorexia nervosa, hyperemesis gravidarum, gastrointestinal diseases and malabsorption, other than chronic alcoholism.

withdrawl will see- It is characterised by tremors, nausea and vomiting, headache, agitation, transient hallucinations, tachycardia, raised blood pressure, etc. This man does not have signs and symptoms of alcohol withdrawal, and there is no evidence of him reducing his alcohol intake significantly in a short period of time.

delirum trememens - Delirium tremens is a severe acute alcohol withdrawal state and is a medical emergency. It develops between 24 hours and 1 week after alcohol cessation and peaks at 72 hours. It is characterised by confusion, hallucinations, delusions, marked tremor and autonomic arousal (eg. fever, tachycardia, diaphoresis, etc.). This man’s signs and symptoms and the time of his last alcohol use do not suggest delirium tremens.

Question 12

alogia

Answer 12

Some people are naturally quiet and don’t say much. But if you have a serious mental illness, brain injury, or dementia, talking might be hard. This lack of conversation is called alogia, or “poverty of speech.”
tkae ages to repsond

negative feature of shizophrenia

Question 13

Which of the following is the first line treatment for autoimmune encephalitis?

Answer 13

Steroids and IV immunoglobulin

Autoimmune encephalitis is a form of non-infectious neuroinflammation that can lead to acute mental state and behavioural change. Steroids and IV immunoglobulins are the first line management of autoimmune encephalitis. Plasma exchange can also be used as an adjunctive treatment

Question 14

thouhgt blocking

Answer 14

Thought blocking, in which the patient suddenly halts in their thought process and cannot continue, is demonstrated here by this patient’s abrupt silence. It is a phenomenon sometimes seen in schizophrenia, which the patient is known to have.

sudden stop

Question 15

differnce bweteen OCD and OCPD

Answer 15

Obsessive compulsive disorder

Obsessive compulsive disorder also features a preoccupation with rules, details and organization to the detriment of other aspects of their life. However, in contrast to obsessive compulsive personality disorder, these thoughts and behaviours are distressing and associated with significant anxiety. As this patient reports enjoying her hygiene behaviour, without associated distress, obsessive compulsive personality disorder is the most likely diagnosis.

Obsessive compulsive personality disorder

In obsessive compulsive personality disorder, patients are preoccupied by rules, details and organization to the detriment of other aspects of their life.

However in contrast to obsessive-compulsive disorder, these activities are seen as pleasurable and desirable.
As this patient reports enjoying her hygiene behaviour, without associated distress, obsessive compulsive personality disorder is the most likely diagnosis

Question 16

hypomania does not impaire social or occupational interactions and no pyshcosis whereas mania does imapire , stops sleep etc

Answer 16

true

Question 17

conversion disorder - what is it and what is it linked too

Answer 17

Conversion disorder

Conversion disorder is the presence of neurological symptoms without any underlying neurological cause. The tests ruled out any medically explained causes such as a tumour or a stroke. Conversion disorder is linked to emotional distress, which this patient could be experiencing through taking his exams.

Question 18

Dilated ventricles disproportionate to cerebral atrophy

Answer 18

NPH

associated with
This man has the classic triad of normal pressure hydrocephalus (NPH) – gait disturbance, dementia and urinary incontinence. Many patients do not have all three symptoms. NPH is a rare condition characterised by excessive fluid building up in the ventricles of the brain. Most cases occur without an identifiable cause, but it can be due to other brain disorders, eg. tumour, head injury, infections, etc.

Question 19

What term is used to describe a phenomenon in Parkinson’s disease where a patient may get stuck on a word in a sentence and repeat it over again?

Answer 19

Logoclonia describes a phenomenon in Parkinson’s Disease where the patient gets ‘stuck’ on a particular word of a sentence and repeats it.

Question 20

For what time period must symptoms be seen before a diagnosis of depression can be made?

Answer 20

2w

Question 21

anxoeria pts at risk of

Answer 21

hypoglycaemia

Question 22

During which time period is postpartum psychosis most likely to be seen?

Answer 22

2 weeks after delivery

Postpartum psychosis can include paranoia, delusions, hallucinations, mania, depression or confusion, and generally develops within the first two weeks of giving birth.

Question 23

what illness is cuased by faking illness to get attention

Answer 23

Munchausen syndrome

This is a syndrome where patients fake illnesses to receive attention, playing the patient role. This includes adding blood to urine, not taking medications or faking pain. This patient relaxes and begins to be happier when he is receiving treatment. The boxes of antidiarrhoeal medication could suggest he has deliberately induced this episode of constipation to seek medical care.

Question 24

ECG changes seen in refeeding syndrome

Answer 24

In refeeding syndrome, patients are at risk of low phosphate, magnesium and potassium levels, as well as hyperglycaemia. Prominent U waves are a feature of hypokalaemia and may therefore be seen in refeeding syndrome.

Question 25

side effect of olanzapine

Answer 25

weight gain

Question 26

3 d side effects of antipyschotics such as olanzapaine

Answer 26

dysglycaemia, dyslipidaemia, and diabetes mellitus

Question 27

explain the steps of hypophosphataemia in refeeding syndrome

Answer 27

Pathophysiology of Hypophosphatemia in Refeeding Syndrome:
Shift from Fat to Carbohydrate Metabolism: In refeeding syndrome, the reintroduction of carbohydrates leads to a shift from fat to carbohydrate metabolism. This switch activates insulin secretion, which in turn increases cellular uptake of glucose.
Intracellular Movement of Phosphate: Insulin and increased glucose uptake stimulate the intracellular movement of phosphate, which is used in the synthesis of ATP and 2,3-diphosphoglycerate in erythrocytes. This intracellular shift reduces serum phosphate levels.
Decreased Phosphate Stores: Patients with chronic malnutrition often have depleted phosphate stores, although their serum phosphate levels may initially be normal. When refeeding starts, the sudden demand for phosphate in anabolic processes exceeds the supply, leading to hypophosphatemia.

Question 28

what are the clinical consequences of hypophosphatemia

Answer 28

cardiac dysfunction - reduced contractility and arrhythmias
resp failure - - phosphate essential for ATP production necessary for resp muscle function
neuro cx - confusion to seizure
haematolgical effects - hypoxia due to erthryoctes malfunction as reduced 23 diphophsphoglycerate
rhabdo

Question 29

what is brief psychotic disorder

Answer 29

Brief psychotic disorder often resolves with a return to baseline functioning
less than a month

Question 30

SSRI in first trimester can cause

Answer 30

• Use during the first trimester gives a small increased risk of congenital heart defects

Question 31

SSRI in the third trimester can cause

Answer 31

• Use during the third trimester can result in persistent pulmonary hypertension of the newborn

Question 32

treatment resistive schizo tx

Answer 32

think clozapine

Question 33

disccontinuation sx of ssri

Answer 33

ncreased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

Question 34

Electroconvulsive Therapy used when

Answer 34

with severe depression refractory to medication (e.g. catatonia) those with psychotic symptoms

Question 35

absolute CI to ECT

Answer 35

raised ICP

Question 36

long term se of ECT

Answer 36

memory impairment

Question 37

when is ECT performed

Answer 37

Catatonia, a neuropsychiatric syndrome characterized by abnormal movements, behaviors, and withdrawal, is a condition that is most often seen in mood disorders but can also be seen in psychotic, medical, neurologic, and other disorders.

Indications for ECT include the following:
treatment resistant severe depression
manic episodes
an episode of moderate depression know to respond to ECT in the past
life threatening catatonia

Question 38

Long-term lithium use can result in

Answer 38

hyperparathyroidism and resultant hypercalcaemia

Question 39

cotard syndrome - dead is associated with what mental health condition

Answer 39

Cotard syndrome is associated with severe depression

Question 40

how long must Joseph’s symptoms last to be classified as a depressive episode?

Answer 40

2w

Question 41

Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia