General

Question 1

In the differential hierarchy, what order are differential considered in? (5)

Answer 1

Organic disorder
Psychotic disorder
Mood disorder
Neurotic disorder
Personality disorder

Question 2

When considering a psychiatric diagnosis, what structure can be used to order thinking? (3)

Answer 2

Predisposing, Precipitating and Maintaining factors for each of;
Biological
Psychological
Social factors.

Question 3

What are the principles of mental capacity? (4)

Answer 3

1. Mental capacity is time and decision specific
2. Capacity is presumed until proven otherwise
3. Assessor must do everything possible to enhance the ability of the pt to demonstrate capacity
4. Every adult has right to make own decisions if have capacity to do so.
5. If pt does not have capacity, the individual making their decisions must be acting in their best interests.

Question 4

What must a person be able to do in order to demonstrate capacity? (4)

Answer 4

Understand
Retain
Weigh up
Communicate decision

Question 5

What is Lasting Power of Attorney? (2)

Answer 5

Chosen person has authority to make decisions that are as valid as the ones made by the person themselves.
LPA can cover, decisions regarding property and affairs or decisions regarding welfare.

Question 6

What is an advanced decision? (2)

Answer 6

Enables person over 18 years old while still capable to refuse specified medical treatment for a time in the future, when they may lack the capacity to consent or refuse treatment.

Question 7

Name the broad heading that should be covered in a psychiatric history. (7)

Answer 7

PC
HPC
PPsychH
PMedH
PSurgH
DH
FH
SH: drugs, alcohol. Childhood, School, Occupations, Social situation, Forensic history
Premorbid personality

Question 8

What is ECT? (3)

Answer 8

• Medical procedure used under controlled condition to treat major psychiatric conditions resistant to treatment.
• Patient is anaesthetised and given muscle relaxant
• Scalp electrodes deliver brief electrical stimuli to brain inducing seizures.
• Usually twice weekly sessions up to total of 12.

Question 9

Name 3 indications for ECT. (3)

Answer 9

Severe depression, mania, puerperal psychosis and catatonic schizophrenia.
Mainly used in treatment resistant cases or when rapid response is required.

Question 10

How does the Mental heath act relate to ECT? (2)

Answer 10

Can only be given if patient has capacity and consents

OR if patient lacks capacity, second doctor must agree and advanced directive must not be overridden

Question 11

Name 2 medications that should be stopped before ECT can occur. (2)
Why? (1)

Answer 11

Benzodiazepines and Anti-epileptics, both increase the seizure threshold.

Question 12

Name 2 side effects of ECT. (2)

Answer 12

Confusion, short term memory loss, headache

Question 13

What are the two classes of dementia medications? (2)

Give an example of each (2)

Answer 13

Acetylcholine esterase inhibitors eg donepezil, galantamine, rivastigmine
NMDA receptor antagonist eg memantine

Question 14

Name 3 side effects of acetylcholine esterase inhibitors. (3)

Answer 14

eg donepezil, galantamine, rivastigmine
GI: nausea, vomiting, PUD, GI haemorrhage
CV: dizziness, syncope, bradycardia, heart block, MI
Psych: hallucinations, agitation

Question 15

Name 2 indications for carbamazepine. (3)

Answer 15

Prophylaxis in bipolar disorder
Epilepsy
trigeminal neuralgia

Question 16

Name 2 indications for lithium therapy. (2)

Answer 16

Prophylaxis of bipolar disorder (mood stabiliser)
Augments anti-depressives
Mania
Aggressive or self-mutilating behaviours

Question 17

Name 4 side effects of lithium therapy. (4)

Answer 17

General: weight gain, fine tremor, muscle weakness, oedema.
GI: diarrhoea, nausea, vomiting, metallic taste
Renal: nephrogenic diabetes insipidus, impaired renal function
Endo: hypothyroidism, hyperparathyroidism
CV: T wave inversion
Haem: leucocytosis

Question 18

How does lithium toxicity present? (4)
Why does it occur? (1)
How should it be treated? (2)

Answer 18

Narrow therapeutic index leads to ease of toxicity. Toxicity also precipitated by several drugs and dehydration.
Presents as; severe nausea, vomiting, diarrhoea, disorientation, seizures, drowsiness, coma and death.

Stop lithium, get Li levels, give fluids, determine need for haemodialysis.

Question 19

What monitoring is required with lithium therapy and how often? (3)

Answer 19

Lithium levels: 3 monthly after dose stabilised

Regular FBC, U&E, Ca and TFTs

Question 20

Give 2 pieces of advice to a patient beginning lithium therapy. (2)

Answer 20

Signs of toxicity (Nausea, vomiting, diarrhoea, seizures)
Importance of contraception if female.
Importance of maintaining adequate fluid intake
Avoid diets that may alter sodium intake.

Question 21

Name 2 indications for sodium valproate. (2)

Answer 21

Mania in bipolar
Prophylaxis of bipolar
Refractory depression
Epilepsy