Knowledge revision - Psych

Question 1

What are the key options for depression and anxiety?

Answer 1

Medication
Lifestyle modifications
Counselling/CBT

Question 2

What are the first-line medications for depression and anxiety?

Answer 2

SSRIs

Question 3

Which SSRI is licensed in young people?

Answer 3

Fluoxetine

Question 4

What is the major side effect of SSRIs for patients to be aware of?

Answer 4

Potential increase in suicidal ideation in first 4 weeks

Question 5

Give differential diagnoses for psychosis.

Answer 5

Medication or drug-induced
Schizophrenia
Bipolar (mania)
Psychotic depression
Delirium

Question 6

What are the first-rank symptoms of schizophrenia?

Answer 6

Auditory hallucinations
Delusions (usually persecutory)
Thought insertion, withdrawal, broadcasting
Made actions/feelings
Somatic hallucinations

Question 7

Which medication class are typically used in the management of schizophrenia?

Answer 7

Anti-psychotics

Question 8

Give examples of typical antipsychotics.

Answer 8

Haloperidol, chlorpromazine

Question 9

Give examples of atypical antipsychotics.

Answer 9

Olanzapine, Quetiapine, Risperidone, clozapine

Question 10

What is the major side effect to be aware of of typical antipsychotics?

Answer 10

Parkinsonism

Question 11

What is the major side effect to be aware of for atypical antipsychotics?

Answer 11

Metabolic syndrome

Question 12

What is the major risk with clozapine?

Answer 12

Agranulocytosis

Question 13

Under which circumstances can clozapine be initiated?

Answer 13

psychosis/schizophrenia resistant to at least 2 antipsychotics from different classes

Question 14

How is mania typically managed?

Answer 14

Anti-psychotics

Question 15

How is bipolar depression typically managed?

Answer 15

Antipsychotics +/- antidepressants

Question 16

How is bipolar managed long-term?

Answer 16

Mood stabilisers eg. lithium, lamotrigine etc

Question 17

How long after a dose of lithium should levels be measured?

Answer 17

12 hours

Question 18

Which symptoms may suggest lithium toxicity?

Answer 18

Confusion
Drowsiness
Visual problems
Excessive thirst/urination

Question 19

What are the main headings for mental state examination?

Answer 19

Appearance
Behaviour
Speech
Mood
Affect
Thought
Perception
Cognition
Insight

Question 20

Which areas should be considered under ‘thought’ in a MSE?

Answer 20

Form, content, possession

Question 21

Moving quickly from one topic to another is called…

Answer 21

Flight of ideas

Question 22

Give potential causes of memory loss.

Answer 22

o Dementia – Alzheimer’s, Parkinsons, vascular, LBD
o Delirium
o Head injury
o Encephalitis
o Thyroid/kidney/liver disease
o B12 deficiency

Question 23

How would you investigate memory loss?

Answer 23

o Cognitive assessment eg. MMSE, MoCA
o Bloods inc Folate/B12, TFTs, LFTs etc
o CT head if ? bleed
o MRI brain may be useful if suspecting dementia

Question 24

What is delirium?

Answer 24

Acute & fluctuating disturbance in consciousness, attention & cognition

Question 25

Give causes of delirium

Answer 25

o Stroke, tumour, subdural haematoma o Drugs o Infection – CNS, UTI, sepsis o Pain o Electrolyte imbalance o Change in environment, acute stress etc

Question 26

What should you look for when examining someone with delirium?

Answer 26

Signs of infection & neuro exam

Question 27

Which screening test is used for delirium?

Answer 27

4AT

Question 28

What is included in 4AT?

Answer 28

 Attentiveness  AMT4 – age, DOB, place, current year  Attention – months of the year backwards  Acute change or fluctuating?

Question 29

How should delirium be managed?

Answer 29

o Treating any underlying cause o Remove any aggravating drugs o Environmental – orientating themselves – clock, date, room, people, hearing aids/glasses

Question 30

Which drugs may aggravate delirium?

Answer 30

Opioids, anticholinergics, steroids, TCAs, zopiclone, BZDs

Question 31

What can be given for agitation in deliriun?

Answer 31

0.5-1mg Haloperidol or lorazepam if very agitated/danger to self or others

Question 32

What are the conditions for detention under the MH Act?

Answer 32

o Has a mental disorder o Ability to make decisions is sig impaired due to mental disorder o Detention in the patient’s best interests o Sig risk to self or others if not detained o Treatment is available & necessary

Question 33

Which areas are important in assessing a person's capacity?

Answer 33

ability to understand, weigh and retain information/decisions