Medications

Question 1

What effect does Lithium have on white blood cells?

Answer 1

Neutrophil levels are increased

Question 2

SSRIs can cause which electrolyte abnormality?

Answer 2

Hyponatreamia

Question 3

MAOIs are contraindicated in patients suffering from what physical condition?

Answer 3

Phaeochromocytoma

(Phaeochromocytoma are catecholamine secreting tumours, as MAOIs inhibit catecholamine breakdown they could cause a hypertensive crisis which may cause brain damage or death)

Question 4

Increased bleeding risk is associated with what medication group?

Answer 4

Anti-depressants. SSRIs inhibit platelet aggregation but the mechanism for other anti-depressants is unclear.

Question 5

Which is the best medication for paraphilia (intense sexual arousal to inappropriate things) and hyper-sexuality?

Answer 5

Sertraline and other SSRIs as their side effects include reduced libido and delayed orgasm.

Question 6

What is Cyproterone acetate?

Answer 6

Anti-androgen which can be used to treat hyper-sexuality

Question 7

What are the side effects of Lurasidone?

Answer 7

Lurasidone is an atypical anti-psychotic which commonly causes akathisia and sedation as side effects. It has a neutral metabolic profile. Minimum effective dose is 37mg

Question 8

Which anti-depressant is most suitable for a depressed patient with ischaemic heart disease?

Answer 8

Sertraline

The SADHART study demonstrated that sertraline is safe in patients with IHD. Other anti-depressants have not been evidenced as safe. Mirtazapine is the safest second line alternative however can cause weight gain

Question 9

30-50% of patients with long term exposure to Vigabatrin experience what visual change?

Answer 9

Irreversible concentric visual field loss

Question 10

What are the side effects of Lithium?

Answer 10

Thyroid disorders such as hypothyroidism, hyperthyroidism and thyroiditis. These can present with lethargy, weight gain and hypothermia

Question 11

Who wrote The Divided Self?

Answer 11

R D Laing - an important figure in the anti-psychiatry movement so said that schizophrenia was a theory not a fact

Question 12

Who wrote Psychiatry in Dissent?

Answer 12

Anthony Clare

Question 13

Who wrote The Red Book?

Answer 13

Carl Jung

Question 14

Who wrote The Road Less Travelled?

Answer 14

Scott Peck

Question 15

Who wrote The Myth of Mental Illness?

Answer 15

Thomas Szasz

Question 16

What are the symptoms of discontinuation syndrome?

Answer 16

Flu-like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal

Discontinuation is most likely with antidepressants with a short half life such as venlafaxine or paroxetine

Question 17

In which stages of pregnancy should Lithium be avoided?

Answer 17

First trimester - causes atrialisation of the right ventricle

Breast-feeding - it is excreted in breast milk and toxic lithium levels can develop rapidly in the infant if they become dehydrated

Lithium can be used in the second and third trimesters but dose requirements are increased

Question 18

Which anti-depressant causes the least sexual dysfunction?

Answer 18

Agomelatine

Question 19

Which anti-depressant is best for atypical depression?

Answer 19

Phenelzine

Question 20

What is the long term effect of Lithium on kidney function?

Answer 20

Nephrogenic diabetes insipidus

First sign is often nocturia
Occurs in 20-40% of patients on long term lithium
Causes a progressive decline in eGFR (but creatinine is usually normal)

Question 21

Which anti-convulsant is contraindicated with Clozapine?

Answer 21

Carbamazepine due to risk of agranulocytosis

Question 22

What are the side effects of Sodium Valproate?

Answer 22

Hyperammonaemia
Gastric irritation
Nausea
Lethargy
Confusion
Weight gain
Hair loss
Peripheral oedema
Hepatic failure
Thrombocytopenia
PCOS
Pancreatitis

Question 23

What are the side effects of Lamotrigine?

Answer 23

Dizziness
Headache
Sedation
Tremor
Nausea
Ataxia

Question 24

What is the mode of action of Disulfiram?

Answer 24

Inhibits acetaldehyde dehydrogenase (metabolises alcohol)so that drinking alcohol causes a build up of acetaldehyde which is unpleasant and possibly fatal