Mental Health

Question 1

Lithium toxicity in prev. well controlled pt - what to do with lithium dose? (2 options)

Answer 1

1. Reduce drug dose –> then re-test lit. level
2. Withhold for 24-48 hours –> then re-test lit. level

Question 2

BPSD pharmacological Rx (2)
Side effects (7)

Answer 2

1. Risperidone 0.25mg BD initially -> max 2mg daily
2. Olanzapine 2.5mg daily -> 10mg daily max

-further cognitive decline
-Drowsiness/insomnia
-EPSEs
-Weight gain
-Metabolic syndrome
-Stroke/falls/gait disturbane
-Bradycardia/QT prolongation

Question 3

Adjustment disorder timeframes

Answer 3

onset of symptoms within 3 months of psychosocial stressor
Resolution of symptoms within 6 months of stressor ending

A/w significant functional impact

Question 4

Antidepressants in depression: 1st, 2nd, 3rd lines

Answer 4

1. SSRIs (+mirtazapine)
2. SNRIs (+agomelatine)
3. Reverisble MAOis

• Discontinuation symptoms more likely with paroxetine & the SNRIs (venlafaxine, desvenla, duloxetine)
  • No dose reduction needed for fluoxetine

Question 5

Delirium precipitants DDx (broad categories - many)

Answer 5

Acute organ failure
Cardiac events (e.g AMI, arrythmia)
Constipation
Pain
Meds
Thyroid disease
Infections
Intracranial events (stroke/seizure/ICH)
Metabolic/eletrolyte disturbances
Withdrawal (from eTOH or benzos)
Urinary retention/catheterisation

Question 6

Eating disorder physical/examination features

Answer 6

Dorsal finger callouses, brittle nails
Stress fractures
Muscle cramps
Dental caries
Parotid enlargement
Irregular menses/amenorrhoea
Dry hair/skin
Lanugo (soft baby hair)
Hypercarotenaemia
Bone pain

Question 7

Nicotine replacement therapy doses:
Patch dose =
Inhalater dose =
Gum/lozenge dose =

Answer 7

Patch dose = 21mg/24hr
Inhalater dose = 15mg
Gum/lozenge dose = 2-4mg

Suitable for adolescents. ?No harm in pregnancy

Question 8

Bupropion (Zyban) a/e’s, contraindications

Answer 8

• A/e’s - insomnia, dry mouth, nausea, dizziness, anxiety
  
  • Small risk of seizures
    ○ Contraindicated if Hx of seizures/eating disorders

Question 9

Bipolar Affective Disorder features

Answer 9

○ Persistent/abnormal elevated or irritable mood
○ Increased energy
○ Grandiosity
○ Lowered sleep requirements
○ Racing thoughts
○ Distractibility, talkativeness
-Engaging in risky activities

○ Hypomania = above less severe, present for shorter period of time (at least 4 days, mania = at least one week)
○ Mania = associated psychotic features, marked impairment in social/occupational function, unwell enough to need hospitalisation

Question 10

Bipolar Disorder monotherapy drug options (5)

Answer 10

lamotrigine
lithium
lurasidone
olanzapine
quetiapine

Combination therapy = lithium/lurasidone/olanzapine/quetiapine/sodium valproate + antidepressant

Question 11

Antidepressant first line class in post-natal depression

Answer 11

SSRIs first line for mod-severe PND (safe in most breastfeeding, except prems)

Question 12

Pharm Rx steps for OCD

Answer 12

SSRIs remain 1st line for OCD and GAD
8-12 weeks to take effect
Up to 6 months to determine treatment efficacy

Clompiramine monotherapy if 2 SSRIs trialled & poor response
Then augmentation - CBT/risperidone

Question 13

Antidepressants with higher risks of discontinuation syndrome (4)

Answer 13

-Paroxetine
-Duloxetine
-Venlafaxine
-Desvenlafaxine

Fluoxetine - no wean required, no risk of discontinuation syndrome