Mental Health

Question 1

What are the components of the MSE

Answer 1

A-ppearance and behavior
S-peech
E-motion (mood) - objective and subjective
P-erceptions
T-hought, form and content
I-nsight
C-ognition

Question 2

biological symptoms review of mood?

Answer 2

sleep (early morning waking)
appetite (loss of appetite, comfort eating)
concentration (cant focus)
libido (mania up, depression down)

Question 3

how long for antidepressants to improve symptoms

Answer 3

3-6w typically (after 2 months switch or up dose)

Question 4

why there is a suicide risk in antidepressants?

Answer 4

as common sym of depression.
pt misunderstanding the time for theraputic effect
energy improvement before cognition improvement
COUNSELLING IS KEY - safety net

Question 5

tricyclic antidepressants

Answer 5

SRI, Noradrenaline RI, 5HT2A Antagonism
side efffects:
lethal in overdose.
lower seizure threshold,
cardiotoxic (prolonged QT interval),
anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention, confusion, memory problems)
antiadrenergic effects (postural hypotension, sexual disfunction and tachycardia)
antihistaminic effects (sedation, weight gain)

Question 6

SSRIs SE?

Answer 6

first line
small cardiotoxic risk in overdose
common: GI upset, sexual dysfunction, anxiety, restlessness, nervousness, insomnia, fatigue or sedation, dizziness.
discontinuation syndrome: agitiation, nausea, disequilibrium, dysphoria.

Question 7

serotonin syndrome - symptoms and treatment

Answer 7

increased serotonin
autonomic dysfunction: (((hyperthermia, hypertension, hyperreflexia, tachycardia, tremor, agitation, irritability, sweating, diarrhoea, dilated pupils))), abdo pain, myoclonus, delirium, cardiovascular shock and death
treatment: discontinue medication, benzodiazepines for agitation, severe: cyproheptadine - serotonin antagonist, active cooling

Question 8

what are the classes of mood stabilisers

Answer 8

lithium
anticonvulsants
atypical antipschotics

Question 9

what does lithium do and what factors predict a positive response to it?

Answer 9

prophylaxis of mania and depressive episodes.
positive responsive factors: prior response, family member with good response. classic pure mania, mania is followed by depression

Question 10

lithium investigations and monitoring

Answer 10

before: baseline U&Es, TFTs, FBC, weight + BMI, ECG
check for pregnancy
monitoring: one week after starting and one week after any dose changes. weeekly until stable then 3 monthly (TFT, BMI every 6 months)
always measure 12 hours post dose

Question 11

lithium short/med and long term common side effects

Answer 11

short: GI distress, nausea, vom, diarrhoea, tremor
med: hair loss, acne, polyuria, polydipsia
long: hypothyroidism, renal failure, cardiac arrhythmias, lowering seizure threshold

Question 12

signs of lithium toxicity and mild/mod/severe

Answer 12

mild: 1.5-2mmol/l vom, diarr, ataxia, slurred speech, nystagmus
mod: nausea, anorexia, blurred vision, chronic limb movements, convulsions, delirium, syncope
severe: generalized convulsions, oliguria, renal failure.

Question 13

valproate semi-sodium (depakote)
what does it treat?
contraindications?
monitoring?

Answer 13

more effective for mania prophylaxis then depression
contraindicated in child-bearing age
before starting get baseline LFTs and FBC

Question 14

VALPROATE SIDE EFFECTS

Answer 14

thrombocytopenia and platelet dysfunction
N&V weight gain
sedation, tremor, altered LFTs and chemical hepatitis
RISK teratogenicity

Question 15

lamotrigine side effects

Answer 15

N&V
sedation, dizziness, ataxia and confusion
SJS and TEN (any rash discontinue immidiately)
be careful of increased lamotrigine levels with sertraline, valproic acid etc

Question 16

Depressive disorder (ICD-10) symptoms (2 of which = diagnosis)

Answer 16

over the past two weeks:
persistent low mood
loss of interest or pleasure
fatigue or low energy
if any of above ask about…
- disturbed sleep
- poor concentration or indecisiveness
- low self confidence
- poor or increased appetite
- suicidal thoughts or acts
- agitation or slowing of movement
- guilt or self-blame
severity:
4 symtpoms = mild
5-6 = moderate
7+ = severe (+/- psychotic symptoms)

Question 17

classifications of anxiety

Answer 17

Generalised anxiety disorder
situational anxiety (phobias)
social anxiety
OCD
PTSD
agrophobia

Question 18

biological symptoms of anxiety

Answer 18

autonomic arousal: dry mouth, difficulty swallowing, chest tightness, SOB, palpitations, tremor, headache, sweating, tingling

Question 19

psychological symptoms of anxiety

Answer 19

worrying, poor concentration, sleep disturbance, restlessness, irritable

Question 20

social symptoms of anxiety

Answer 20

avoidance of places, situation, people. affects relationships, work and social

Question 21

what is panic disorder

Answer 21

severe overwhelming anxiety attacks
come on suddenly last minutes up to 30(long one)
pt feels as if theyre having a heart attack/stroke

Question 22

what is OCD?

Answer 22

obsessions (intrusive repetitive thoughts)
compulsion to do something (OCD can be without compulsions)
compulsions are usually out of anxiety a ritual to keep the thoughts away
OCD pts recognize the thoughts as their own

Question 23

biological symptoms of depression

Answer 23

difficulty sleeping (early morning waking)
appetite changes (reduced usually)
libido reduced
concentration

Question 24

core symptoms of depression

Answer 24

tearful, low energy, low mood, sadness, anhedonia

Question 25

cognitive symptoms of depression

Answer 25

low mood (diurnal variation)
reduced concentration
anergia (reduced motivation/energy)
worry
forgetfulness
negative pattern of self, world, future

Question 26

psychotic symptoms with depression

Answer 26

“mood congruent” guilt, poverty
catatonic retardation
somatic delusions
nihilistic

Question 27

what to ask someone following a suicide attempt?

Answer 27

What precipitated the attempt?
Why did he choose that time and place?
Was it planned or impulsive?
Did he leave a suicide note?
Was he intoxicated (drugs/alcohol)?
Did he take any precautions against discovery (Did they tell work in advance that they wouldn’t be in that day?)
Previous attempts at suicide or self-harm by any methods?
How do they feel about the episode now? (e.g. regrets the attempt? wishes he had succeeded?)
Questions to assess his current severity of depression, including ongoing suicidal thoughts. Completing the PHQ-9 with him may be a helpful first step.
If he goes home, what supports – and stresses – will he have there?
Does he have thoughts to harm/kill anyone else as well as himself? Are there young children at home? Does he have unsupervised responsibility for them? Are they potentially at risk?
What does he think about the future?

Question 28

treatment of mild (less severe) depression:

Answer 28

start with low-intensity psychosocial intervention eg. CBT, if depression persists then consider pharmacological treatment

Question 29

treatment for moderate to severe (more severe) depression?
stepwise approach?

Answer 29

combination of antidepressant medication and high-intensity psychological intervention
1. SSRI (sertraline or citalopram)
2. venlafaxine, mirtazapine or escitalopram
3. add an augumenting agent e.g. second gen antipsychotic e.g. quetiapine then lithium
4. TCA: amitriptyline or clomipramine
5.MAOI: monclobomide THEN phenelzine

Question 30

what are the components of the generalized anxiety disorder 7 questionnaire?

Answer 30

over the past week how often have you been bothered by the following problems? (none=0,several days=1, over half=2, nearly everyday=3)

Feeling nervous, anxious or on edge
Not being able to sleep or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid, as if something awful might happen

Question 31

antidepressants in pregnancy: how safe and possible SE (which is best to use)

Answer 31

relatively safe
possible links to cardiac malformations with paroxetine and increased risk of miscarriage with venlafaxine
persistent pulmonary htn of newborn
poor neonatal adaptation syndrome
ADHD and autism (low link)
first line: sertraline preg and breastfeeding

Question 32

risks of antipsychotics in obstetrics and which cannot be used

Answer 32

hyperprolactinaemia = subfertility
metabolic disturbances and gestational diabetes
poor neonatal adaptation syndrome
Major teratogens
monitoring required in breastfed infants (do not use clozapine)

Question 33

mood stabilizers affects on pregnancy

Answer 33

sodium valproate: 10% NTD and congenital malformation
lithium linked to ebstein anomaly

Question 34

antipsychotic: classes and side effects

Answer 34

typicals (high and low potency) and atypicals (serotonin-dopamine 2 antagonists)
atypical: risperidone: extrapyramidal side effects (dose dependent), hyperprolactinemia, weight gain and sedation.
Olanzapine: weight gain, hypertriglyceridemia, hypercholestrolemia, hyperglycaemia, hyperprolactinemia
Clozapine: used when treatment resistance:
se: sedation, weight gain, agranulocytosis, deranged LFTs, lowers seizure threshold

Question 35

neuroleptic malignant syndrome: symptoms, complications and treatment

Answer 35

autonomic dysfunction (hyperthermia, HTN, hyperreflexia, tachycardia, tremor etc) , severe muscle rigidity, high fever, confusion, elevated WBC and LFTs.
complications: rhabdomyolysis, hyperkalaemia, kidney failure or seizures
treatment: discontinue medication
ICU
reverse hyperthermia (active cooling)
dantrolene/bromocriptine for rigidity
benzodiazepam for agitation
IV hydration for diuresis

Question 36

stimulants used for ADHD (and stimulant side effects)

Answer 36

ritalin group (methylphenidate)
adderall group (mixed amphetamine salts)
dexedrine group (dextroamphetamine)
aside effects: poor appetite and weight loss (later improves), troubles with sleep, stomach ache and headache.
less common: Too serious/spaced out, rebound irritability, tics, hallucinations (rare). Tachycardia, HTN, decreased growth.