MENTAL HEALTH Flashcards
Which SINGLE treatment, if any, has been shown to be clearly beneficial in REDUCING the incidence of relapse or recurrence of depression in children and adolescents?
No clear benefit from any single or combination treatment
Which is the SINGLE MOST appropriate statement concerning the effects of cognitive enhancers for people with mild cognitive impairment (MCI)? Select ONE option only.
Question 5Select one:
A.
Cholinesterase inhibitors improve cognition in MCI
B.
Cholinesterase inhibitors improve function in MCI
C.
Anti-dementia medications are associated with urinary frequency
D.
Anti-dementia medications are associated with nausea
E.
Glutamate receptor antagonists improve cognition in MCI
Anti-dementia medications are associated with nausea. Evidence-based recommendations does not indicate anti-dementia drugs as being effective for cognition or function among people with mild cognitive impairment.
moderate premenstrual dysphoric disorder. First line treatment within primary care
Ethinylestradiol and drospirenone
Social anxiety disorder is MOST LIKELY to be co-morbid with which of the following mental health disorders?
alcohol misuse and major depression
sign or symptom most likely to represent organic brain disorder (dementia, delirium, alcohol or metabolic causes)
visual hallucination
sign or symptom most likely to represent psychosis
Auditory hallucinations
sign or symptom most likely to represent schizophrenia
delusions of persecution
flight of ideas is a usual feature of
mania
delusions of perescution is feature of
schizophrenia, depression or cognitive impairment
used in the long-term treatment of bipolar disorder, 4 answes
lithium, olanzapine, lamotrigine, sodium valproate
licensed for psychosis in parkinson’s
clozapine
main side effect of clozapine
agranulocytosis
antipsychotic that can cause agranulocytosis
clozapine
how long to review patient started on anti depressant with increased risk for suicide. What are the increased risks for suicide (age)
1 week, 18-25 years old
how long to review patient started on anti depressant WITHOUT increased risk for suicide
2 weeks
How long after a first depressive episode has resolved should medications continue?
6 months
second line for OCD (after SSRIs)
Clomipramine
herbal remedy contraindicated when considering treatment with selective serotonin re-uptake inhibitors (SSRIs)
St John’s wort
A personal history of which of the following is the SINGLE MOST likely predictor of postpartum psychosis?
Bipolar affective disorder
What to monitor on patients on lithium
Lithium levels, U+Es (sodium imbalance and dehydration are common precipitants of toxicity), TFT and bone profile
are common precipitants of lithium toxicity
Na imbalance and dehydration
Which SINGLE ONE of the following is the most COMMON form of self-harm?
Cutting
bilateral resting tremor, with occasional rhythmic involuntary movements of his face - side effect of?
flupentixol (or anti-psychotics)
most common comorbidity on patients with severe mental illness
IHD
common side effect of citalopram or SSRI 3 answers
hyponatraemia, prolong QT interval, postural hypotension
used to tread postherpetic neuralgia
amitriptylline
symptoms of SSRI syndrome
agitation, tachycardia, diarrhoea, tremor
can cause serotonin sysndrome the most
phenelzine
anti-depressant can cause weight gain, usual answer?
mirtazapine
Which is the SINGLE MOST appropriate INITIAL medication for the treatment of depression in children and young people?
Fluoxetine
When is the MOST appropriate time for lithium level to be checked?
12 hours post-dose
Which one of the following is the most appropriate advice to reduce adverse effects of vomiting in someone with bulimia nervosa?
Avoid highly acidic drinks
What is the MINIMUM recommended duration of treatment for patients with a generalised anxiety disorder (GAD) where drug therapy has been found to be effective?
12 months
how frequently should eye tests be completed for lederly with recurrent falls and dementia
Every 2 years
what to monitor on adolescents taking antipsychotic medications for schizophrenia as baseline?
Blood pressure, (baseline bloods such as prolactin, glucose, HBA1cm lipid profile)
what to monitor on adolescents taking antipsychotic medications for schizophrenia DURING active treatment and every when
- the emergence of movement disorders
- weight, weekly for the first 6 weeks, then at 12 weeks, at 1 year and then annually (plotted on a chart)
- waist circumference annually (plotted on a chart)
- pulse and blood pressure at 12 weeks, at 1 year and then annually
- fasting blood glucose or HbA1c, and blood lipid levels at 12 weeks, at 1 year and then annually
According to current guidance, which is the SINGLE MOST appropriate initial psychological management of binge eating disorder in an adult?
Guided self-help
SCOFF questionnaire questions
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life? (2 or more indicates likley eating disorder
When to monitor lithium levels and other bloods indicated from starting the drug (time in months)
weekly until stable level the every 3 months for first year, then every 6 months after that
According to current guidelines, which SINGLE option is recommended to be used to help identify postnatal depression during the early postnatal period?
no specific screening tool
NICE recommends that GPs should ask all pregnant women two questions to screen for possible depression at the woman’s first contact with primary care during pregnancy or at her booking visit, and also postnatally (during the first year after childbirth):
During the past month, have you often been bothered by feeling down, depressed, or hopeless?
During the past month, have you often been bothered by having little interest or pleasure in doing things?
If the woman answers ‘yes’ to either of the initial questions, is at risk of developing a mental health problem, or there is clinical concern, then NICE recommend using either the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire (PHQ-9), as part of a full assessment (not initial identification).
Which of the options below makes school refusal more likely than school truancy in a 16-year-old boy?
Somatic symptoms
Expected signs and symptoms of lithium toxicity are
tremor, dry mouth, altered taste sensation, increased thirst, urinary frequency, nausea and weight gain. Also vomiting, diarrhoea, muscle weakness, ataxia, slurred speech, blurred vision, lethargy, confusion and seizures.
drugs that interact with lithium that can increase risk of toxcitiy (drug groups)
ACE inhibitors, thiazides and NSAIDs
anti-depressant to srtart a patient if increased risk of bleeding
Mirtazapine, not SSRI
What is the recommended drug-free gap required when switching from fluoxetine to another selective serotonin reuptake inhibitor (SSRI)
4-7 days (fluoxetine has a long half life)
Caution is recommended when prescribing antipsychotic drugs in elderly patients with dementia owing to an associated increased risk of which ONE of the following conditions?
Transient ischaemic attack
most common form of domestic abuse is.
Coercive control
SSRI associated with a higher risk of discontinuation symptoms on stopping treatment
Paroxetine
For a person with psychosis or schizophrenia being cared for in primary care, consider re-referral to psychiatric services if there is
Poor response to treatment
Non-adherence to medication
Intolerable side effects from medication
Comorbid alcohol or substance misuse
Risk to self or others.
Which is the SINGLE MOST appropriate psychotherapeutic intervention in the management of patients with medically unexplained symptoms (MUS)
CBT
Patients with medically unexplained symptoms commonly have
past histories of trauma or abuse
What is the most common age range for onset of bipolar disorder?
15-19 years
Which is the SINGLE MOST appropriate screening instrument, if any, in the diagnosis of panic disorder?
No recommended tool for diagnosis
likely to be helpful in the INITIAL physical health assessment of a patient with an eating disorder?
U+Es, LFTs, Random glucose (U+E IMPORTANT DUE TO HYPOKALAEMIA RISK)
PTSD usually involves (symptom)
overarousal states including dysregulation of emotions (hyperacute emotions which are difficult to control), nightmares and sleep disturbance
treatment for adolescents to treat self-harm in secondary care
Dialectical behavioural therapy (DBT)
When is postnatal depression MOST likely to occur following delivery?
0–5 weeks
life threatening emergency for patients taking antipyschotics with pyrexia and tremor
neuroleptic malignant syndrome
medication linked to cognitivre decline in elderly
amitriptylline
diagnostic criteria for post-traumatic stress disorder
ICD-11
Exposure to an extremely threatening or horrific event or series of events
All of the following must be present:
Re-experiencing the traumatic event either awake via vivid intrusive memories or flashbacks or asleep with nightmares. These are accompanied by overwhelming emotions (e.g. fear or horror) and strong physical sensations
Avoidance of thoughts and memories of the event(s) or avoidance of activities, situations or people that are reminders of the event;
Heightened threat perception (e.g. hypervigilance or enhanced startle reaction)
The symptoms persist for at least several weeks and they cause significant impairment to personal, family, social, educational, occupational or other important functioning
Bulimia: Both binge eating and compensatory behaviours occur in what time frame
at least once a week for at least one month
first line for PTSD
individual trauma-focused cognitive behavioural therapy
can be considered second line for PTSD if non-combat related trauma
eye movement desensitisation and reprocessing
widely used in the UK for treatment of insomnia it does not actually have a UK license for this indication
amitriptyline
appropriate psychotherapy in the management of MILD postnatal depression
Facilitated self‑help
monitoring for patients on sodium valproate and when
FBC, LFT + weight and BMI (initial, 6 months then annually)
Antipsychotic usually NOT used for pregnancy
sodium valproate
Which is the antidepressant of choice for patients with bipolar disorder who develop severe depression?
Fluoxetine (usually treatment is fluoxetine and olanzapine)
local social services authority may NOT approve who to act as an approved mental health professional.
Registered medical practitioner
Which medications are MOST likely to cause drug induced psychosis
dopamine agonists (levodopa), antimalaial, antiretroviral, cessation of dopamine antagonists such as aripiprazole
Feeding disorders
pica, avoidant-restrictive food intake disorder or rumination regurgitation disorder)
difference between feeding and eating disorders
Eating disorders ‘involve abnormal eating behaviour and preoccupation with food as well as prominent body weight and shape concerns whilst FEEDING disorders have no weight or body shape concerns
Suicide rates are highest when
within the first six months after the index episode of self-harm.
progressive cognitive decline usually over months. Typically there is fluctuations in alertness and attention, along with visual hallucinations and Parkinsonian symptoms such as rigidity and tremor
Lewy Body dementia
What, if any, is the MINIMUM duration of unexplained, appropriately investigated symptoms before a formal diagnosis of medically unexplained physical symptoms (MUPS) should be considered?
Three months
You diagnose depression in a 62-year-old lady who recently suffered a stroke.
What is the SINGLE MOST appropriate management option?
Still SSRI, need to assess bleeding risk though with antiplatelets
