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1
Q

What is recommend for treatment of premenstrual syndrome?

A

SSRIs

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2
Q

What are the pharmacological options for restless leg syndrome?

A
  • iron replacement if needed
  • dopamine agents i.e. ropinorole and levadopa
  • anticonvulsants
  • opioids
  • clonazepam
  • gabapentin
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3
Q

Which factors are most significant predisposing factors for post-concussion symptoms amongst soldiers?

A

Depression and post traumatic stress

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4
Q

What is the prevalence of somatoform pain disorder?

A

8%

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5
Q

The connectivity between amygdala and which structure is thought to be crucial for fear processing?

A

orbitofrontal cortex

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6
Q

The most common cause of a fugue is?

A

Epilepsy

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7
Q

NREM Sleep disorders include

A

Sleep walking, sleep terrors and confusion arousals.

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8
Q

REM sleep parasomnias include

A

REM behavioural disorder, Night mares and Sleep paralysis

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9
Q

What’s the most common concurrent psychiatric disorders in patients with hypochondriasis?

A

Generalised anxiety disorder (71%)

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10
Q

Hyperorality, hypersexuality, and abnormal eating behaviour characterized by carbohydrate craving after herpes encephalitis is suggestive of?

A

Kluver-Bucy syndrome resulting from medial temporal lobe damage.

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11
Q

Features of REM sleep

A
  • decreased parasympathetic activity
  • increased cerebral blood flow
  • increased tendon reflexes
  • increased resp rate
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12
Q

Mean age of onset of chronic fatigue syndrome

A

29-35 years

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13
Q

Features of REM sleep disorders

A
  • complex behaviours
  • limited awareness of surrounding
  • episodes arise during middle to latter third of the night
  • may occurs idiopathically
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14
Q

Features of Gerstmann syndrome?

A

DOMINANT (LEFT) PAREITAL LOBE DYSFUNCTION

  • left-right disorientation
  • finger agnosia
  • agraphia
  • acalcul
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15
Q

Features of non dominant (right) pareital lobe dysfunction

A
  • anosognosia
  • constructional apraxia
  • contralateral neglect
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16
Q

Features of bilateral pareital lobe dysfunction (Balint syndrome)

A
  • optic ataxia
  • ocular apraxia
  • simultanagnosia
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17
Q

Which signs are seen in Delusional infestation?

A
  • Pin bottle sign

- Matchbox sign

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18
Q

Post concussion symptom that happens in first 7-10 days

A

Hypersensitivity to noise

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19
Q

What is the genetic/biological basis of narcolepsy

A
  • Can be sporadic but often associated with HLA DQB1*0602 or HLA-DR2 markers
  • Low concentrations of hypocretin in CSF observed
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20
Q

Features of chronic fatigue syndrome

A 
Low cortisol
Motivational disturbances in f-MRI scan
Physical emphasis with regard to symptom origin
Deficient natural killer cell function
Altered physiological response to stress
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21
Q

At any given time, the proportion of general population (in percentage) who report sleep disturbances is

A

30%

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22
Q

The rate of spontaneous congenital malformations associated with pregnancy is

A

2-3%

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23
Q

What predicts poor treatment response in chronic fatigue syndrome when treated with CBT/graded exercise?

A
  1. claiming a disability related benefit
  2. low sense of control
  3. strong focus on physical symptoms
  4. being passive with reduced activity
  5. membership of self help group
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24
Q

Inability to recognise objects, persons, sounds, shapes or smell is indicative of

A

Agnosia

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25
Q

By what percentage should the seven day Crisis Response Service as part of priority actions for the NHS reduce suicide?

A

10%

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26
Q

is able to read occasional words, but is not able to grasp the meaning of the whole sentence.

A

Anterior alexia

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27
Q

people from which ethnic background showed the longest delay in help seeking for mental illness

A

Asian

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28
Q

What is Dhat?

A

Culture bound syndrome seen in India
vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite and guilt attributed to semen loss through nocturnal emissions, urine and masturbation though there is no evidence of loss of semen.

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29
Q

Utilisation behaviours are seen in?

A

Major depression, ADHD and frontotemporal dementia

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30
Q

Patient can copy or describe letters but can’t read them?

A

Pure word blindness

visual cortex and splenium of corpus callosum affected

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31
Q

Which antibiotic is most likely to contribute to raised QTc?

A

Erythromycin

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32
Q

What percentage of those non-compliant with medication are thought to be non-compliant due to forgetting their medication?

A

10%

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33
Q

The Suicide rate in patients with Epilepsy

A

10%

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34
Q

Economic cost of mental health illness to the UK per year

A

70 - 100 billion

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35
Q

What is piblokto?

A

culture-specific hysterical reaction in Inuit (arctic and subarctic eskimos) especially women, who may perform irrational or dangerous acts, followed by amnesia for the event.

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36
Q

What is zar?

A

culture bound syndrome - experience of spritual possession, which may inlcude dissociative episodes that include laughing, hitting, singing or weeping. Apathy and withdrawal may also be seen

Seen in North Africa and the Middle East

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37
Q

What is Trichotillomania and which disorders is it related to?

A

recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling

Seen in:
OCD
Alopecia Areata
Stereotypic movement disorder
Facticious disorder
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38
Q

Approximately what percentage of patients who attend hospital with self-harm receive a psychosocial assessment from a mental health practitioner?

A

50%

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39
Q

Risk factors for completed suicide

A

Psychiatric history

Male

Older age

Previous attempts

Unemployment

Poor physical health

Living alone

Medical severity of the act - especially near-fatal self-harm

Hopelessness

Continuing high suicidal intent

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40
Q

Risk factors for non-fatal repetition of self-harm

A

A history of self-harm prior to the current episode

Psychiatric history, especially as an inpatient

Current unemployment

Lower social class

Alcohol or drug-related problems

Criminal record

Antisocial personality

Uncooperativeness with general hospital treatment

Hopelessness

High suicidal intent

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41
Q

What is the risk of a spontaneous major malformation in a confirmed pregnancy?

A

2-4%

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42
Q

Which medication would increase the risk of liver damage in a patient who has taken an overdose of paracetamol?

A

Phenytoin

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43
Q

According to NICE guidelines, women who need inpatient care for a mental disorder should be admitted to a specialist mother and baby unit if they become unwell within which time period following delivery?

A

0 - 12 months

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44
Q

SSRIs taken after 20 weeks gestation may be associated with an increased risk of what in the neonate?

A

Persistent pulmonary hypertension

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45
Q

A 24 year old man is admitted to hospital following an episode of deliberate self-harm. What would you estimate to be his risk for suicide over the next 12 months?

A

0.5%

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46
Q

What’s rhythmic movement disorder?

A

A group of stereotyped, repetitive movements involving large muscles, usually of the head and neck. The movements typically occur immediately prior to sleep onset and are sustained into light sleep.

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47
Q

Who is rhythmic movement disorder common in?

A

In infants and toddlers and usually resolves in the second or third year of life

Persistence beyond four years of age is unusual.

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48
Q

What are the subclasses of Dyssomnias (primary sleep disorders)?

A

Intrinsic sleep disorder
Extrinsic sleep disorders
Circadian rhythm disorders

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49
Q

Examples of Intrinsic sleep disorders?

A

Narcolepsy, psychopsychologic insomnia, idiopathic hypersomnia, restless leg syndrome, periodic limb movement disorder, obstructive sleep apnea

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50
Q

Examples of Extrinsic sleep disorders?

A

Inadequate sleep hygiene, alcohol dependent sleep disorder

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51
Q

Examples of Circadian rhythm disorders?

A

Jet lag syndrome, shift work sleep disorder, irregular sleep wake pattern, delayed sleep phase syndrome, advanced sleep phase disorder

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52
Q

What are the subclasses of parasomnias (affect sleep process)?

A

Arousal disorders
Sleep wake transition disorders
Parasomnias associated with REM sleep
Other parasomnias

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53
Q

Examples of Arousal disorders?

A

Sleep walking, sleep terrors

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54
Q

Examples of Sleep wake transition disorders?

A

Rhythmic movement disorder, sleep talking, nocturnal leg cramps

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55
Q

Examples of Parasomnias associated with REM sleep?

A

Nightmares, sleep paralysis

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56
Q

Examples of Other parasomnias?

A

Sleep bruxism

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57
Q

Risk factors for restless leg syndrome

A 
Iron deficiency and anaemia = MOST COMMON secondary cause
Older age
Female sex (2:1)
Pregnancy
Renal failure
Hypothyroidism
Diabetes
B12 and Magnesium deficiency
Medications i.e. antihistamines, antipsychotics, caffeine, antidepressants
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58
Q

Which SSRI is associated with significant neonatal withdrawal symptoms?

A

Paroxetine

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59
Q

The spontaneous abortion rate in confirmed pregnancies is

A

10-20%

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60
Q

The risk of spontaneous major malformation in confirmed pregnancies is

A

2-3% (1 in 40)

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61
Q

AEDs assoiciated with risk of neural tube defects

A

Valproate - 1-2%

Carbamazepine - 0.5-1%

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62
Q

Risk of Ebstein’s abnormality if Lithium is used in pregnancy?

A

1: 1 000

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63
Q

Relative risk of Ebstein’s abnormality if Lithium is used in pregnancy?

A

10-20 times

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64
Q

Which abnormalities in the newborn is use of benzos in pregnancy associated with?

A

oral clefts in newborns
urinary tract malformationn
floppy baby syndrome (if used late in pregnancy)

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65
Q

Which SSRI is associated with with an increased risk of congenital malformations (particulaly heart defects ASD and VSD)?

A

Paroxetine

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66
Q

Which antidepressants are suggested in pregnancy?

A 
Fluoxetine
Sertraline
Amitriptyline
Imipramine
Nortriptyline
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67
Q

Which antidepressants should be avoided in pregnancy?

A

Paroxetine

Clomipramine and all MAOIs

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68
Q

Which antipsychotics are suggested in pregnancy?

A 
Olanzapine
Quetiapine
Haloperidol
Clozapine
Chlorpromazine
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69
Q

Which mood stabilisers are recommended during pregnancy?

A

None - use antipsychotics instead

  • however if patients are controlled on mood stabiliser do not discontinue unless absolutely necessary
  • if valproate/carbamemezapine used then px 5mg folate and prophylactic vit K to mum and baby
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70
Q

Which sedatives are recommended in pregancy?

A

Promethazine (widely used but little data)

Benzodiazepines (probably not teratogenic but avoid in late pregnancy due to floppy baby syndrome)

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71
Q

Which antidepressants are suggested in breastfeeding?

A

Setraline or Paroxetine

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72
Q

Which antipsychotics are suggested in breastfeeding?

A

Olanzapine or Sulpiride

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73
Q

Which mood stabilisers are suggested in breastfeeding?

A

None - use antipsychotics instead

Valproate if a must

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74
Q

Which sedatives are suggested in breastfeeding?

A

For anxiety - Lorazepam

For insomnia - Zolpidem

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75
Q

What are infants of mothers who take first gen antipsychotics during pregnancy most susceptible to?

A

Premature delivery

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76
Q

Which drug can lead to fingernail hypoplasia when used during pregnancy?

A

Carbamemezapine

77
Q

Benzodiazepines should be avoided in pregnancy except in which of the following situations?

A

Extreme anxiety and agitattion

78
Q

What was the first fully structured instrument developed to be used by lay interviewers?

A

Diagnostic Interview Schedule (DIS)

79
Q

The usage of SSRIs for the treatment of depressive disorders in pregnancy could lead to which abnornalities?

A
  • pulmonary hypertension
  • reduction in gestational age
  • reduction in birth weight
  • spontaneous abortion
80
Q

The usage of paroxetine and venlafaxine in pregnancy for the treatment of depressive disorder has been linked to the development of which abnormalities?

A

agitation and irritatability

81
Q

Lamotrigine is a medication that requires further evaluation as it is not routinely used in pregnancy. It might result in the development of which abnormalities?

A

Cleft palate

Stevens-johnson syndrome

82
Q

Which of antipsychotic should be avoided in breastfeeding?

83
Q

What percentage of women experience transient episodes of emotional lability following childbirth?

84
Q

After a personal and family history of psychiatric illness, what appears to be the most important risk factor for puerperal psychosis?

85
Q

What is the prevalence of narcolepsy?

86
Q

What are the features of narcolepsy?

A
  • sudden sleep attacks (REM sleep - refreshing)
  • excessive daytime sleepiness
  • sleep paralysis (30% of patients)
  • cataplexy (75%)
  • Hypnagogic hallucinations

Only 10% experience all of these

87
Q

How is narcolepsy treated?

A

Stimulants i.e. methylphenidate, modafanil

Imipramine for cataplexy

88
Q

In what stage of sleep does sleepwalking occur?

89
Q

What is REM B Sleep Disorder?

A
  • No loss of muscle tone and dreams are acted out as complex behaviours with limited awareness of surroundings
  • Occurs in middle/latter third of night during REM sleep
  • Can be idiopathic or associated with/prodromal of Parkinson’s, LBD, multiple system atrophy and Guillain Barre
  • Treated with clonazepam
90
Q

What is the difference between Restless Legs Syndrome and PLMD (Periodic Limb Movement Disorder)?

A

Patient is asleep with PLMD which must be diagnosed using EMG

91
Q

What is bruxism?

A
  • Persistent grinding of the teeth (usually during sleep) - associated with stress and anxiety
  • Basal ganglia dysfunction is a potential cause
92
Q

What is the prevalence of Chronic Fatigue Syndrome?

A

0.5% (M:F = 1:3)

93
Q

What is the mean illness duration for CFS?

94
Q

What are the features of Chronic Fatigue Syndrome?

A

Persistent/chronic fatigue not due to exertion or organic disease and not alleviated by rest for at least 6 months

4 of the following for at least 6 months:

  • Impaired memory/concentration
  • Sore throat
  • Tender axillary or cervical lymph nodes
  • Muscle pain
  • Joint pain (several joints)
  • New headaches
  • Unrefreshing sleep
  • Malaise after exertion

Psychiatric disorders must be excluded

95
Q

What is the cause of Chronic Fatigue Syndrome?

A

Likely multifactorial, factors include

  • Predisposing: neuroticism, childhood inactivity or illness
  • Precipitating: Glandular fever, Q fever, Lyme disease, any serious life event
  • Perpetuating: strong belief in physical cause, activity avoidance, poor self control, primary/secondary gains

*HPA axis and serotonin pathway abnormalities described - 1/3 have low cortisol

96
Q

What is the treatment of Chronic Fatigue Syndrome?

A

1st line = CBT, Graded exercise therapy
2nd line = Pacing
*Do NOT routinely use antidepressants

97
Q

What is the rate of depression among patients with CFS?

A

23% - current

50-75% - history of

98
Q

What conditions are associated with CFS?

A

Fibromyalgia (significant overlap)
IBS
TMJ dysfunction
Multiple chemical sensitivity

99
Q

What percentage of depressed adults report pain?

100
Q

The DAI and the MARS are useful scales for assessing

A

compliance with medication

101
Q

Which medication level is done via a peak (not a trough) sample?

102
Q

What % of major congenital malformations do drugs account for?

A

5 in 100 (5%)

103
Q

What is the risk of pueperal psychosis?

A

0.1-0..25% in the general population
50% in BPAD
50-90% if personal hx of pueperal psychosis

104
Q

Incidence of pueperal psychosis

105
Q

Risks of untreated perinatal mental illness

A

To mother: suicide, substance misuse, poor compliance with appointments, impulsivity, unhealthy lifestyle

To baby: low birth weight, small head circumference, preterm birth, FAS if alcohol dependence, neglect, infanticide

106
Q

What happens to blood volume in 3rd trimester and how should this affect prescribing?

A

Increases by 30% so increased doses may be required

107
Q

Which antidepressant has the least placental exposure?

A

Sertraline

108
Q

Risk of any malformation if Lithium is used in pregnancy?

109
Q

Risks of using carbamezapine in pregnancy

A 
Spina bifida and neural tube defects
fingernail hypoplasia
poor growth and reduced head circumference
craniofacial defects
developmental delay
110
Q

Risks of using valproate in pregnancy

A 
foetal distress
poor growth
hepatotoxicity
congenital malformations: spina bifida and neural tube defects, digit and limb defects, urogenital defects
low IQ

7.2% risk of birth defects

111
Q

In a catatonic patient with no psych hx that worsens with benzos what are the differentials?

A

Organic causes - tumours, encephalitis

112
Q

Prevalence of suicide in the UK

A

8 - 11 per 100 000

113
Q

Most common method of suicide in men (and therefore overall)?

A

Hanging (40%)
Overdose (20%)
Car exhaust fumes (10%)

114
Q

Most common method of suicide in women?

A

Overdose (46%)

Hanging (27%)

115
Q

Whch occupations are high risk for suicide?

A

Doctors - especially female: anesthetists, GPs, psychiatrists
Farmers

116
Q

Risk of suicide in mood disorder?

117
Q

Risk of suicide in alcohol dependence?

118
Q

Risk of suicide in schizophrenia?

A

6% (10x higher than general population)

119
Q

Relative risk of sucide in anorexia nervosa?

A

20x higher than gen population

120
Q

Global annual rate of suicide

A

1 in 6 000 per year

121
Q

M:F suicide

122
Q

Most common psychiatric diagnoses in suicide

A 
Depression (30-31%)
Alcohol dependence (17-24%)
123
Q

% suicides that have at lease one DSH attmept

124
Q

% that repeat DSH within a year

125
Q

% in suicides that had contact with psychiatric services within one year of death

A

25%

25% on outpatient registers

126
Q

% suicides attempted under the influence of alcohol

A

25%

50% of these had alcohol within 6 hours of attempt

127
Q

% suicides seen by psychiatrist in previous week

128
Q

% suicides seen by health worker in prev 3 weeks

129
Q

% suicides seen by GP in last four weeks

130
Q

% suicides seen by GP in last week

131
Q

% inpatient suicide in first week of admission

132
Q

% inpatient suicide when under routine obs

133
Q

% suicides not compliant with medication

134
Q

% suicides within 3 months of discharge

135
Q

Strongest risk factor for suicide

A

Previous attempt/DSH

136
Q

% suicide of Care Plan approach cases

137
Q

% older patients who visited GP on same day as suicide

138
Q

% older patients who visited GP within a week of suicide

139
Q

% older patients who visited GP within a month of suicide

140
Q

% inpatient suicides descrried as preventable by mental health teams in England and Wales

141
Q

rate of DSH in the UK

A

3 per 1000

142
Q

% DSH that eventually complete suicide

143
Q

Management of catatonia

A

Benzos

Consider dantrolene or bromocriptine if concerned about NMS

144
Q

Managmet of agitation in delirious patients

A

Haloperidol

145
Q

What is catastrophic reaction?

A

Response to cognitive challenge seen in patients with dementia

146
Q

Which country has higher female than male rates of suicide?

147
Q

Lifetime prevslence of DSH in possible psychotic disorder?

148
Q

Prevalence of suicidal ideation among school going adolescents in last year

149
Q

% suicide that have recognised Psychiatric disorder at time of death

150
Q

% elerly patients with cogntitve impairment who present with sexual disinhibition

151
Q

% patients who progress from having suicidal ideas to plans in 1 year is

152
Q

Persistent apnoea has been reported in babies with which drug started during breastfeeding?

A

Clonazepam

153
Q

Surgery for male to female trans patients involves

A

Orchidectomy and Penectomy with Vaginoplasty using penile skin

154
Q

Surgery for male to female trans patients does not involve

A

Phalloplasty

155
Q

Surgery for FTM patients involves

A

bilateral mastectomy, hysterectomy, and bilateral salpingo-oopherectomy.

156
Q

PTSD M:F

157
Q

Alzheimer’s M:F

158
Q

BPD M:F

159
Q

Alcohol dependence M:F

160
Q

ASPD M:F

161
Q

The percentage of patients who commit suicide seen by psychiatrist in the last one week

162
Q

Drug that is contraindicated in heart failure

163
Q

Drug that is contraindicated post MI

A

Lofexidine

164
Q

Drug that is contraindicated in sick sinus syndrome

165
Q

Drug that is contraindicated in pulmonary insufficiency

A

Chlormethiazole, Diazepam

166
Q

Important factors found in a parent that can predict the severity of suicidal behaviour in the children

A

History of early onset attempts
Cluster B personality traits
History of childhood sexual abuse
(independent of mood disorders)

167
Q

Known risk factor for infanticide

A
  • Mother who attempted suicide when pregnant
  • domestic violence and a history of childhood maltreatment in the perpetrator
  • concealed or denial of pregnancy
  • unintended pregnancies in young women
168
Q

Patient can speak normally but cant comprehend spoken speech

A

Pure word deafness

169
Q

Which assessment of needs records both staff and patient views separately without giving primacy to either perspective?

A

Camberwell Assessment of Need

170
Q

Tobacco smoking is unikely to affect the levels of which drug?

171
Q

Zopilclone is contraindicated in:

A

Unstable myesthenia gravis
Breastfeeding
Severe sleep apnoea
Respiratory failure

172
Q

Features of frontal lobe damage

A 
Contralateral hemiplegia
impaired problem solving
disinhibition
lack of initiative
Broca's aphasia and agraphia (dominant)
173
Q

Features of temporal lobe damage

A 
Wernicke's aphasia (dominant)
homonymous upper quadrantanopia
auditory agnosia (non-dominant)
174
Q

Features of non-dominant parietal lobe damage

A

Anosognosia
dressing apraxia
spatial neglect
constructional apraxia

175
Q

Features of dominant parietal lobe damage

A 
Gerstmann's syndrome:
Finger agnosia
Right left disorientation
dyscalculia
dysgraphia
176
Q

Features of occipital lobe damage

A

Visual agnosia
visual illusions
contralateral homonymous hemianopia

177
Q

Risk of post partum depression

A

Without a history of depression, the risk of postpartum depression is 10%. This is increased to 25% if there is a history of depression, and to 50% if there is a history of postpartum depression.

178
Q

Which of the following is the most accurate estimate of the proportion of those aged over 60 who commit suicide in the 12 months following an episode of self-harm?

179
Q

What percentage of people who attend an emergency department following self-harm will self-harm again in the following year?

180
Q

Chronic grief is present when symptoms of grief are still present how long after bereavement?

181
Q

Which diagnosis is most commonly associated with dangerous driving?

182
Q

What is most likely to increase the risk of developing depression among people with epilepsy?

A

Complex partial seizures

183
Q

Inpatient suicide rates in the UK have reduced significantly since 2000. What is thought to have contributing most to this decrease?

A

Removal of potential ligature points

184
Q

What is the male: female ratio of reading difficulties?

185
Q

Which of the following is the greatest risk factor for the development of an autism spectrum disorder?

A

low apgar score

186
Q

Generalised, bilateral, synchronous, 3Hz (3 waves per second) spike and wave pattern

A

Petit Mal epilepsy

187
Q

Hyperactive, fast trace on EEG

188
Q

Early on there is non specific slowing, later periodic biphasic and triphasic synchronous sharp wave complexes superimposed on a slow background rhythm on EEG

A

Sporadic CJD

MB (16 decks)

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