MISCELLANEOUS FACTS FROM PASSMED Flashcards
What is the definition of somatisation disorder?
Presence of multiple physical symptoms for at least 2 years
Patient refuses to accept reassurance or negative test results
What is the definition of hypochondrial disorder?
Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
Like somatisation disorder the patient refuses to accept reassurance or negative test results
How is somatisation disorder different to hypochondrial disorder?
Somatisation disorder involves the presence of unexplained symptoms. In hypochondrial disorder there is a specific diagnosis that the patient feels they have despite negative test results.
What is conversion disorder?
This typically involves the loss of motor or sensory function as the presenting symptom, but where the organic cause is not found.
The patient is not consciously feigning the symptoms (factitious disorder) or seeking material gain (malingering)
Patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
What is dissociative disorder?
Dissociation is a process of ‘separating off’ certain memories from normal consciousness
A subtype of this is dissociative identity disorder (DID). DID is the new term for multiple personality disorder and is the most severe form of dissociative disorder.
What are the differences between conversion and dissociative disorder?
They are actually quite similar in some ways, but conversion disorder manifests as physical symptoms, whereas dissociation disorder manifests as psychological symptoms, e.g. Amnesia, fugue, stupor.
What is the difference between Munchausen’s disorder (or factitious disorder) and malingering?
They both involve the intentional production of symptoms or feigning of symptoms, however malingering is for material gain (eg insurance scam) whereas in Munchausen’s this in not the motive. The motive in Munchausen’s is often to assume the ‘sick role’ and be the centre of attention.
How do we medically manage someone who has taken an overdose of paracetamol?
Activated charcoal if ingested less than 1 hour ago
N-acetylcysteine (NAC)
Liver transplantation
How do we manage someone who has taken an overdose of salicylate (aspirin)?
Haemodialysis
Urinary alkalisation is now rarely used.
How do we medically manage someone who has taken an overdose of opioids?
Naloxone
How do we medically manage someone who has taken an overdose of benzodiazepines?
Flumazenil
How do we medically manage someone who has taken an overdose of tricyclic antidepressants such as amitriptyline and is showing a widening of the QRS interval?
IV bicarbonate to reverse acidosis
Which antiarrhythmic medications can be given to patients who have taken an overdose of tricyclic antidepressants such as amitriptyline?
Rarely given at all
Class 1a (e.g. Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation. Class III drugs such as amiodarone should also be avoided as they prolong the QT interval. Response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in management of tricyclic induced arrhythmias
How do we manage someone who has taken an overdose of lithium?
Mild-moderate intoxication may respond to volume resuscitation
Haemodialysis is needed for toxicity
Sodium bicarbonate has a theoretical place here as increasing the alkalinity of the urine promotes lithium excretion.
How do we manage someone who has been poisoned with ethylene glycol (anti-freeze)?
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
Ethanol was used as first line for many years. It works by competing with ethylene glycol for the enzyme alcohol dehydrogenase. This limits the formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning.
How do we manage someone who has been poisoned with methanol?
Fomepizole or ethanol
How do we manage a patient who has been poisoned with carbon monoxide?
100% oxygen
Hyperbaric oxygen
How do we manage a patient who has been poisoned with cyanide?
Hydroxocobalamin
What are the features of sleep paralysis?
Paralysis - this occurs after waking up or shortly before falling asleep
Hallucinations - images or speaking that appear during the paralysis
How do we treat sleep paralysis?
Often reassurance is all that is needed. If troublesome clonazepam may be used.
What is the most appropriate time to take blood samples for therapeutic monitoring of lithium levels?
12 hours after last dose
What is the age bracket with the highest rate of suicide in the UK?
35-49 year olds
Which of the following is a risk factor for suicide?
First presentation to mental health services
Male gender
Age 20-30 years
Female gender
Being married
Male gender
Which of the following adverse effects do antipsychotics increase the risk of in elderly patients?
Atrial fibrillation
Myocardial infarction
Aspiration pneumonia
Stroke
Breast cancer
Antipsychotics in the elderly - increased risk of stroke and VTE
What class of drugs should absolutely not be used in patients with Parkinson’s plus syndromes?
Antipsychotics
What are nihilistic delusions?
Nihilistic delusions are mood congruent delusions, which are generally depressive forms of self-blame with feelings of guilt and hypochondriacal ideas that are developed to their most extreme depressive form.
Patients basically think life is meaningless, and sometimes believes that they are dead.
What is the talking therapy used in personality disorders?
Dialectical behaviour therapy
What is eye movement desensitization and reprocessing therapy used for?
PTSD
What is the definition of an obsession?
A thought that comes from the person not outside. The patient must also have insight into the fact that the thought is not true.
Fine tremor is a sign of lithium toxicity. True or false?
False. Fine tremor is a side effect of lithium. Coarse tremor is a sign of lithium toxicity.
What do we give as first line for neuroleptic malignant syndrome?
Dantrolene and bromocriptine
What is De Clerambaults syndrome?
The delusion that a person of high standing is in love with them.
A 31-year-old woman visits her GP in a tearful state. One month ago her 5-year-old son died after drowning whilst at a party with friends. Upon questioning the woman tells her GP that she is struggling to sleep, can’t seem to function normally and at times suffers from bad stomach cramps. She expresses thoughts that she wishes she had died instead but denies any current suicidal ideation. She says that she has seen her son sitting on the sofa at home at times but knows that this is not real.
Which of the following conditions is she most likely to be suffering from?
Cyclothymia
Psychosis
Severe depression
Normal grief reaction
Personality disorder
Normal grief reaction
After major loss a grief reaction is common, it can often last up to 6 months and present with both physical and psychological symptoms. Distinguishing between depression and a normal grief reaction can be difficult as they can often display similar symptoms; however a normal grief reaction lasts under 6 months whereas depression can last longer.
You review a patient who has been taking citalopram for the past two years to treat depression. He has felt well now for the past year and you agree a plan to stop the antidepressant. How should the citalopram be stopped?
Can be stopped immediately
Withdraw gradually over the next 3 days
Withdraw gradually over the next week
Withdraw gradually over the next 2 weeks
Withdraw gradually over the next 4 weeks
Withdraw gradually over the next 4 weeks
Which one of the following is not a recognised feature of anorexia nervosa?
Raised cortisol levels
Low FSH
Raised growth hormone levels
Hyperkalaemia
Impaired glucose tolerance
Hyperkalaemia - often show hypokalaemia as a result of starvation or vomiting
Anorexia features:
- Most things low
- G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
A 34-year-old female with a history of depression is reviewed. She is currently taking St John’s Wart which she bought from the local health food shop and a combined oral contraceptive pill. What is the most likely effect of taking both medications concurrently?
Worsening of depressive symptoms
Increased risk of severe skin reactions
Increased risk of serotonin syndrome
Increased risk of venous thromboembolism
Reduced effectiveness of combined oral contraceptive pill
Reduced effectiveness of combined oral contraceptive pill
St John’s Wort is an inducer of P450
You are called by the husband of a 45-year-old patient who is registered at your practice. Her only history of note is type 2 diabetes mellitus treated with metformin. For the past three days he states that she has been ‘talking nonsense’ and starting to hallucinate. An Approved Mental Health Professional is contacted and makes her way to the patient’s house. On arrival you find a thin, unkempt lady who is sat on the pavement outside her house, threatening to ‘kick your head in’. What is the most appropriate action?
Ask her husband to restrain her
Lorazepam IM 1mg
Haloperidol IM 5mg
Call the police
Check her blood sugar
Call the police.
The patient is in a public place and threatening violent behaviour. The police should be contacted to transport her to a place of safety where she may be formally assessed.
A 69-year-old man is diagnosed as having Parkinson’s disease. Which one of the following psychiatric problems is most likely to occur in this patient?
Tics
Psychosis
Mania
Dementia
Depression
Depression
Whilst dementia is common in patients with Parkinson’s disease depression is known to exist in around 40%
A 25-year-old man comes for review of his depression. He has now been taking fluoxetine 20mg od for 4 weeks with no effect on his symptoms. It is decided to switch him to citalopram. How should this be done?
Withdraw fluoxetine with commencement of citalopram the next day
2 week period of overlapping the drugs
Wait 1 week after withdrawing fluoxetine before commencing citalopram
1 week period of overlapping the drugs
Wait 2 weeks after withdrawing fluoxetine before commencing citalopram
Wait 1 week after withdrawing fluoxetine before commencing citalopram
Which one of the following intervention is most likely to be beneficial in a patient with schizophrenia?
Counselling
Electroconvulsive therapy
Social skills training
Exercise prescription
Cognitive behavioural therapy
Cognitive behavioural therapy
Oral atypical antipsychotics are first-line but cognitive behavioural therapy should be offered to all patients.
A 22 year old woman is 14 days postpartum. She is formula feeding her baby. She attends her GP requesting emergency contraception as she had unprotected sexual intercourse (UPSI) 2 days ago. Which of the following would you recommend?
Levonorgestrel (Levonelle)
Ulipristal acetate (ellaOne)
No emergency contraception required
Mirena coil
Copper intra-uterine device (Cu-IUD)
No emergency contraception required
Emergency contraception (EC) is not required before day 21 postpartum. The earliest date of ovulation in a non-breastfeeding woman is thought to be day 28 postpartum. Therefore, contraception is required from day 21 onwards, as sperm can survive for up to 7 days. Woman who are exclusively breastfeeding will take longer to ovulate, however contraception should still be advised if pregnancy is not desired.
After day 21 postpartum, progesterone only EC (Levonelle and ellaOne) can be used in both breastfeeding and non-breastfeeding woman.
The Cu-IUD should not be inserted before day 28 postpartum, due to the increased risk of uterine perforation if inserted before this time.
A 30-year-old primigravida lady is 41 weeks pregnant. At her 41 week antenatal visit, she was offered a vaginal examination and a membrane sweeping hoping that she would go into labour. However, to no avail, she does not go into labour even after 6 hours. On examination her cervix is firm, 1cm dilated, 1.5cm in length and in the middle position. Fetal head station is -3. She is otherwise healthy and there were no problems with the pregnancy.
What would be the appropriate next course of action?
Amniotomy
IV Syntocinon
Vaginal prostaglandin gel
Oral prostaglandin
Caesarian section
Vaginal prostaglandin gel
From this scenario, the Bishop score was
